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The COVID-19 pandemic has led to the implementation of unprecedented public health measures. The effect of these lockdown measures on road safety remain to be fully understood, however preliminary data shows reductions in traffic volume and increases in risky driving behaviors. The objective of the present study is to compare self-reported risky driving behaviors (speeding, distracted driving, drinking and driving, and drugged driving) during the pandemic in Canada and the U.S. to determine what differences exist between these two countries. Data was collected using the Road Safety Monitor (RSM), an annual online public opinion survey that investigates key road safety issues, administered to a representative sample of N = 1,500 Canadian drivers and N = 1,501 U.S. drivers. Respondents were asked about the likelihood of engaging in risky driving during the pandemic as compared to before COVID-19. Results show the majority of respondents indicated their behavior did not change, and most positively, a small proportion reported they were less likely to engage in these risky driving behaviors. However, notable proportions indicated they were more likely to engage in risky driving behaviors during the pandemic, as compared to before COVID-19. Of those who indicated this, U.S. drivers had significantly higher percentages compared to their Canadian counterparts. Behaviors most often reported by this sub-section of drivers who admit to being more likely to engage in risky driving during the pandemic were speeding (7.6%) and drinking and driving (7.6%) in the U.S., and speeding (5.5%) and distracted driving (4.2%) in Canada. Logistic regression results confirm that country was a significant factor, as U.S. drivers had greater odds of reporting they were more likely to engage in these risky driving behaviors, with the exception of speeding. Age also had a significant effect, as increasing age was associated with lower odds of reporting that these risky driving behaviors were more likely during the pandemic. Conversely, sex did not have a significant effect. Overall, the current findings suggest that a small proportion of drivers reported being more likely to engage in risky driving behaviors and the pandemic may have led to changes in the profiles of those drivers engaging in risky driving behaviors during lockdown measures. These results have important implications for policies and can inform how to manage road safety during future lockdowns.

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The term "hard core" has been used extensively over the past 15 years to identify persons who drink and drive regularly, typically at high blood alcohol levels. This article discusses how the term arose and clarifies what it means, both as a concept and in practice. It describes the characteristics of hard core drinking drivers and estimates their contribution to drinking driver trips, arrests, and crashes. It summarizes current knowledge and recommendations on the most effective means to affect their behavior and reduce their drinking and driving.

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INTRODUCTION: Burn surgery is complicated by blood loss. The tumescent technique of subdermal injection of epinephrine has been utilized to decrease intraoperative blood loss. We hypothesized that this would safely decrease blood loss during burn surgery. METHODS: Twenty patients utilized the tumescent technique. The tumescent group had subdermal injections of epinephrine beneath the excision and donor site plus thrombin spray and warm saline soaked laparotomy pads. Ten patients grafted prior to adopting the tumescent technique utilized thrombin spray and warm saline soaked laparotomy pads for hemostasis. Blood loss was determined by operative estimation and calculation. Data were analyzed by Student's t-test and paired t-test. RESULTS: The two groups were demographically similar. The tumescent group had significantly less total blood loss and blood loss per unit area excised. There were no clinically detectable arrythmias, changes in heart rate or blood pressure noted. CONCLUSIONS: The tumescent technique significantly reduced intraoperative blood loss. It is safe, inexpensive and easy to use. The subdermal epinephrine/saline injection creates a smooth, tense surface which assists with debridement and donor harvest.

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BACKGROUND: This study investigated the effects of intra-abdominal blood on the systemic response to peritonitis using a murine model of hemorrhage, peritonitis, and multiple organ dysfunction syndrome. METHODS: The model used male ICR mice subjected to hemorrhage and intraperitoneal zymosan. Half of the mice received intraperitoneal blood. Outcome measures included lung myeloperoxidase, lung edema, lung injury score, and plasma and lung tissue chemokine production. RESULTS: Peritoneal blood (in association with peritoneal inflammation) increased lung neutrophil sequestration (myeloperoxidase) (2.56 +/- 1.42 vs. 1.45 +/- 0.49 U/left lung, p = 0.04) and lung weight (0.11 +/- 0.04 vs. 0.07 +/- 0.02 g/left lung, p = 0.02), and was associated with significantly higher chemokine levels in plasma (KC and MCP-1) and lung tissue (KC, MIP-2, and MCP-1). Both plasma and lung tissue neutrophil chemoattractants KC and MIP-2 were significantly linearly correlated with myeloperoxidase (p < 0.009), and lung tissue KC (a neutrophil chemokine) and MCP-1 and MIP-1alpha (mononuclear cell chemokines) correlated with lung injury score (p < 0.003). CONCLUSION: Although blood alone in the peritoneal cavity was well tolerated, in conjunction with inflammation, it was synergistic in amplifying the systemic inflammatory response. The amplified lung injury in this model was associated with significant increases in circulating and lung tissue chemokine concentrations.

