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Fracture of the penis is a rupture of the tunica albuginea of the corpus cavernosum, usually while the penis is rigid and erect. When erect, the albuginea layer stretches so far until its thickness reaches approximately 0.25 – 0.5 mm, compared with a 2 mm thick when flaccid. Thus the erect penis is much more vulnerable to serious damage from blunt trauma than the pendulous, flaccid penis. The most common cause of penile fracture is vigorous vaginal intercourse, more likely when woman is on top, but it can also occur during masturbation, forced bending of the erect penis or any mechanical trauma to the erect penis. The classic presentation described by the patient cracking or popping sound, followed by rapid detumescence, severe pain, ecchymosis of the penile skin, and swelling of the affected side with deviation of the penis shaft away from the affected side. In most cases, the penile fracture is a transverse corporeal tear close to the corpus spongiosum on the ventral aspect of penis shaft or on the lateral aspect and the tunical tear is usually 1 to 2 cm in length. The rupture can involve one or both corpora cavernosa as well as corpus spongiosum with the contained urethra therefore urethral rupture can also occur in. Most urethral injuries are associated with gross hematuria, blood at the meatus or inability to void, although the absence of these findings does not definitively rule aut urethral injury.

peer-reviewed ; Even in our modern and high-tech manufacturing industry, it is often difficult to automate industrial processes which necessities the involvement of human workers. Subsequently, workers are exposed to factors that increase their risk of injury, particular experiencing Musculoskeletal Disorders (MSDs). In addition to contributing to workplace absenteeism and disability rates, injured workers have a negative impact on job productivity and quality.While earlier research and development of exoskeletons is targeted at military and rehabilitation, there is a shifting of interest to target industrial settings. Targeting industrial environments, the Robo-Mate consortium aims to develop a lightweight, flexible, easy-to-wear, easy-to-maneuver, and intelligent exoskeleton that augments the user's personal capabilities while accommodating their physical limitations. The safety of industrial worker exoskeletons is an emerging topic in legislation and standardization. Guidance from standards is only partially possible since no standard exists for industrial exoskeleton technology. This presents a challenging task since an exoskeleton combines technological characteristics of robots (collaborative), machines and appliances, and is used in proximity to and has close contact with the human body. The innovative character of the Robo-Mate technology requires a multidisciplinary approach to the identification of risk and usability while addressing both product safety and workplace safety. This requires a novel safety management approach that governs the life cycle of this new kind of product. This paper will discuss the risk management approach the Robo-Mate project developed and the resulting leading scenarios.

United States veterans are a multifaceted population with a distinct culture that includes, but is not limited to, values, customs, ethos, selfless duty, codes of conduct, implicit patterns of communication, and obedience to command. Veterans experience mental health disorders, substance use disorders, post-traumatic stress, and traumatic brain injury at disproportionate rates compared to their civilian counterparts. Eighteen to 22 American veterans commit suicide daily and young veterans aged 18–44 are most at risk. Health care professionals must be aware of patients' military history and be able to recognize suicide-risk factors, regardless of age. Advancement in medical technology has allowed servicemen to survive their injuries but, for many, at the cost of a traumatic limb amputation and associated mental scarring. Health care professionals must be able to address physical safety concerns, as well as, emotional health of veterans. Approximately 49,933 American veterans are homeless and face the same difficulties as non-veterans in addition to service-related matters. Separation from military service and issues related to complex multiple deployments are among specifically identified veteran issues. Successful veteran reintegration into civilian life rests upon providing veterans with training that builds on their military knowledge and skill, employment post-separation from service, homelessness prevention, and mental health programs that promote civilian transition. Preparing health care providers to meet the complex needs of a vast veteran population can be facilitated by implementing veteran content into curricula that includes veteran patient simulations and case studies, and utilizes veteran clinical faculty.

