WorldWideScience

Sample records for level ii trauma

  1. Use of laparoscopy in trauma at a level II trauma center.

    Science.gov (United States)

    Barzana, Daniel C; Kotwall, Cyrus A; Clancy, Thomas V; Hope, William W

    2011-01-01

    Enthusiasm for the use of laparoscopy in trauma has not rivaled that for general surgery. The purpose of this study was to evaluate our experience with laparoscopy at a level II trauma center. A retrospective review of all trauma patients undergoing diagnostic or therapeutic laparoscopy was performed from January 2004 to July 2010. Laparoscopy was performed in 16 patients during the study period. The average age was 35 years. Injuries included left diaphragm in 4 patients, mesenteric injury in 2, and vaginal laceration, liver laceration, small bowel injury, renal laceration, urethral/pelvic, and colon injury in 1 patient each. Diagnostic laparoscopy was performed in 11 patients (69%) with 3 patients requiring conversion to an open procedure. Successful therapeutic laparoscopy was performed in 5 patients for repair of isolated diaphragm injuries (2), a small bowel injury, a colon injury, and placement of a suprapubic bladder catheter. Average length of stay was 5.6 days (range, 0 to 23), and 75% of patients were discharged home. Morbidity rate was 13% with no mortalities or missed injuries. Laparoscopy is a seldom-used modality at our trauma center; however, it may play a role in a select subset of patients.

  2. Cost Benefit Analysis of Providing Level II Trauma Care at William Beaumont Army Medical Center (WBAMC)

    National Research Council Canada - National Science Library

    Gerepka, Peter

    2002-01-01

    .... During the period from 1 October 2000 to 30 September 2001, WBAMC, a designated Level II trauma center by the American College of Surgeons, provided care for 410 patients of which 181 were civilian emergencies...

  3. The Clinical and Economic Impact of Generic Locking Plate Utilization at a Level II Trauma Center.

    Science.gov (United States)

    Mcphillamy, Austin; Gurnea, Taylor P; Moody, Alastair E; Kurnik, Christopher G; Lu, Minggen

    2016-12-01

    In today's climate of cost containment and fiscal responsibility, generic implant alternatives represent an interesting area of untapped resources. As patents have expired on many commonly used trauma implants, generic alternatives have recently become available from a variety of sources. The purpose of this study was to examine the clinical and economic impact of a cost containment program using high quality, generic orthopaedic locking plates. The implants available for study were anatomically precontoured plates for the clavicle, proximal humerus, distal radius, proximal tibia, distal tibia, and distal fibula. Retrospective review. Level II Trauma center. 828 adult patients with operatively managed clavicle, proximal humerus, distal radius, proximal tibia, tibial pilon, and ankle fractures. Operative treatment with conventional or generic implants. The 414 patients treated with generic implants were compared with 414 patients treated with conventional implants. There were no significant differences in age, sex, presence of diabetes, smoking history or fracture type between the generic and conventional groups. No difference in operative time, estimated blood loss or intraoperative complication rate was observed. No increase in postoperative infection rate, hardware failure, hardware loosening, malunion, nonunion or need for hardware removal was noted. Overall, our hospital realized a 56% reduction in implant costs, an average savings of $1197 per case, and a total savings of $458,080 for the study period. Use of generic orthopaedic implants has been successful at our institution, providing equivalent clinical outcomes while significantly reducing implant expenditures. Based on our data, the use of generic implants has the potential to markedly reduce operative costs as long as quality products are used. Therapeutic Level III.

  4. Evaluating trauma team performance in a Level I trauma center: Validation of the trauma team communication assessment (TTCA-24).

    Science.gov (United States)

    DeMoor, Stephanie; Abdel-Rehim, Shady; Olmsted, Richard; Myers, John G; Parker-Raley, Jessica

    2017-07-01

    activations. Diagnostic tests or criteria, level II.

  5. [Low grade renal trauma (Part II): diagnostic validity of ultrasonography].

