删繁就简，让故事讲述走向高效通道

对于篇幅较长的文本,我们不能处处着力,而需要在梳理细节和留白处,让学生在朗读和表演中理解和积累故事,并通过实践性拓展和想象的过程,在理解思维中历练学生的创新意识,真正为学生核心能力的生长服务。本文提出要强化榜样引领,多重朗读为讲述奠基;模拟创设情境,角色表演为讲述支架;奠定认知平台,方法编创为讲述释放。

Advanced Methods of Evaluating Benefits from Improved Flood Immunity in Queensland

The regular occurrence and the high costs of flooding to both road agencies and communities is a strong impetus to investigate the methodologies applied to evaluating flood immunity road projects. Very little literature exists on methods of evaluating the benefits of improving flood immunity through better road infrastructure. This paper attempts to address some of the numerous issues hindering the accurate evaluation of flood immunity road projects. The methodologies presented in this paper are designed to evaluate benefits that are not normally included or not fully considered in evaluations; such benefits include reduced flood related road accidents, costs of not travelling during the closure period and additional costs from unanticipated flood events. A key focus of the paper is the consideration of the evaluation of improved flood immunity from a network perspective rather than the typical approach of evaluating flood immunity projects in isolation to each other. The application of the proposed methodologies is demonstrated with a hypothetical example of a typical rural network subjected to regular flooding. The results of the analysis, conducted using the proposed methodologies, reveals that the currently applied methodologies account for less than half the likely value of benefits of a package of projects that will prevent the complete isolation of communities during serious flood events.

Multivariate Analysis of Accidents in Children Under 15 in Algeria （2012-MICS4）

Usually, data on road traffic accidents in Algeria are not available to researchers. Fortunately, MICS4mthe Multiple Indicator Cluster Survey conducted by UNICEF during 2012-2013 has introduced a module on accidents among children less than 15 years. In Algeria, the MICS4 survey targeted a sample of 28,000 households distributed over the national territory. These are the main results of polynomial logistic regression： Children in the richest quintile （B = .562, p 〈 .05）, are much less exposed than children in the poorest quintile. The odd ratio is 1.75. Compared to children aged 12 to 14, the younger children of 0-2 years （B = -1.059, p 〈 .05）, are three times less exposed （odd ratio = .347） to road traffic accidents; and children of 9-11 years （B = .520, p 〈 .05）, are most exposed with an odd ratio of 1.68. For territorial planning areas, with the South being taken as a reference category, the risk of traffic accidents for a child is the lowest in the West Highlanders （B = -1.257, p 〈 .05）, followed by the North Center （B = -1.163, p 〈 .05）, the East Highlands （B = -1.053, p 〈 .05）, the Northwest （B = -1.034, p 〈 .05）, and the Northeast （B = -.805, p 〈 .05）. Odd ratio values are respectively .29, .313, .349, .356, and .447.

Evaluation of Road Accidents in Pristina in the Period 2009-2012

Approximately 15,000-17,000 thousand people die worldwide in traffic accidents as a consequence of all types of injuries. This study has a descriptive nature. It is based on data obtained from archives including the treatment database of the Emergency Center. The period January 2009 to December 2012 has been considered for this research. The aim of this study is to assess the prevalence of fatal road traffic accidents in Pristine, Kosovo, and describe their determinants. The number of injured in traffic accidents who have sought emergency medical assistance in the Emergency Center from January 2009 to December 2012 is increasing significantly. It is concluded that except reasons mentioned above and among others, there also are the following factors： enormous increase of number of persons equipped with driving license, driving speeds above limits which are considered to be the primary cause of the road traffic accidents. These findings can serve as a basis for health care professionals and policymakers to create preventive measures for traffic accidents.