Health and labor organizations have increasingly identified work-related stress as a "modern epidemic" with highly detrimental effects on the health and productivity of workers. The definition of work stress, however, remains contested, and there are huge financial and political stakes involved in codifying work stress as an official category of occupational hazard. Taking urban transportation work as a case study, this dissertation examines how understandings of work stress as an industrial hazard are produced, institutionalized and contested. Transportation workers are one of the most studied categories of worker within the field of stress sciences, and this research has shown transit workers to be among sickest workers of any occupation, particularly in regard to chronic, stress-related diseases. This dissertation project approaches transit work as a uniquely powerful site for studying the broader mechanisms underlying the social and material determinants of chronic disease, and as a point of departure for explorations into the politics of work, the sciences of stress, and state and legal frameworks for regulating injury and disease.Using ethnographic methods, this project documents workers' understanding and experiences of stress, how biomedical scientists recognize (and disregard) the harms of work, and how political and economic interests shape everyday and medical understandings of health and wellbeing for workers. My analyses reveal how the bodily impacts of working conditions—as well as the biomedical recognition of work-related harms—are shaped by race, class and a broader reorganization of work in the United States.

United States veterans are a multifaceted population with a distinct culture that includes, but is not limited to, values, customs, ethos, selfless duty, codes of conduct, implicit patterns of communication, and obedience to command. Veterans experience mental health disorders, substance use disorders, post-traumatic stress, and traumatic brain injury at disproportionate rates compared to their civilian counterparts. Eighteen to 22 American veterans commit suicide daily and young veterans aged 18–44 are most at risk. Health care professionals must be aware of patients' military history and be able to recognize suicide-risk factors, regardless of age. Advancement in medical technology has allowed servicemen to survive their injuries but, for many, at the cost of a traumatic limb amputation and associated mental scarring. Health care professionals must be able to address physical safety concerns, as well as, emotional health of veterans. Approximately 49,933 American veterans are homeless and face the same difficulties as non-veterans in addition to service-related matters. Separation from military service and issues related to complex multiple deployments are among specifically identified veteran issues. Successful veteran reintegration into civilian life rests upon providing veterans with training that builds on their military knowledge and skill, employment post-separation from service, homelessness prevention, and mental health programs that promote civilian transition. Preparing health care providers to meet the complex needs of a vast veteran population can be facilitated by implementing veteran content into curricula that includes veteran patient simulations and case studies, and utilizes veteran clinical faculty.

Hemorrhage and trauma induced coagulopathy remain major drivers of early preventable mortality in military and civilian trauma. Interest in the use of prehospital plasma in hemorrhaging patients as a primary resuscitation agent has grown recently. Trauma center-based damage control resuscitation using early and aggressive plasma transfusion has consistently demonstrated improved outcomes in hemorrhaging patients. Additionally, plasma has been shown to have several favorable immunomodulatory effects. Preliminary evidence with prehospital plasma transfusion has demonstrated feasibility and improved short-term outcomes. Applying state-of-the-art resuscitation strategies to the civilian prehospital arena is compelling. We describe here the rationale, design, and challenges of the Prehospital Air Medical Plasma (PAMPer) trial. The primary objective is to determine the effect of prehospital plasma transfusion during air medical transport on 30-day mortality in patients at risk for traumatic hemorrhage. This study is a multicenter cluster randomized clinical trial. The trial will enroll trauma patients with profound hypotension (SBP ≤ 70 mmHg) or hypotension (SBP 71–90 mmHg) and tachycardia (HR ≥ 108 bpm) from six level I trauma center air medical transport programs. The trial will also explore the effects of prehospital plasma transfusion on the coagulation and inflammatory response following injury. The trial will be conducted under exception for informed consent for emergency research with an investigational new drug approval from the U.S. Food and Drug Administration utilizing a multipronged community consultation process. It is one of three ongoing Department of Defense-funded trials aimed at expanding our understanding of the optimal therapeutic approaches to coagulopathy in the hemorrhaging trauma patient.