    Science.gov (United States)

    Grill, R; Báca, V; Otcenásek, M; Zátura, F

    2010-04-01

    The aim of the study was to verify whether ultrasonography can be considered a reliable method for the diagnosis of low-grade renal trauma. The group investigated included patients with grade I or grade II blunt renal trauma, as classified by the AAST grading system, in whom ultrasonography alone or in conjunction with computed tomography was used as a primary diagnostic method. B-mode ultrasound with a transabdominal probe working at frequencies of 2.5 to 5.0 MHz was used. Every finding of post-traumatic changes in the renal tissues, i.e., post-contusion hypotonic infiltration of the renal parenchyma or subcapsular haematoma, was included. The results were statistically evaluated by the Chi-square test with the level of significance set at 5%, using Epi Info Version 6 CZ software. The group comprised 112 patients (43 women, 69 men) aged between 17 and 82 years (average, 38 years). It was possible to diagnose grade I or grade II renal injury by ultrasonography in only 60 (54%) of them. The statistical significance of ultrasonography as the only imaging method for the diagnosis of low-grade renal injury was not confirmed (p=0.543) Low-grade renal trauma is a problem from the diagnostic point of view. It usually does not require revision surgery and, if found during repeat surgery for more serious injury of another organ, it usually does not receive attention. Therefore, the macroscopic presentation of grade I and grade II renal injury is poorly understood, nor are their microscopic findings known, because during revision surgery these the traumatised kidneys are not usually removed and their injuries at autopsy on the patients who died of multiple trauma are not recorded either. The results of this study demonstrated that the validity of ultrasonography for the diagnosis of low-grade renal injury is not significant, because this examination can reveal only some of the renal injuries such as perirenal haematoma. An injury to the renal parenchyma is also indicated by

  6. Then we all fall down: fall mortality by trauma center level.

    Science.gov (United States)

    Roubik, Daniel; Cook, Alan D; Ward, Jeanette G; Chapple, Kristina M; Teperman, Sheldon; Stone, Melvin E; Gross, Brian; Moore, Forrest O

    2017-09-01

    Ground-level falls (GLFs) are the predominant mechanism of injury in US trauma centers and accompany a spectrum of comorbidities, injury severity, and physiologic derangement. Trauma center levels define tiers of capability to treat injured patients. We hypothesized that risk-adjusted observed-to-expected mortality (O:E) by trauma center level would evaluate the degree to which need for care was met by provision of care. This retrospective cohort study used National Trauma Data Bank files for 2007-2014. Trauma center level was defined as American College of Surgeons (ACS) level I/II, ACS III/IV, State I/II, and State III/IV for within-group homogeneity. Risk-adjusted expected mortality was estimated using hierarchical, multivariable regression techniques. Analysis of 812,053 patients' data revealed the proportion of GLF in the National Trauma Data Bank increased 8.7% (14.1%-22.8%) over the 8 y studied. Mortality was 4.21% overall with a three-fold increase for those aged 60 y and older versus younger than 60 y (4.93% versus 1.46%, P < 0.001). O:E was lowest for ACS III/IV, (0.973, 95% CI: 0.971-0.975) and highest for State III/IV (1.043, 95% CI: 1.041-1.044). Risk-adjusted outcomes can be measured and meaningfully compared among groups of trauma centers. Differential O:E for ACS III/IV and State III/IV centers suggests that factors beyond case mix alone influence outcomes for GLF patients. More work is needed to optimize trauma care for GLF patients across the spectrum of trauma center capability. Copyright © 2017 Elsevier Inc. All rights reserved.

  7. Impact of a TeamSTEPPS Trauma Nurse Academy at a Level 1 Trauma Center.

    Science.gov (United States)

    Peters, V Kristen; Harvey, Ellen M; Wright, Andi; Bath, Jennifer; Freeman, Dan; Collier, Bryan

    2018-01-01

    Nurses are crucial members of the team caring for the acutely injured trauma patient. Until recently, nurses and physicians gained an understanding of leadership and supportive roles separately. With the advent of a multidisciplinary team approach to trauma care, formal team training and simulation has transpired. Since 2007, our Level I trauma system has integrated TeamSTEPPS (Team Strategies & Tools to Enhance Performance & Patient Safety; Agency for Healthcare Research and Quality, Rockville, MD) into our clinical care, joint training of nurses and physicians, using simulations with participation of all health care providers. With the increased expectations of a well-orchestrated team and larger number of emergency nurses, our program created the Trauma Nurse Academy. This academy provides a core of experienced nurses with an advanced level of training while decreasing the variability of personnel in the trauma bay. Components of the academy include multidisciplinary didactic education, the Essentials of TeamSTEPPS, and interactive trauma bay learning, to include both equipment and drug use. Once completed, academy graduates participate in the orientation and training of General Surgery and Emergency Medicine residents' trauma bay experience and injury prevention activities. Internal and published data have demonstrated growing evidence linking trauma teamwork training to knowledge and self-confidence in clinical judgment to team performance, patient outcomes, and quality of care. Although trauma resuscitations are stressful, high risk, dynamic, and a prime environment for error, new methods of teamwork training and collaboration among trauma team members have become essential. Copyright © 2017 Emergency Nurses Association. Published by Elsevier Inc. All rights reserved.