Transport Risk Assessment for the Environment

Transport risk assessment for the environment has two important aspects--problem solving model and solution veracity. Problem solving model is larger understanding of tasks interconnection, which represents in itself partial solution of general risk assessment. Veracity of solution means how the results are consistent with the reality. By researching of both aspects, it rises many unanswered questions. It is concerned about verification and validation of risk assessment results. By risk assessment for the environment it is possible to meet wide variety of more or less good soluble problems. It exists simple problems based on risk assessment of common traffic accidents connected with service charge outflow. On the other site, it exists complex problems of risk assessment connected with dangerous goods transport by traffic or pipelines. By simple problems solving there are not many questions about risk assessment veracity. It is possible to determine traffic accidents frequencies and service charge outflows consequences on the basis of examined events in transportation with great veracity. By complex problems the situation is quite different. The frequencies of large accidents are very low but the consequences for the environment may be large. Both are encumbered by large level of uncertainty. That is why the question is rising. To what degree, it is in these cases correct to make decision based on risk assessment.

Restraint Usage Characteristics and Other Factors Associated with Safety of Children Involved in Motor Vehicle Crashes

Involvement in road traffic crashes as vehicle occupants is a leading cause of death and serious injury among children. The objective of this study was to investigate crash severity factors and child safety restraint use characteristics in order to identify effective countermeasures to increase children＇s highway safety. Characteristics and percentages of restraint use among child passengers aged 4-13 years were examined using highway crash data from Kansas. The association between restraint use, injury severity and characteristics of children involved in crashes were investigated using OR （odds ratios） and a logistic regression model, which was used to identify risk factors. Results showed that children, who were unrestrained, were seated in the front seat, traveling with drunk drivers and on rural roads, and traveling during nighttime was more vulnerable to severe injury in the case of motor vehicle crashes. The most frequent contributing causes related to crashes involving children included driver＇s inattention while driving, failure to yield right-of-way, driving too fast, wet roads and animals in the road. Based on identified critical factors, general countermeasure ideas to improve children＇s traffic safety were suggested, including age-appropriate and size-appropriate seat belt restraints and having children seated in the rear seat. Parents and children must gain better education regarding these safety measures in order to increase child safety on the road.

框架理论视野下的《海南日报·深读》

《海南日报·深读》坚持客观、平衡报道的新闻专业主义,既注重深度又追求可读性,采取融媒体言说方式从多个端口输出,在多次开发、多方互动中开掘新的深度。

Efficacy of open reduction and internal fixation with a miniplate and hollow screw in the treatment of Lisfranc injury

Purpose： To investigate efficacy of open reduction and internal fixation with the miniplate and hollow screw in the treatment of Lisfranc injury. Methods： Ten cases of Lisfranc injury treated by open reduction, miniplate and hollow screw in our hospital were retrospectively analyzed. There were 6 males and 4 females with age ranging from 25 to 45 years （mean 32 years）. Among them, one case was classified as Type A, six Type B and three Type C. Injury mechanism included road traffic accidents （3 cases）, fall from height （5 cases） and hit by heavy object （2 cases）. All injuries were closed without cerebral trauma or other complicated injuries. The time interval between injury and operation was 6-10 days （average 6.6 days）. Postoperatively, the foot function was assessed using Visual Analogue Scales （VAS） and American Orthopaedic Foot and Ankle Society （AOFAS） Scales. Healing time and complications were observed. Results： All patients were followed up for 18-24 months （average 20 months）. Anatomic reduction was achieved in all patients on images. There was statistical significance between preoperative score （Z89 ± 0.34） and score at postoperative 8 weeks （0.67 ± 0.13）. According to the AOFAS score, 5 cases were defined as excellent, 3 cases as good and 2 cases as fair. During follow-up, there was no wound infection or complications except for osteoarthritis in 2 cases. Healing time ranged from 3 to 6 months with an average of 3.6 months. Conclusion： Anatomical reduction of Lisfranc injury can be achieved by open reduction and internal fixation with the miniplate and hollow screw. Normal structure of Lisfranc joint is regained to a great extent; injured ligaments were also repaired. Therefore, this method offers excellent curative effect and can avoid postoperative complications and improve the patients＇ quality of life.