In accordance with the 20680 law, the Chilean legal system recognize the right of grandparents to maintain a direct and regular relationships with their grandchildrens. The author considers that this Family law reform should entail a reform in Inheritance law that provides for the possibility to recognise the disinheritance for hindering the exercise of this grandparents right and also this could be considerer as an unworthiness ground. Because of this lack of adequate legislative regulation, the article envisages the possibility of a jurisprudential interpretation that considers the impediment to the exercise of the grandparents visitation rights it is an injury ex article 1208.1 CC for the disinheritance or an unworthiness ground ex article 968.2 CC. ; Tras la Ley 20.680 se reconoce en el ordenamiento chileno el derecho de los menores y los abuelos a mantener una relación directa y regular entre sí. Se considera que esta reforma en el ámbito del Derecho de familia debería llevar consigo una reforma en el Derecho sucesorio tendente a reconocer la posibilidad de desheredación por impedir el ejercicio de este derecho e incluso su consideración como una causal de indignidad. De no llevarse a cabo la oportuna reforma legislativa, en el artículo se plantea la posibilidad de que por vía interpretativa los tribunales puedan considerar el impedimento del ejercicio de este derecho como una injuria grave del artículo 1208.1 CC a efectos de la desheredación, o como un supuesto del artículo 968.2 CC en el caso de la indignidad.

Each year large numbers of persons sustain serious injury as a consequence of criminal behaviours. All Australian jurisdictions provide systems of compensation to those harmed in this way. In many instances assessors of compensation have to consider not simply the appropriate and fair amount of compensation but how a person will be affected by the payment of compensation. Often those applicants apply through their guardians or a public trustee, although many applicants apply in person. This paper examines the use of legislative provisions, rules regulations and practices in the various Australian jurisdictions in relation to how vulnerable criminal injuries applicants may be protected once an award of compensation is made in their favour. Most jurisdictions provide for a mechanism by which compensation awarded may be held in trust in the event that the compensation assessor considers that the applicant may be unable to manage her or his financial affairs and where it would be in the best interests of the applicant. When considering what is in the best interests of the applicant the assessor will have regard to the manner in which the inability to manage financial matters has arisen either as a consequence of the offence the subject of the application, pre-exiting mental health issues, substance addiction and abuse or vulnerability to exploitation by family members or close associates. This paper explores what factors are taken into account by assessors in the absence of and pursuant to legislative directions. It considers how the approach may vary across jurisdictions and creative approaches to protection vulnerable criminally injured persons.

AbstractThe major dependent variable in peace science research has appropriately been death from inter-group conflict with war the major focus. However, a tenable hypothesis is that the same or similar motivations result in other risks to life. For example, the number of human deaths each year from preventable nonmilitary sources is approximately 20,000,000. Most major sources that assess the loss of life from military and related conflicts identify, over a long period of time, not more than 2,000,000/year. This dependent variable may also be extended to the non-military category. For example, evidence has emerged that approximately twenty-percent of the active duty female members of the US military are sexually assaulted by other members of the military during their period of service (Dick 2012). Thus, it seems reasonable to address a variety of phenomena that may be represented by a common set of attributes. These variables should include degree of physical injury, size of acting units, and public vs. private agents. Preventable non-military death is similar to the classification for death from war except that the agents are frequently private, such as corporations. This analysis is intended to contribute to a continuing discussion of the boundaries of the peace science domain. One function of the discussion is to foster the examination of a range of behaviors that may derive from a set of basic motives and goals. The discussion section concludes with reference to the problem of understanding a central factor in inter-group conflict – identification with the group.