  8. Epidemiological Trends of Spine Trauma: An Australian Level 1 Trauma Centre Study

    Science.gov (United States)

    Tee, J. W.; Chan, C. H. P.; Fitzgerald, M. C. B.; Liew, S. M.; Rosenfeld, J. V.

    2013-01-01

    Knowledge of current epidemiology and spine trauma trends assists in public resource allocation, fine-tuning of primary prevention methods, and benchmarking purposes. Data on all patients with traumatic spine injuries admitted to the Alfred Hospital, Melbourne between May 1, 2009, and January 1, 2011, were collected from the Alfred Trauma Registry, Alfred Health medical database, and Victorian Orthopaedic Trauma Outcomes Registry. Epidemiological trends were analyzed as a general cohort, with comparison cohorts of nonsurvivors versus survivors and elderly versus nonelderly. Linear regression analysis was utilized to demonstrate trends with statistical significance. There were 965 patients with traumatic spine injuries with 2,333 spine trauma levels. The general cohort showed a trimodal age distribution, male-to-female ratio of 2:2, motor vehicle accidents as the primary spine trauma mechanism, 47.7% patients with severe polytrauma as graded using the Injury Severity Score (ISS), 17.3% with traumatic brain injury (TBI), the majority of patients with one spine injury level, 7% neurological deficit rate, 12.8% spine trauma operative rate, and 5.2% mortality rate. Variables with statistical significance trending toward mortality were the elderly, motor vehicle occupants, severe ISS, TBI, C1–2 dissociations, and American Spinal Injury Association (ASIA) A, B, and C neurological grades. Variables with statistical significance trending toward the elderly were females; low falls; one spine injury level; type 2 odontoid fractures; subaxial cervical spine distraction injuries; ASIA A, B, and C neurological grades; and patients without neurological deficits. Of the general cohort, 50.3% of spine trauma survivors were discharged home, and 48.1% were discharged to rehabilitation facilities. This study provides baseline spine trauma epidemiological data. The trimodal age distribution of patients with traumatic spine injuries calls for further studies and intervention targeted

  9. Injury patterns of child abuse: Experience of two Level 1 pediatric trauma centers.

    Science.gov (United States)

    Yu, Yangyang R; DeMello, Annalyn S; Greeley, Christopher S; Cox, Charles S; Naik-Mathuria, Bindi J; Wesson, David E

    2018-05-01

    This study examines non-accidental trauma (NAT) fatalities as a percentage of all injury fatalities and identifies injury patterns in NAT admissions to two level 1 pediatric trauma centers. We reviewed all children (<5years old) treated for NAT from 2011 to 2015. Patient demographics, injury sites, and survival were obtained from both institutional trauma registries. Of 4623 trauma admissions, 557 (12%) were due to NAT. However, 43 (46%) of 93 overall trauma fatalities were due to NAT. Head injuries were the most common injuries sustained (60%) and led to the greatest increased risk of death (RR 5.1, 95% CI 2.0-12.7). Less common injuries that increased the risk of death were facial injuries (14%, RR 2.9, 95% CI 1.6-5.3), abdominal injuries (8%, RR 2.8, 95% CI 1.4-5.6), and spinal injuries (3%, RR 3.9, 95% CI 1.8-8.8). Although 76% of head injuries occurred in infants <1year, children ages 1-4years old with head injuries had a significantly higher case fatality rate (27% vs. 6%, p<0.001). Child abuse accounts for a large proportion of trauma fatalities in children under 5years of age. Intracranial injuries are common in child abuse and increase the risk of death substantially. Preventing NAT in infants and young children should be a public health priority. Retrospective Review. II. Copyright © 2018. Published by Elsevier Inc.

  10. Trauma Systems. An Era of Development

    NARCIS (Netherlands)

    Lansink, K.W.W.

    2017-01-01

    The introduction of an inclusive trauma system in the Netherlands during last decade of the past century, has led to an improvement in Dutch trauma care. Eleven trauma regions were formed nationwide each surrounding a level I trauma center. All hospitals in a trauma region were assigned levels I, II

  11. Trauma surgeon becomes consultant: evaluation of a protocol for management of intermediate-level trauma patients.

    Science.gov (United States)

    Fallon, Sara C; Delemos, David; Christopher, Daniel; Frost, Mary; Wesson, David E; Naik-Mathuria, Bindi