Open reduction and internal fixation for displaced supracondylar fractures of the humerus in children with crossed K-wires via lateral approach

Objective： To assess the therapeutic results of open reduction and internal fixation with crossed K-wires via lateral approach for displaced supracondvlar fractures of the humerus in children. Methods： We prospectively followed 52 children who presented with Gartland type 3 displaced supraeondylar fractures of the humerus and were managed by open reduction and internal fixation with crossed K-wires via lateral approach.There were 37 male and 15 female patients; average age was 7.39 years. The most common mechanism of trauma was fall while playing （n=23）, followed by fall from height （n=20）, road traffic accidents （n-5） and fall from standing height （n=2）. In 2 cases, mode of injury was not available. The mean follow-up was 12 months and patients were assessed according to Flynn＇s criteria. Results： Lateral approach provided an excellent view of the lateral column between two nervous planes and enabled an anatomical reduction in all cases. Immobilizing the elbow at 90 degrees or more of flexion was not needed after cross K-wire fixation. Majority of patients regained full range of motion within 6 weeks of pin removal. Two patients had postoperative ulnar nerve injuries that resolved after pin removal. The common late complication of cubitus varus was not seen in any patient. Delayed presentation to the emergency department, repeated manipulations by bone setters and massage with edible oil were responsible for stiffness in 5 patients. Superficial pin tract infection was noted in 5 patients that resolved with dressings and antibiotics. No deep infection occurred. A detailed clinical examination and radiographic analysis was done at final follow-up. They included measurement of carrying angle and range of movements of both operated and normal sides, and radiographs of both upper limbs for comparison. According to Flynn＇s criteria, 90.4% patients showed satisfactory results. Conclusion： Lateral approach for open reduction and internal fixation of the widely-displaced supracondylar fracture of the humerus is safe and straightforward, ensuring anatomical reduction and excellent function. The approach is easy and familiar to most orthopedic surgeons in our setup.

Road traffic fatalities among pedestrians, bicyclists and motor vehicle occupants in Sirjan, Kerman, Iran

Objective： To analyze the crash and injury data in forensic medicine for years of 2004-2007. Methods： A sample of over 567 accident cases （9 pedestrians, 116 bicyclists, and 442 motor vehicle occupants） was considered from the Department of Forensic Medicine, Shahid Bahonar University of Kerman, involving drivers of all ages and covering a four-year period. Results： The male fatality rates were significantly higher than female ones. The groups at 15-30 years old and at 30-55 years old had the first and second highest numbers of deaths （40% and 34%, respectively）. There were substantial differences in distribution of injuries in motor vehicle occupants and pedestrians and bicyclists. Among motor vehicle occupants, there were more head injuries, such as skull fracture, brain contusion, subdural haemorrhage, and epidural haemorrhage. Nearly 77% of fatalities occurred during 08：00-22：00 in Sirjan. Internal bleeding was also higher in motor vehicle occupants. Pedestrians and bicyclists also had head injuries frequently. Conclusions： In spite of reduction of road traffic fatalities in Sirjan in 2007, it is still one of the cities with high road traffic fatality in the world. These results underline the importance of preventive strategies in transportation, suggesting that different methods are necessary to reduce fatalities of various traffic participants.

Spinal fractures resulting from traumatic injuries

Objective： To illustrate mechanisms of spine fractures and the pattern of spinal injuries characterized by the major mechanisms in urban population of Iran. Methods： Data regarding spinal injuries including demographics, mechanism and level of spinal injury, abbreviated injury score, associated injuries and final fate of the patients were extracted from the Iranian national trauma registry database from 1999 to 2004. Results： A total of 619 patients with traumatic spine fractures were identified, of whom 68.5% were males. The peak frequency of these injuries occurred in the 21-40 year age-group. Accidental falls and road traffic crashes （RTCs） were the most common mechanisms of spinal fractures （47.2% and 44.1%, respectively）. RTCs tended to occur in younger patients compared with accidental falls. The most common spinal region for spinal fracture was the lumbar spine （53.63%）. Cervical spine fractures were significantly more common in RTCs, while lumbar spine fractures were more common in accidental falls （P〈0.001）. A total of 171 （27.6%）patients had associated non-spinal injuries, of whom 127 had associated extremity injuries, and 55 had head injuries. Thirty-six （5.6%） patients had spinal cord injury （SCI）.The injury severity score of the RTC group was significantly higher than that of accidental falls （P=-0.002）. Fifteen （4%） patients died of traumatic injuries. The rate of death was significantly higher in RTCs compared with accidental falls （5.1% vs 2.1%, P=0.039）. Conclusions： The patterns of spinal fractures are similar to those reported from developed countries. RTCs tend to affect the younger age population and are associated with a higher degree of associated injuries and mortality than accidental falls. Therefore preventive strategies should be based on reduction of the number and severity of RTCs.