Background: Severe social withdrawal behaviors among young people have been a subject of public and clinical concerns. Aims: This study aimed to explore the prevalence of social withdrawal behaviors among young people aged 12–29 years in Hong Kong. Methods: A cross-sectional telephone-based survey was conducted with 1,010 young individuals. Social withdrawal behaviors were measured with the proposed research diagnostic criteria for hikikomori and were categorized according to the (a) international proposed duration criterion (more than 6 months), (b) local proposed criterion (less than 6 months) and (c) with withdrawal behaviors but self-perceived as non-problematic. The correlates of social withdrawal among the three groups were examined using multinomial and ordinal logistic regression analyses. Results: The prevalence rates of more than 6 months, less than 6 months and self-perceived non-problematic social withdrawal were 1.9%, 2.5% and 2.6%, respectively. In terms of the correlates, the internationally and locally defined socially withdrawn youths are similar, while the self-perceived non-problematic group is comparable to the comparison group. Conclusions: The study finds that the prevalence of severe social withdrawal in Hong Kong is comparable to that in Japan. Both groups with withdrawal behaviors for more or less than 6 months share similar characteristics and are related to other contemporary youth issues, for example, compensated dating and self-injury behavior. The self-perceived non-problematic group appears to be a distinct group and the withdrawal behaviors of its members may be discretionary.

In 2010, the governments of the world declared 2011-2020 as the Decade of Action for Road Safety. The unanimous support for this Decade of Action from member states explains the growing awareness of the devastating scale of road traffic injuries as a global public health and development problem. Despite the enormous toll exacted by road traffic injuries, they have for many years been neglected by global health and development agendas, and funding for interventions has not been commensurate with the scale of the problem. Strategies do exist, however, that have proven to reduce road traffic injuries and a number of countries have successfully used these to reduce their road traffic deaths. The objective of this study is to use the Oyo State-Nigeria evidence-based case to explain the need to take cognisance of neighbourhood characteristics in policy designs and decision- making to enhance significant remedial effect from interventions in an attempt to reduce road traffic injuries and deaths. The characteristics investigated include major road lengths, travel density, residential population and the area of administration. The study concludes that spillover effects do exist in road traffic crashes (RTC) within spatial units across geographical regions – as such, neighbourhood characteristics cannot be ignored when planning for intervention. Apparently, the need to incorporate spatial analysis with existing strategies to achieve maximum remedial effect cannot be over emphasised. These results should enable the orientation of safety and injury prevention policies targeted towards reducing the frequencies of RTC.

ObjectiveHeart rate variability (HRV), thought to reflect autonomic nervous system function, is lowered under conditions such as posttraumatic stress disorder (PTSD). The potential confounding effects of traumatic brain injury (TBI) and depression in the relationship between HRV and PTSD have not been elucidated in a large cohort of military service members. Here we describe HRV associations with stress disorder symptoms in a large study of Marines while accounting for well-known covariates of HRV and PTSD including TBI and depression.MethodsFour battalions of male active-duty Marines (n = 2430) were assessed 1 to 2 months before a combat deployment. HRV was measured during a 5-minute rest. Depression and PTSD were assessed using the Beck Depression Inventory and Clinician-Administered PTSD Scale, respectively.ResultsWhen adjusting for covariates, including TBI, regression analyses showed that lower levels of high-frequency HRV were associated with a diagnosis of PTSD (β = -0.20, p = .035). Depression and PTSD severity were correlated (r = 0.49, p < .001); however, participants with PTSD but relatively low depression scores exhibited reduced high frequency compared with controls (p = .012). Marines with deployment experience (n = 1254) had lower HRV than did those with no experience (p = .033).ConclusionsThis cross-sectional analysis of a large cohort supports associations between PTSD and reduced HRV when accounting for TBI and depression symptoms. Future postdeployment assessments will be used to determine whether predeployment HRV can predict vulnerability and resilience to the serious psychological and physiological consequences of combat exposure.