    2014-01-01

    At our level 1 pediatric trauma center, 9-54 intermediate-level ("level 2") trauma activations are received per month. Previously, the surgery team was required to respond to and assume responsibility for all patients who had "level 2" trauma activations. In 8/2011, we implemented a protocol where the emergency room (ER) physician primarily manages these patients with trauma consultation for surgical evaluation or admission. The purpose of this study was to prospectively evaluate the effects of the new protocol to ensure that patient safety and quality of care were maintained. We compared outcomes of patients treated PRE-implementation (10/2010-7/2011) and POST-implementation (9/2011-5/2012), including surgeon consultation rate, utilization of imaging and laboratory testing, ER length of stay, admission rate, and missed injuries or readmissions. Statistical analysis included chi-square and Student's t-test. We identified 472 patients: 179 in the PRE and 293 in the POST period. The populations had similar baseline clinical characteristics. The surgical consultation rate in the POST period was only 42%, with no missed injuries or readmissions. The ER length of stay did not change. However, in the POST period there were significant decreases in the admission rate (73% to 44%) and the mean number of CT scans (1.4 to 1), radiographs (2.4 to 1.7), and laboratory tests (5.1 to 3.3) ordered in the emergency room (all p<0.001). Intermediate-level pediatric trauma patients can be efficiently and safely managed by pediatric emergency room physicians, with surgical consultation only as needed. The protocol change improved resource utilization by decreasing testing and admissions and streamlining resident utilization in an era of reduced duty hours. © 2014.

  12. Correlation of Level of Trauma Activation With Emergency Department Intervention.

    Science.gov (United States)

    Cooper, Michael C; Srivastava, Geetanjali

    2018-06-01

    In-hospital trauma team activation criteria are formulated to identify severely injured patients requiring specialized multidisciplinary care. Efficacy of trauma activation (TA) criteria is commonly measured by emergency department (ED) disposition, injury severity score, and mortality. Necessity of critical ED interventions is another measure that has been proposed to evaluate the appropriateness of TA criteria. Two-year retrospective cohort study of 1715 patients from our trauma registry at a Level 1 pediatric trauma center. We abstracted data on acute interventions, level and criterion of TA, ED disposition, and mortality. We report odds ratio (OR) with 95% confidence intervals (CIs), positive predictive value, and frequency of acute interventions. Trauma activation was initiated for 947 (55%) of the 1715 patients. There were 426 ED interventions performed on 235 patients (14%); 67.8% were in level 1 activations; 17.6% in level 2, and 14.6% in level 3. Highest-level activations were highly associated with need for ED interventions (OR, 16.1; 95% CI, 11.5-22.4). The ORs for requiring an ED intervention were low for lower level activations (OR, 0.4; 95% CI, 0.3-0.5), trauma service consults (OR, 0.3; 95% CI, 0.2-0.4), and certain mechanism-based criteria. The ORs for ED intervention for isolated motor vehicle collision (0.2; 95% CI, 0.1-0.7), isolated all-terrain vehicle rollover (0.4; 95% CI, 0.1-1.7), and suspected spinal cord injury (0.5; 95% CI, 0.1-3.7) were significantly lower than 1. Highest-level activation criteria correlate with high utilization of ED resources and interventions. Lower level activation criteria and trauma service consult criteria are not highly correlated with need for ED interventions. Downgrading isolated motor vehicle collision and all-terrain vehicle rollovers and suspected spinal cord injury to lower level activations could decrease the overtriage rate, and adding age-specific bradycardia as a physiologic criterion could improve our

  13. The changing epidemiology of spinal trauma: a 13-year review from a Level I trauma centre.

    Science.gov (United States)

    Oliver, M; Inaba, K; Tang, A; Branco, B C; Barmparas, G; Schnüriger, B; Lustenberger, T; Demetriades, D

    2012-08-01

    Spinal injuries secondary to trauma are a major cause of patient morbidity and a source of significant health care expenditure. Increases in traffic safety standards and improved health care resources may have changed the characteristics and incidence of spinal injury. The purpose of this study was to review a single metropolitan Level I trauma centre's experience to assess the changing characteristics and incidence of traumatic spinal injuries and spinal cord injuries (SCI) over a 13-year period. A retrospective review of patients admitted to a Level I trauma centre between 1996 and 2008 was performed. Patients with spinal fractures and SCI were identified. Demographics, mechanism of injury, level of spinal injury and Injury Severity Score (ISS) were extracted. The outcomes assessed were the incidence rate of SCI and in-hospital mortality. Over the 13-year period, 5.8% of all trauma patients suffered spinal fractures, with 21.7% of patients with spinal injuries having SCI. Motor vehicle accidents (MVAs) were responsible for the majority of spinal injuries (32.6%). The mortality rate due to spinal injury decreased significantly over the study period despite a constant mean ISS. The incidence rate of SCI also decreased over the years, which was paralleled by a significant reduction in MVA associated SCI (from 23.5% in 1996 to 14.3% in 2001 to 6.7% in 2008). With increasing age there was an increase in spinal injuries; frequency of blunt SCI; and injuries at multiple spinal levels. This study demonstrated a reduction in mortality attributable to spinal injury. There has been a marked reduction in SCI due to MVAs, which may be related to improvements in motor vehicle safety and traffic regulations. The elderly population was more likely to suffer SCI, especially by blunt injury, and at multiple levels. Underlying reasons may be anatomical, physiological or mechanism related. Copyright © 2012 Elsevier Ltd. All rights reserved.