Femoral head fracture without hip dislocation

Femoral head fractures without disloca- tion or subluxation are extremely rare injuries. We report a neglected case of isolated comminuted fracture of femoral head without hip dislocation or subluxation of one year duration in a 36-year-old patient who sustained a high en- ergy trauma due to road traffic accident. He presented with painful right hip and inability to bear full weight on right lower limb with Harris hip score of 39. He received cementless total hip replacement. At latest follow-up of 2.3 years, functional outcome was excellent with Harris hip score of 95. Such isolated injuries have been described only once in the literature and have not been classified till now. The purpose of this report is to highlight the extreme rarity, pos- sible mechanism involved and a novel classification system to classify such injuries.

Educational level and age as contributing factors to road traffic accidents

Objective： This research analyzes data on road traffic accidents （RTA） in Fars province, whose roads are among the highly dangerous ones in Iran. It inves- tigates educational level and age involved in RTA in order to discover patterns that can prevent or decrease accidents. Methods： This research made use of data visualization techniques to find hidden patterns. The data included mor- tality rate related to RTA in Fars province and were obtained from Fars Forensic Medicine Registry covering a period of 1 year from March 21, 2010 to March 21, 2011. All data were analyzed using SPSS 11.5. The results were reported as de- scriptive indices such as frequency （percentage）. The Chi- square test was applied to the data concerning educational level and age. P value less than 0.05 was considered significant. Results： In the mentioned period, 1 831 people were killed, out of whom un/lowly educated people （69.6%） ac- counted for the highest mortality rate. The significant rela- tionship between educational level and mortality rate was found （X2=275.98, P〈0.0001）. Also three was a significant association between age and mortality rate （X2=371.20, P〈0.0001）. Young people （age between 20 and 29 years） contribute to higher RTA mortality rate compared with other age groups. Conclusion： The educational level and age are signifi- cantly correlated to mortality rate. The youth and un/lowly educated people suffer more fatal RTA.

Time analysis of fatal traffic accidents in Fars Province of Iran

Objective： To analyze the time factor in road traffic accidents （RTAs） in Fats Province of Iran. Methods： This study was conducted in Fars Province, Iran from November 22, 2009 to November 21,2011. Victims＇ information consisted of age, sex, death toll involving dri- vers or passengers of cars, motorcycles and pedestrians, and site of injury etc. Accidents were analyzed in relation to hour of the day, season of the year, lighting condition in- cluding sunrise, sunset, daytime and nighttime. Results： Atotal of 3 642 deaths （78.3% were males, and the ratio of males to females was about 3.6：1） were studied regarding their autopsy records. There was a steady in- crease in fatal accidents occurring at midnight to 15：59. The risk of being involved in a fatal traffic accident was higherfor those injured between 4：00 to 7：59 than at other times （OR=2.13, 95% C11.85-2.44）. The greatest number of fatal RTAs took place in summer. Mortalities due to RTA during spring and summer were more pronounced at 20：00 to 23：59 and midnight to 3：59, whereas mortalities in fall and winter were more pronounced from 12：00 to 15：59. Conclusion： The high mortality rate ofRTAis a major public health problem in Fars Province. Our results indicate that the time is an important factor which contributes to road traffic deaths.