Purpose – In order to reduce the number of injuries on construction sites, a European Directive prescribes that the clients shall appoint safety and health coordinators in their projects. The purpose of this paper is to find out who are appointed to be health and safety coordinators for the design and planning phase and what they do in order to prevent injuries on sites. Design/methodology/approach – Since the 1st of January 2009, there shall be a coordinator for the design and planning phase in Swedish construction projects. Telephone interviews were made with the coordinators in 42 Swedish building projects. Findings – The coordinators' education and experiences varied widely, as well as their descriptions of their duties: no duties, administration and active injury prevention. The coordinators who were classified as most active had at least one additional leading role in the projects. Research limitations/implications – The study is qualitative for an increased understanding, not a statistical reflection of the coordinator population. Practical implications – The legislation needs to clarify whether the early conceptual phase of the project is included in the coordinator's commission and whether she/he is supposed to participate in identifying, assessing and reducing risks through design changes. These clarifications will have an influence on when the coordinator should be appointed and what competence she/he needs. Originality/value – The study increases the understanding of how the health and safety coordinators of the planning and projecting phase of building projects perceive their mission and what factors, according to them, have an influence on what they do. ; QC 20150217

Introduction: To assess the ability of the shock index (SI) to predict 28-day mortality in traumatic hemorrhagic shock patients treated in the diaspirin cross-linked hemoglobin (DCLHb) resuscitation clinical trials. Methods: We used data from two parallel DCLHb traumatic hemorrhagic shock efficacy trials, one in U.S. emergency departments, and one in the European Union prehospital setting to assess the relationship between SI values and 28-day mortality. Results: In the 219 patients, the mean age was 37 years, 64% sustained a blunt injury, 48% received DCLHb, 36% died, and 88% had an SI>1.0 at study entry. The percentage of patients with an SI>1.0 dropped by 57% (88 to 38%) from the time of study entry to 120 minutes after study resuscitation (p1.0, 1.4, and 1.8 at any time point were 2.3, 2.7, and 3.1 times, respectively, more likely to die by 28 days than were patients with SI values below these cutoffs (p1.0 were 3.9x times more likely to die by 28 days (40 vs. 15%, p<0.001). Although the distribution of SI values differed based on treatment group, the receiver operator characeristics data showed no difference in SI predictive ability for 28-day mortality in patients treated with DCLHb. Conclusion: In these traumatic hemorrhagic shock patients, the shock index correlates with 28-day mortality, with higher SI values indicating greater mortality risk. Although DCLHb treatment did alter the distribution of SI values, it did not influence the ability of the SI to predict 28-day mortality. [West J Emerg Med. 2014;15(7):–0.]

Авторы проанализировали состояние здоровья военнослужащих (мужчин) Северного флота, проходивших службу по призыву (n = 420) и по контракту (n = 1370) на специальных водолазных должностях в Кольском Заполярье за последние несколько лет. Для сравнения темпов снижения уровня здоровья в различных условиях службы авторами приведены усредненные результаты ранее проведенных в этот же период времени исследований у военнослужащих береговых воинских частей на Европейском Севере, военнослужащих из состава экипажей надводного корабля и атомной подводной лодки. В статье рассмотрены особенности первичной заболеваемости и травматизма. Исследование и мониторинг причинно-следственных отношений между особенностями военно-профессиональной деятельности и уровнем и структурой первичной заболеваемости позволяет формировать основные направления профессиональной реабилитации специалистов флота. ; The authors analyzed the health status of military personnel (males) of the Northern Fleet who did call-up military service (n = 420) and served on contract (n = 1370) in special diving positions in the Kola Arctic over the past few years. For the comparison of the rate of the decline of health level in different conditions of service the authors presented the averaged results of studies previously performed in the same period of time in the service personnel of coastal military units in the European North, troops from the surface ship crews and crew nuclear submarine. In the article there are considered the features of the primary disease and injury. Research and monitoring of causative-consecutive relationships between the features of military professional activity and the level and structure ofprimary morbidity rate allow to form the main directions of vocational rehabilitation for fleet specialists.