  14. Quality and dose optimized CT trauma protocol. Recommendation from a university level-I trauma center

    Energy Technology Data Exchange (ETDEWEB)

    Kahn, Johannes; Boening, Georg; Rotzinger, Roman; Freyhardt, Patrick; Streitparth, Florian [Charite School of Medicine and Univ. Hospital Berlin (Germany). Dept. of Radiology; Kaul, David [Charite School of Medicine and Univ. Hospital Berlin (Germany). Dept. of Radiation Oncology; Schwabe, Philipp [Charite School of Medicine and Univ. Hospital Berlin (Germany). Dept. of Trauma Surgery; Maurer, Martin H. [Inselspital Bern (Switzerland). Dept. of Diagnostic, Interventional and Pediatric Radiology; Renz, Diane Miriam [Univ. Hospital Jena (Germany). Inst. of Diagnostic and Interventional Radiology

    2017-09-15

    As a supra-regional level-I trauma center, we evaluated computed tomography (CT) acquisitions of polytraumatized patients for quality and dose optimization purposes. Adapted statistical iterative reconstruction [(AS)IR] levels, tube voltage reduction as well as a split-bolus contrast agent (CA) protocol were applied. Materials and Methods 61 patients were split into 3 different groups that differed with respect to tube voltage (120 - 140 kVp) and level of applied ASIR reconstruction (ASIR 20 - 50%). The CT protocol included a native acquisition of the head followed by a single contrast-enhanced acquisition of the whole body (64-MSCT). CA (350 mg/ml iodine) was administered as a split bolus injection of 100 ml (2 ml/s), 20 ml NaCl (1 ml/s), 60 ml (4 ml/s), 40 ml NaCl (4 ml/s) with a scan delay of 85s to detect injuries of both the arterial system and parenchymal organs in a single acquisition. Both the quantitative (SNR/CNR) and qualitative (5-point Likert scale) image quality was evaluated in parenchymal organs that are often injured in trauma patients. Radiation exposure was assessed. The use of IR combined with a reduction of tube voltage resulted in good qualitative and quantitative image quality and a significant reduction in radiation exposure of more than 40% (DLP 1087 vs. 647 mGy x cm). Image quality could be improved due to a dedicated protocol that included different levels of IR adapted to different slice thicknesses, kernels and the examined area for the evaluation of head, lung, body and bone injury patterns. In synopsis of our results, we recommend the implementation of a polytrauma protocol with a tube voltage of 120 kVp and the following IR levels: cCT 5mm: ASIR 20; cCT 0.625 mm: ASIR 40; lung 2.5 mm: ASIR 30, body 5 mm: ASIR 40; body 1.25 mm: ASIR 50; body 0.625 mm: ASIR 0. A dedicated adaptation of the CT trauma protocol (level of reduction of tube voltage and of IR) according to the examined body region (head, lung, body, bone) combined with a

  15. Quality and dose optimized CT trauma protocol. Recommendation from a university level-I trauma center

    International Nuclear Information System (INIS)

    Kahn, Johannes; Boening, Georg; Rotzinger, Roman; Freyhardt, Patrick; Streitparth, Florian; Kaul, David; Schwabe, Philipp; Maurer, Martin H.; Renz, Diane Miriam

