Risk ratios, odds ratios, and hazard ratios are three common, but often misused, statistical measures in clinical research. In this paper, the authors dissect what each of these terms define, and provide examples from the medical literature to illustrate each of these statistical measures. Finally, the correct and incorrect methods to use these measures are summarized.

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Introduction: Given the widespread prevalence of concussions in children under the age of 19, the adolescent perspective, as well as an understanding of the mechanisms behind traumatic brain injury (TBI), is extremely important. The authors sought to assess the knowledge, awareness, and attitudes regarding concussion among middle school children and whether a brief educational intervention based on clinical data and science resulted in a change of their knowledge or attitudes towards concussions. Methods: A 20-question survey design was administered before and after an educational intervention. The surveys were anonymous, but they were paired so that it was possible to correlate the pre- and post-test answers to the respondents. An eighth-grader at a Florida middle school conducted this study after school hours after the student and their parent or legal guardian signed informed consent. This project was approved by the Science Department at Howard Bishop Middle School in Alachua County, Florida. JMP® 14.0 (SAS Institute Inc., Cary, NC) was used for statistical analyses. Results: The cohort was 64% female, age range: 13 - 15, and consisted of local eighth-grade students. Forty-three percent never wore a helmet when riding a bicycle or skateboard. Only 68% knew that the state had a helmet law for kids. Participants were significantly more likely to feel they had good TBI knowledge after the intervention (p = 0.0005, 95% confidence interval (CI) 0.1937 to 0.6863) and that the didactic lectures changed the way they thought about safety (p = 0.0034, 95% CI 0.1025 to 0.5175). Students reported that their mothers (vs. fathers) were significantly more likely to wear seatbelts (p = 0.05, 95% CI 0.0036 to 0.5036), and they themselves reported wearing seatbelts more often after the survey. Conclusions: There still exists a knowledge gap when it comes to pediatric concussion. Expanding awareness is important in order to bolster safety measures among adolescents.

Background/Objective First discovered by Alois Alzheimer in 1906, Alzheimer’s disease (AD) has become a growing global health concern with numerous implications for individuals and modern society. As patients’ symptoms of dementia continue to worsen, they gradually grow more limited in their independence. As a result, family members and close acquaintances often become caregivers for the patient and become more involved in maintaining the patient’s lifestyle. The authors of this research sought to study what motivates caregivers to look after AD patients and the impact of AD on their lifestyles and physical, mental, and social health. Methods The authors crafted a survey of fourteen questions and collected data from 200 caregivers regarding AD’s impact on their physical, emotional, and social health along with their key demographic and background information (e.g. whether or not they are a caregiver for a patient with AD). Results The results indicate that most AD caregivers are family members (78%). AD often strains the caregiver’s relationship with the patient (47.5%), and 58% of participating caregivers report extreme stress levels while 65% realize it is incredibly difficult to take care of a patient. Because of the increased levels of stress, 47% of participating caregivers sleep less; 43% feel more isolated from their family; and, 35.5% did not try to get help from others. Love and a strong sense of duty seem to be the primary motivation for caregivers to take care of a patient. Worry for the patient (50%), financial worries (12.5%), lack of medical experience (10.5%), and their own health (10.5%) seem to be the primary stressors for caregivers. Caregivers rely on numerous support systems and coping mechanisms, with physical activity (54.5%) and increased alcohol and marijuana usage (35.5%) the most frequent. Conclusions Although caregivers have support systems and found coping methods that would alleviate their burden of caring for a patient with AD, the clear negative impact AD has on caregivers affects their physical, mental, and social health. As there is currently no cure for AD, compassion and greater support for caregivers are necessary.

Objectives:This study sought to: 1) estimate the penetrance (in terms of youth coaches being aware of them) of the CDC “Heads Up!” guidelines, 2) determine whether these guidelines changed the coaches’ practice, and 3) understand whether these guidelines resulted in a perceived decrease in the number of concussions.Methods:This was a cross-sectional survey of pediatric sports coaches in the United States designed to assess the impact of the CDC "Heads Up!" guidelines. “Heads Up!” Concussion in Youth Sports is a free, online course available to coaches, parents, and others helping to keep athletes safe from concussions. The “Heads Up!” fact sheet provides important information on preventing, recognizing, and responding to a concussion.Results:Half the cohort had heard of the CDC “Heads Up!” campaign. Fifty-five percent of the cohort thought that pediatric concussions in youth sports was a “big deal” (rated on a Likert scale from 1-10). Coaches who were also parents (58%) were significantly more likely to have heard of the campaign (P=0.0032, 95% CI=0.1153-0.5513). Having heard of the “Heads Up!” campaign was significantly associated with how important coaches thought pediatric concussions are (P=0.0133, 95% CI=0.0590-0.4960), as was higher income of the coaches (P=0.0100), and this was significantly correlated with the coach being more likely to call the athlete’s parent at injury (P=0.0030, 95% CI=0.1160-0.5471). Coaches of football/soccer were significantly more likely to think pediatric concussions were a “big deal” (P=0.0021,95% CI=0.1374-0.5947). More than a third of coaches 35% reported that the “Heads Up!” campaign decreased the number of concussions on their team.

The authors describe the case of a middle-aged female who presented to the emergency department with exquisite right upper quadrant pain. Computed tomography scan of the abdomen revealed a hydropic gallbladder, confirmed with abdominal ultrasonography. The clinical presentation, imaging findings, and management of this interesting condition are discussed.

Extremity trauma is a common emergency department presentation. The authors report a case of an elderly woman who sustained a trimalleolar ankle fracture. Emergency department care includes stabilization of the fracture with a splint, with careful assessment of neurovascular status. Trimalleolar fractures are unstable and thus almost always will require surgical repair. This is true even for elderly patients and those with co-morbidities. Patients who do not get a surgical repair for these fractures are at risk for significant morbidity, including compartment syndrome, arthritis, malunion, and loss of mobility.

The authors present a case of a fatal intentional acetaminophen (APAP) overdose and remind the physician how ubiquitous the drug is. This case presentation highlights the clinical presentation and treatment options for APAP overdose in unresponsive patients. In cases of massive APAP overdose (> 300 µg/ml plasma at four hours post-ingestion), prompt administration of N-acetylcysteine (NAC) and early hemodialysis are indicated.