Wilderness & Environmental Medicine - Articles in Press

Animal-Related Motorcycle Collisions in North Dakota - Corrected Proof

2012-01-20

Objective.—: To study the epidemiology and mortality of animal-motorcycle collisions. Methods.—: A retrospective study of all motorcycle collisions recorded in the North Dakota Department of Transportation Crash Reporting System from January 2007 to December 2009 was conducted. Mortality was designated as the main outcome measure. Results.—: Seven hundred sixty-six collisions involving 798 motorcycles were included in this study; 48 of these collisions were with animals (6.3% of all motorcycle collisions). Deer were the most common animal involved (81%). Most animal-motorcycle collisions took place during nighttime with clear weather and on straight rural roads. Drivers were older in animal collisions compared with nonanimal collisions (median of 44 vs 30 years old, respectively, P < .0001). Most drivers were males, whereas most passengers were females. Helmets were worn by only 32% of drivers and 12% of passengers. There were 4 (8%; 95% CI, 3%–20%) fatal animal collisions; 9% of the collisions with large animals were fatal compared with 3% of nonanimal collisions (P = .0411). Conclusions.—: Animal-motorcycle collisions are a small subgroup of all motorcycle collisions, but with a high mortality rate. Efforts should be made to increase helmet usage, mitigate these collisions, and increase awareness of this problem among motorcycle riders.

Burchell's Zebra - Corrected Proof

Peter Kummerfeldt — 2012-01-19

••• - Corrected Proof

Luanne Freer — 2012-01-19

Surgical Tick Removal - Corrected Proof

Stylianos Roupakias, Paraskevi Mitsakou, Angelos Al Nimer — 2011-12-05

Tick-borne diseases are increasing in prevalence. Ticks are best removed as soon as possible, because the risk of disease transmission increases significantly after 24 hours of attachment. Furthermore, signs and symptoms of tick paralysis improve within hours of tick removal, and complete recovery occurs within 24 hours. Removing ticks may not be easy and it is very difficult to remove nymphs without damaging them. It is important to completely remove the tick, including the mouth part and the cement the tick has secreted to secure its attachment. A small tick remnant in the skin is difficult to detect and localize, and attempts to remove these parts may result in significant skin trauma or a secondary skin infection. Improper tick removal may lead to infection or granuloma formation, which must always be surgically resected during a second procedure. An effective tick removal method must reduce the possibility of fluid regurgitation and transmission into the host during the procedure. Although there is conflicting evidence whether the removal technique influences infection rates, killing the tick in situ may increase the risk of regurgitation and transmission of infectious agents. Theoretically, touching the tick during the removal attempt may also irritate the tick and cause it to force more liquid into the wound. To prevent tick-borne disease, therefore, it is important to urgently remove the tick, to use the correct removal procedure, and to remove the whole tick, intact and alive, without any remnants. It is preferable that a medical practitioner remove the tick as an office procedure and not in an outdoor condition, especially in areas where ticks are endemic.

Pulse Oximetry After 6-Minute Walk Test and Summit Success on Kilimanjaro - Corrected Proof

Rob Daniels — 2011-12-02

Kilimanjaro, at 5896 m, is famous both as 1 of the 7 summits and as an accessible trekking peak that can be climbed with minimal experience or technical skill. It is a popular destination for charity fundraisers from the United Kingdom; each year approximately 30,000 trekkers attempt the climb, with success rates of 61% to 75%, and symptoms of altitude illness developing in as many as 77% of trekkers.