A systematic review of the effect of various interventions on reducing fatigue and sleepiness while driving

Purpose： To identify and appraise the published studies assessing interventions accounting for reducing fatigue and sleepiness while driving. Methods： This systematic review searched the following electronic databases： Medline, Science direct, Scopus, EMBASE, PsyclNFO, Transport Database, Cochrane, BIOSIS, ISI Web of Knowledge, specialist road injuries journals and the Australian Transport and Road Index database. Additional searches included websites of relevant organizations, reference lists of included studies, and issues of major injury journals published within the past 15 years. Studies were included if they investigated interventions/exposures accounting for reducing fatigue and sleepiness as the outcome, measured any potential interventions for mitigation of sleepiness and were written in English. Meta-analysis was not attempted because of the heterogeneity of the included studies. Results： Of 63 studies identified, 18 met the inclusion criteria. Based on results of our review, many interventions in the world have been used to reduce drowsiness while driving such as behavioral （talking to passengers, face washing, listening to the radio, no alcohol use, limiting the driving behavior at the time of 12 p.m. - 6 a.m. etc）, educational interventions and also changes in the environment （such as rumble strips, chevrons, variable message signs, etc）. Meta-analysis on the effect of all these in- terventions was impossible due to the high heterogeneity in methodology, effect size and interventions reported in the assessed studies. Conclusion： Results of present review showed various interventions in different parts of the world have been used to decrease drowsy driving. Although these interventions can be used in countries with high incidence of road traffic accidents, precise effect of each intervention is still unknown. Further studies are required for comparison of the efficiency of each intervention and localization of each intervention ac- cording to the traffic pattems of each country.

Epidemiology of patients admitted to a major trauma centre in northern India

Objective： Trauma in India is an increasingly significant problem, particularly in light of rapid development and increasing motorization. Social changes are resulting in alterations in the epidemiology of trauma. The aim of the study was to assess the various epidemiological parameters that influence the cause of injury in the patients admitted to a major trauma centre in northem India. Methods： An observational study of 748 patients chosen by random assortment was carried out over a peri- od of 1 year （August 2008 to July 2009）. Age, sex, injury type and pattern were noted. Injury mode of upper and lower limbs was also noted. Results： Injuries occur predominately in the age group of 15-30 years. Males incurred more injury with male to female ratio of 6：1. The most vulnerable group was motorcycle users. Among the injured, farmers were the most commonly involved. Blunt injuries （94.92%） were much more common than penetrating injuries. Among patients with head injury, two wheelers related accidents were the most common （40.3%）. Most spinal cord injuries were caused by falls from height （51.09%）. Most lower limb fractures were simple type. Compound fractures of the lower limb were more common than up- per limb fractures. Conclusion： Strict enforcement of traffic rules, combined with improved infrastructure and behavior change can decrease the burden of road traffic accidents in India and other developing countries. This study could assist in raising the profile of road traffic accidents as a public health problem which needs to be addressed as a preventable cause of mortality and morbidity, and plan- ning appropriate interventions for this major challenge. Preventive strategies should be made on the basis of these epidemiological trends.

Multi-slice computed tomography for diagnosis of combined thoracoabdominal injury

Purpose： To investigate the diagnostic value of multi-slice computed tomography （MSCT） for combined thoracoabdominal injury. Methods： A retrospective study was conducted to analyze the clinical data and MSCT images of 68 patients who sustained a combined thoracoabdominal injury associated with diaphragm rupture, and 18 patients without diaphragm rupture. All the patients were admitted and treated in the Chongqing Emergency Medical Center （a level I trauma center） between July 2005 and February 2014. There were 71 males and 15 females with a mean age of 39.1 years （range 13-88 years）. Among the 86 patients, 40 patients suffered a penetrating injury, 46 suffered a blunt injury as a result of road traffic accident in 21 cases, fall from a height in 16, and crushing injury in 9. The MSCT images were retrospectively reviewed by two radiologists. The results of CT diagnosis were compared with surgical findings and/or follow-up results. Results： Among the 86 cases, diaphragm discontinuity was found in 29 cases, segmental nonrecognition of the diaphragm in 14, diaphragmatic hernia in 21, collar sign in 14, dependent viscera sign in 18, elevated abdominal organs in 21, bowel wall thickening and/or hematoma in 6, and pneumoperitoneum in 8. CT diagnostic accuracy for diaphragm rupture was 88.4% in the right side and 90.7% in the left side. CT diagnostic accuracy for hemopneumothorax, pulmonary contusion, mediastinal hemorrhage, kidney and adrenal gland injuries was 100%, while for liver, spleen and pancreas injuries was 96.5%, 96.5g, 94.2% respectively. Conclusion： To reach an early diagnosis of combined thoracoabdominal injury, surgeons and radiologists should be familiar with all kinds of images which might show signs of diaphragm rupture, such as diaphragm discontinuity, segmental nonrecognition of the diaphragm, dangling diaphragm sign, diaphragm herniation, collar sign, dependent viscera sign, and elevated abdominal organs.