    2017-01-01

    As a supra-regional level-I trauma center, we evaluated computed tomography (CT) acquisitions of polytraumatized patients for quality and dose optimization purposes. Adapted statistical iterative reconstruction [(AS)IR] levels, tube voltage reduction as well as a split-bolus contrast agent (CA) protocol were applied. Materials and Methods 61 patients were split into 3 different groups that differed with respect to tube voltage (120 - 140 kVp) and level of applied ASIR reconstruction (ASIR 20 - 50%). The CT protocol included a native acquisition of the head followed by a single contrast-enhanced acquisition of the whole body (64-MSCT). CA (350 mg/ml iodine) was administered as a split bolus injection of 100 ml (2 ml/s), 20 ml NaCl (1 ml/s), 60 ml (4 ml/s), 40 ml NaCl (4 ml/s) with a scan delay of 85s to detect injuries of both the arterial system and parenchymal organs in a single acquisition. Both the quantitative (SNR/CNR) and qualitative (5-point Likert scale) image quality was evaluated in parenchymal organs that are often injured in trauma patients. Radiation exposure was assessed. The use of IR combined with a reduction of tube voltage resulted in good qualitative and quantitative image quality and a significant reduction in radiation exposure of more than 40% (DLP 1087 vs. 647 mGy x cm). Image quality could be improved due to a dedicated protocol that included different levels of IR adapted to different slice thicknesses, kernels and the examined area for the evaluation of head, lung, body and bone injury patterns. In synopsis of our results, we recommend the implementation of a polytrauma protocol with a tube voltage of 120 kVp and the following IR levels: cCT 5mm: ASIR 20; cCT 0.625 mm: ASIR 40; lung 2.5 mm: ASIR 30, body 5 mm: ASIR 40; body 1.25 mm: ASIR 50; body 0.625 mm: ASIR 0. A dedicated adaptation of the CT trauma protocol (level of reduction of tube voltage and of IR) according to the examined body region (head, lung, body, bone) combined with a

  16. Quality and Dose Optimized CT Trauma Protocol - Recommendation from a University Level-I Trauma Center.

    Science.gov (United States)

    Kahn, Johannes; Kaul, David; Böning, Georg; Rotzinger, Roman; Freyhardt, Patrick; Schwabe, Philipp; Maurer, Martin H; Renz, Diane Miriam; Streitparth, Florian

    2017-09-01

    Purpose  As a supra-regional level-I trauma center, we evaluated computed tomography (CT) acquisitions of polytraumatized patients for quality and dose optimization purposes. Adapted statistical iterative reconstruction [(AS)IR] levels, tube voltage reduction as well as a split-bolus contrast agent (CA) protocol were applied. Materials and Methods  61 patients were split into 3 different groups that differed with respect to tube voltage (120 - 140 kVp) and level of applied ASIR reconstruction (ASIR 20 - 50 %). The CT protocol included a native acquisition of the head followed by a single contrast-enhanced acquisition of the whole body (64-MSCT). CA (350 mg/ml iodine) was administered as a split bolus injection of 100 ml (2 ml/s), 20 ml NaCl (1 ml/s), 60 ml (4 ml/s), 40 ml NaCl (4 ml/s) with a scan delay of 85 s to detect injuries of both the arterial system and parenchymal organs in a single acquisition. Both the quantitative (SNR/CNR) and qualitative (5-point Likert scale) image quality was evaluated in parenchymal organs that are often injured in trauma patients. Radiation exposure was assessed. Results  The use of IR combined with a reduction of tube voltage resulted in good qualitative and quantitative image quality and a significant reduction in radiation exposure of more than 40 % (DLP 1087 vs. 647 mGyxcm). Image quality could be improved due to a dedicated protocol that included different levels of IR adapted to different slice thicknesses, kernels and the examined area for the evaluation of head, lung, body and bone injury patterns. In synopsis of our results, we recommend the implementation of a polytrauma protocol with a tube voltage of 120 kVp and the following IR levels: cCT 5mm: ASIR 20; cCT 0.625 mm: ASIR 40; lung 2.5 mm: ASIR 30, body 5 mm: ASIR 40; body 1.25 mm: ASIR 50; body 0.625 mm: ASIR 0. Conclusion  A dedicated adaptation of the CT trauma protocol (level of reduction of tube voltage and of IR

  17. Trauma pattern in a level I east-European trauma center

    Directory of Open Access Journals (Sweden)

    Bogdan Stoica

    2015-10-01

    Conclusions: Our trauma pattern profile is similar to the one found in west-European countries, with a predominance of traffic-related injuries and falls. The severity and anatomical puzzle for trauma lesions were more complex secondary to motorcycle or bicycle-to-auto vehicles collisions. A trauma registry, with prospective enrollment of patients, is a very effective tool for constant improvements in trauma care.

  18. Educational paper Abusive Head Trauma Part II: Radiological aspects

    NARCIS (Netherlands)

    Sieswerda-Hoogendoorn, Tessa; Boos, Stephen; Spivack, Betty; Bilo, Rob A. C.; van Rijn, Rick R.

    2012-01-01

    Abusive head trauma (AHT) is a relatively common cause of neurotrauma in young children. Radiology plays an important role in establishing a diagnosis and assessing a prognosis. Computed tomography (CT), followed by magnetic resonance imaging (MRI) including diffusion-weighted imaging (DWI), is the

  19. Epidemiological Trends of Spine Trauma: An Australian Level 1 Trauma Centre Study

    OpenAIRE

    Tee, J. W.; Chan, C. H. P.; Fitzgerald, M. C. B.; Liew, S. M.; Rosenfeld, J. V.