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HYPOTHESIS: IL-10 will reduce morbidity and mortality in murine MODS. Introduction. Intraperitoneal (ip) zymosan causes a triphasic inflammatory process leading to MODS. Phase I is an acute systemic inflammatory response to sterile peritonitis. Phase II is the recovery phase. Phase III is characterized by recurrent illness, progressive organ dysfunction, and elevated proinflammatory cytokines. METHODS: Male ICR mice were randomized (on Experiment Day 0, time = 0 h) into four initial groups (A-D): Control Group A received no zymosan and no IL-10. Group B received zymosan (1 mg/g mouse BW, t = 0) and no IL-10. Group C received no zymosan and IL-10 at t = 2 h. Group D received zymosan and IL-10 at t = 2 h. On Experiment Day 4, mice in Groups B-D were randomized into six further treatment groups (B1 and B2, C1 and C2, D1 and D2). Group B1 received no treatment. Group B2 received IL-10 when clinical signs of recurrent illness developed (Phase III, 12-18 days after zymosan treatment). Mice were sacrificed when they were preterminal (clinical signs of shaking, shivering, or paralysis) or on Experiment Day 28 (survivors). Plasma total bilirubin and creatinine levels were measures of organ function. Terminal pulmonary compliance was measured in situ through a physiologic range of tidal volumes. RESULTS: Mice entering Phase III consistently progressed to MODS characterized by elevated bilirubin and hemorrhagic lungs which, if left untreated, was lethal. Mice treated with IL-10 (Group B2) when they entered Phase III had lower mortality (28.6% vs 100%, P < 0.02), longer survival (25 vs 18 days, P < 0.05), and improved lung pulmonary compliance (slope beta1 = 0.082 ml/mm Hg vs 0.059 ml/mm Hg, P < 0.001) compared to untreated (Group B1) mice in Phase III. CONCLUSIONS: IL-10 improves survival even when given after clinical signs of illness are present.

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OBJECTIVE(S): To demonstrate the limitation of complete reliance on computer generated interpretations and to highlight the need for understanding of pregnancy-related biochemistry when offering prenatal screening. METHODS: Four cases of cytogenetically confirmed trisomy 18 pregnancies are presented. All four cases underwent prenatal screening (Triple Test-AFP, uE3, t beta-hCG) at midgestation and risk assessment by the alpha algorithm. RESULTS: All four cases of trisomy 18 were assessed as being at low risk for DS and/or open NTD. Although marker levels were not consistent with either of these clinical situations, they were indicative of a compromised pregnancy. Circulating levels of trophoblast-derived antigens (uE3, t beta-hCG) were depressed (< or = 0.5 MoM) in all four cases. Further investigations (ultrasonography, amniocentesis) confirmed a trisomy 18 fetus. CONCLUSIONS: Risk assessment by computer based algorithms relies on maternal factors and specific DS/NTD marker profiles. Aberrant marker profiles are not distinguished from normal. Therefore, it is essential that prenatal screening is offered only by those competent in pregnancy biochemistry and able to identify these abnormal situations.

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The recent incidence of acute-on-chronic pelvic inflammatory disease, with associated abscess formation, has dramatically increased. Recurrent abscess formation in chronic pelvic inflammatory disease that fails to respond to maximal antibiotic treatment has been traditionally treated by open surgical drainage, frequently accompanied by pelvic clearance.With the development of techniques associated with in vitro fertilization, treatment can now be effected allowing conservation of fertility. This paper describes 12 cases of ultrasound-directed transvaginal fine-needle aspiration of pelvic abscess. A positive outcome occurred in all patients, thus avoiding major surgery.

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A retrospective study covering the period from January 1, 1980 up to June 30, 1982 was conducted, producing the first definitive normal range for maternal serum alphafetoprotein from the Royal North Shore Hospital in Sydney. The normal range established is based on and applicable to the pregnant women tested at this NSW laboratory. Maternal serum alphafetoprotein levels had been determined by radioimmunoassay for 3,182 pregnancies between 13 and 20 weeks' gestation. Five anencephalics and 2 open spina bifidas were noted in the study. Only one of these abnormalities (spina bifida) was associated with maternal serum alphafetoprotein levels within the normal range, the remainder all having elevated levels. Low false positive and false negative rates of 1.16% and 0.03% respectively were obtained in this study.