Outcomes of surgical management of tracheobronchial injuries a case series from a developing country

Objective： Tracheobronchial injuries are defined as injuries involving the trachea and/or bronchi from the level of the cricoid cartilage extending up to the division of the bronchi. We present a case series with most of the tracheobronchial injuries found to be sustained after penetrating trauma. Methods： A retrospective review was performed at the Aga Khan University, Karachi, Pakistan. From January 2004 to December 2009, 168 patients with thoracic trauma were treated, of whom 15 were recognized to have major tracheobronchial and pulmonary injuries. Results： The average age was 3 l years with most of the patients being male （14：1）. Among them,11 patients had penetrating trauma as the main cause of injury, 3 patients had blunt trauma from road traffic accidents, only 1 patient had combined trauma （blunt and penetrating trauma）. Eightpatients were diagnosed based on radiological findings. All the patients were treated surgically. Lobectomy was the most common intervention performed in 7 patients. The mortality rate was 7% （1 patient）. Most patients survived with no sequelae （10 patients） while 5 survived with disability. We found that penetrating trauma was the leading cause of injury in our series. The severity of injury depends upon the weapon causing the trauma. Patients in our series had multiple injuries and required surgical management. Conclusions： Tracheobronchial injuries are rare but potentially life threatening. They require quick diagnosis and management. Diagnosis tends to be difficult since there are no specialised diagnostic modalities available at present.

Extremity fractures in children： a hospital based study in Tehran

Objective： Although long bone fracture in children is not life-threatening, it may cause major disability, loss of working days and severe psychological distress. We conducted this study to determine the pattern of extremity fracture due to trauma in children. Methods： During one year in six general hospitals in Tehran, trauma patients who were hospitalized for more than 24 hours and sustained injuries within seven days before admission were included in the study. The records of children （≤16 years old） hospitalized in six general hospitals in Tehran due to trauma were reviewed prospectively. Results： During the study period, 1 274 children had sustained extremity fractures. Male to female ratio was 3.6/ 1, with the mean age of （10.3±4.2） years. Falls and traffic crashes were the main causes of injuries, with the percentages of 57.3 % and 37.1%, respectively. Simple fall （falling on the ground） consisted 60% of patients that sustained fall-related injuries. Pedestrians and bicycle riders comprised most of the cases that were injured due to traffic crashes. Of our cases, 56.8% sustained fractures in the upper extremities and 43.2% in the lower extremities. Forearm was the most common fracture site （34.1%）. Comparing our results in preschool and school-age children, falls were the main cause of injuries in both groups, but fractures of lower extremities were significantly more common in preschool children. Conclusions： Improvement of physical condition of sidewalks and crossings in roads will be necessary for prevention of injuries. More attention to safety of home environment should be paid for control of preschools＇ injury at home. Education of children and adults is necessary to reduce injuries resulting from road traffic crashes.

Road traffic crashes in rural setting： an experience of a middle-income country

Objective： To date, there has been little information published on the death of rural road accident deaths. This study uses burden of injury method to explore a more accurate estimate of years of life lost due to road traffic crashes occurring over a four-year period in Guilan province, northern Iran. Methods： Rural road accident deaths from 2009 to 2013 were extracted from Iran＇s Forensic Medicine System, Death Registry System and Road Trauma Research center database. Results： During the study period, the average years of life lost due to motor vehicle crashes was 13.8 per 1 000 persons, ranging from 11.9 during March 2011- 2012 to 15.8 per 1 000 persons during March 2012-2013. Conclusion： Road accident deaths in 2013 remained at the same high level as in 2009. The information obtained from this study provides a new perspective on fatal road traffic crash victims in rural settings and show us that more attention is needed in this area.