    2013-01-01

    Knowledge of current epidemiology and spine trauma trends assists in public resource allocation, fine-tuning of primary prevention methods, and benchmarking purposes. Data on all patients with traumatic spine injuries admitted to the Alfred Hospital, Melbourne between May 1, 2009, and January 1, 2011, were collected from the Alfred Trauma Registry, Alfred Health medical database, and Victorian Orthopaedic Trauma Outcomes Registry. Epidemiological trends were analyzed as a general cohort, with...

  20. Interdisciplinary trauma room management: staff-related apparative and logistic concepts in three level trauma centers in Europe

    International Nuclear Information System (INIS)

    Kroetz, M.; Linsenmaier, U.; Pfeifer, K.J.; Reiser, M.; Bode, P.J.; Haeuser, H.

    2002-01-01

    Objective. To analyse common and divergent features of staff-related, equipmental and spatial/logistical concepts of three large trauma centers of highest health care level.Methods. The health care mandate as well as the staff management, the organisational and the constructional-spacial structure of trauma room diagnostics and therapy of the trauma centers of the Universities of Leiden and Munich (Innenstadt) and the Zentralklinikum Augsburg are described. In particular the technical equipment and the process of the radiological diagnostic procedures in the trauma room are outlined.Results. Staff availability and basic technical equipment of the trauma rooms are comparable between the three hospitals. Divergent concepts exist concerning the complexity of the initial radiologic examination protocols. Spacial connection and importance of computed tomography are also discussed controversially. Urgent interventional procedures are increasingly performed within the trauma room. Magnetic-resonance-tomography does not play a role in early care from multiple injured patients.Conclusion. Trauma centers have to meet certain personnel and technical prerequisites to guarantee a temporally optimised care for multiple injured patients. Differences between the three centers concerning the logistic sequence and the radiologic examination techniques used are mainly due to variable emphasis put on CT in the initial phase of patient care. (orig.) [de

  1. Paediatric Blunt Liver Trauma in a Dutch Level 1 Trauma Center

    NARCIS (Netherlands)

    Nellensteijn, D.; Porte, R. J.; van Zuuren, W.; ten Duis, H. J.; Hulscher, J. B. F.

    2009-01-01

    Introduction: Paediatric blunt hepatic trauma treatment is changing from operative treatment (OT) to non-operative treatment (NOT). In 2000 the American Pediatric Surgical Association has published guidelines for NOT of these injuries. Little is known about the treatment of paediatric liver trauma

  2. Burnout, Perceived Stress, and Job Satisfaction Among Trauma Nurses at a Level I Safety-Net Trauma Center.

    Science.gov (United States)

    Munnangi, Swapna; Dupiton, Lynore; Boutin, Anthony; Angus, L D George

    Nurses are at the forefront of our health care delivery system and have been reported to exhibit a high level of burnout. Burnout and stress in trauma nurses at a safety-net hospital can negatively impact patient care. Safety-net hospitals are confronted with unique social, financial, as well as resource problems that can potentially make the work environment frustrating. The purpose of this study was to explore the levels of burnout, stress, and job satisfaction in nurses providing care to trauma patients at a Level I safety-net trauma center. A cross-sectional survey design was used to investigate principal factors including personal and professional demographics, burnout, perceived stress, and job satisfaction. Trauma nurses working at a Level I safety-net trauma center are stressed and exhibited moderate degree of burnout. The extent of emotional exhaustion experienced by the nurses varied with work location and was highest in surgical intensive care unit nurses. The level of job satisfaction in terms of opportunities for promotion differed significantly by race and the health status of the nurses. Satisfaction with coworkers was lowest in those nurses between the ages of 60-69 years. Female nurses were more satisfied with their coworkers than male nurses. In addition, the study revealed that significant relationships exist among perceived stress, burnout, and job satisfaction. Work environment significantly impacts burnout, job satisfaction, and perceived stress experienced by trauma nurses in a safety-net hospital. Nursing administration can make an effort to understand the levels of burnout and strategically improve work environment for trauma nurses in order to minimize stressors leading to attrition and enhance job satisfaction.

  3. TRAUMA

    African Journals Online (AJOL)

    trauma and on most vascular injuries. South Africa is one of the few .... scan of the brain and abdomen showed a sliver of left subdural and subarachnoid .... and especially on RT. In the event of a life-threatening condition, the rapid response ...