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The results of laparoscopic (lap) and transvaginal (TV) oocyte pickups (OPUs) performed concurrently for in vitro fertilization in 232 consecutive treatment cycles have been reviewed. The patients were compared for age, preoperative estradiol concentration, luteal-phase support, and number of follicles aspirated and were found to be similar but were not matched for cause of infertility. The lap OPU group had more oocytes recovered per follicle aspirated (P less than 0.001), but because of a lower fertilization rate (P less than 0.01), the number of embryos transferred was similar. Nevertheless, more (P less than 0.05) pregnancies occurred in the TV OPU group. Patients were subgrouped so that comparisons of patients with the same cause of infertility, tubal disease alone, were considered. This showed that the pregnancy rate was still higher in the TV OPU group (P less than 0.05). TV OPU was less painful and not associated with increased morbidity, and since the data suggest that TV OPU was at least as successful as lap OPU, it is recommended that all oocyte pickups in the future be performed transvaginally.

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Successful pregnancies have been achieved after in vitro fertilization of oocytes obtained by an ultrasound-guided transvesical approach, as well as with the traditional laparoscope. With the use of the same laboratory facilities, success rates for each retrieval method were evaluated in an established in vitro fertilization program. There was a significantly increased cancellation rate and a decrease in oocyte/follicle rate in the transvesical group, but there was a greater fertilization rate with possible improved embryo quality. Although the transfer rates were similar, the pregnancy rate appeared lower in the transvesical group. A valid comparison of these data is not possible because the two groups are dissimilar for factors known to influence oocyte development and recovery. Different criteria were applied to patient selection and treatment, and operation expertise differed between the two groups.

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We tested 10,715 low-risk pregnancies in a voluntary maternal serum alpha-fetoprotein screening program for the detection of neural tube defects in California. In all, 5.3 percent of women had one elevated serum level, 3.3 percent were referred for sonography and 1.5 percent for amniocentesis. There were 12 cases of open neural tube defects (1.1 per 1,000); all of the mothers had one elevated serum alphafetoprotein level: nine (75 percent) completed the protocol and the neural tube defects were correctly identified. No normal pregnancies were terminated. The risk of an open neural tube defect occurring was about 1 in 50 after the first abnormal serum level and 1 in 15 at amniocentesis. We found significantly increased risk for fetal death and low birth weight after one elevated serum alpha-fetoprotein level, though the likelihood of a normal pregnancy outcome was about 80 percent. Maternal serum screening was also useful in identifying twin pregnancies and correcting underestimated gestational dates.

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In 6 generations of a family with the trismus-pseudocamptodactyly syndrome (TPS), we identified 53 affected individuals, 33 females and 23 males. Thirty-one of the 53 were personally examined, as were 77 unaffected relatives. The clinical findings are compared with those of previous reports. Severity of expression is highly variable, but reduced penetrance was not observed. We obtained blood specimens for linkage analysis on all 108 examined individuals. Linkage could be excluded for 16 polymorphic marker loci. The largest positive lod scores were for the BF and AK1 marker systems, being 0.9 and 0.6, respectively. Since BF and AK1 are on different chromosomes (6 and 9, respectively), these results do not indicate a location for the TPS gene.

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One hundred thirty-four obstetrical diagnostic sonographic examinations were performed on patients of 12--26 gestational weeks. The following abdominal diameter measurements were obtained: (1) anteroposterior transverse diameter; (2) right-to-left transverse diameter; (3) average of (1) and (2); and (4) greatest longitudinal diameter. These measurements were plotted against the respective biparietal diameters, and normal statistical distribution curves were developed. These curves have proven helpful in cases with a questionable disproportionate relation between the fetal head and body size in early pregnancy. The data have facilitated identification of fetal abnormalities sufficiently early in the pregnancies to permit advising therapeutic abortion. Five cases outside the normal range are discussed and compared to normal. In several cases, the sonographic results played a major role in the decision-making process of the patient involved.

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Two cases of constriction of the umbilical cord resulting in fetal demise following midtrimester amniocentesis are presented. In both cases, real-time ultrasonography prior to amniocentesis revealed a viable fetus. Fetal demise was identified immediately following the procedure in the first case and one month later in the other. A localized constriction at the fetal end of the umbilical cord in both, with torsion of the constricted segment in the second case, was observed. Wharton's jelly was noted to be deficient in this segment of the cord in the first case. The mechanism of fetal demise is discussed. It is suggested that this abnormality should be considered when fetal demise follows midtrimester amniocentesis.

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A family is described with congenital hydrocephalus occurring in two pregnancies following the birth of a child with a neural tube defect (NTD). Prenatal diagnosis of hydrocephalus at mid-gestation was achieved by ultrasonography. The increased frequency of hydrocephalus among sibs of probands with a NTD and vice versa suggests that, following the birth of a child with either malformations, subsequent pregnancies should be monitored at mid-gestation by amniotic fluid AFP and serial ultrasound examination.

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