  4. TRAUMA

    African Journals Online (AJOL)

    2017-11-04

    Nov 4, 2017 ... However, the physical and financial resources to manage this massive burden of disease are inadequate. This is especially the case in terms of access to critical care facilities. The development of an electronic trauma registry at our institution has allowed us to capture data in real time on all patients and.

  5. TRAUMA

    African Journals Online (AJOL)

    2017-11-04

    Nov 4, 2017 ... unit in Durban, and to correlate it with injury severity, length of hospital stay ... and via a password protected mobile application program within 6 ..... usage and costs performed in larger numbers on major trauma patients will ...

  6. Oral Assessment Kit, Levels II & III. Draft.

    Science.gov (United States)

    Agrelo-Gonzalez, Maria; And Others

    The assessment packet includes a series of oral tests to help develop speaking as an integral part of second language instruction at levels II and III. It contains: 8 mini-tests for use at level II; 9 mini-tests for use at level III; a rating scale and score sheet masters for evaluating performance on these tests; and a collection of suggested…

  7. An assessment of the impact of trauma systems consultation on the level of trauma system development.

    Science.gov (United States)

    Winchell, Robert J; Ball, Jane W; Cooper, Gail F; Sanddal, Nels D; Rotondo, Michael F

    2008-11-01

    Studies have shown that trauma systems decrease morbidity and mortality after injury. Despite these findings, overall progress in system development has been slow and inconsistent. The American College of Surgeons Committee on Trauma (COT) has developed a process to provide expert consultation to facilitate regional trauma system development. This study evaluated the progress that occurred after COT consultation visits in six regional systems. All six trauma systems undergoing COT consultation between January 1, 2004 and September 1, 2006 were included in the study. Using a set of 16 objective indicators, preconsultation status was retrospectively assessed by members of the original consultation team using data from the final consultation reports. Postconsultation status was assessed by directed telephone conference, conducted by members of the original consultation team with current key representatives from each system. Progress was assessed by comparing changes in both aggregate and individual indicator scores. This study showed a statistically significant increase in aggregate indicator scores after consultation. The largest gains were seen in systems with the longest time interval between the two assessments. Individual indicators related to system planning and quality assurance infrastructure showed the most improvement. Little or no change was seen in indicators related to system funding. The COT consultation process appears to be effective in facilitating regional trauma system development. In this short-term followup study, progress was seen primarily in areas related to planning and system design. Consultation was not effective in helping systems secure stable funding.

  8. Trauma Severity at Level 2 Trauma Center – Attainability of Retrospective Documentation on Severity

    DEFF Research Database (Denmark)

    Hebsgaard, Stine; Zwisler, Stine Thorhauge; Lauritsen, Jens M

    2015-01-01

    -MT patients were excluded, giving 221 adult MT cases for analysis. Forty-one patients (19%, CI: 14-24) had mAIS ≥ 3. Percentages varied with year from 0-29% with no up- or downwards trend throughout the decade. Proportion of mAIS ≥ 3 in the years before implementing the MECU in Svendborg was 17.1% (CI: 10...... month. Based on clinical record reviews and radiology findings, we decided if the patient was Multi Trauma (MT) defined as received by trauma response team and/or CT trauma scanned. Diagnoses were evaluated and maximum Abbreviated Injury Score (mAIS) was assigned dividing patients in severe injured...... with mAIS ≥ 3 and less injured with mAIS

  9. Diagnostic performance of increased overjet in Class II division 1 malocclusion and incisor trauma.

    Science.gov (United States)

    Baccetti, Tiziano; Giuntini, Veronica; Vangelisti, Andrea; Darendeliler, M Ali; Franchi, Lorenzo

    2010-01-01

    The objectives of this study were: 1) to evaluate the associations between an increased overjet (IO) and other dentoskeletal characteristics of Class II division 1 malocclusions in the mixed dentition; 2) to assess whether Class II division 1 malocclusions or rather an increased overjet per se is a risk factor for upper incisor trauma (UIT). A sample of 900 mixed dentition subjects, was observed by clinical inspection, analysis of dental casts, and lateral cephalograms. The diagnostic performance of IO (overjet ≥ 7 mm) was evaluated in relation to other Class II dentoskeletal features (Class II molar and canine relationships, and skeletal Class II relationships). Secondly, the diagnostic performance of IO and of the other Class II dentoskeletal components was tested with regard to the prevalence of UIT. Diagnostic performance was assessed by odds ratio and positive likelihood ratio. The diagnostic performance of IO with regard to the other dentoskeletal components of Class II malocclusions was not significant. The only Class II features associated significantly with an increased risk of UIT was IO. When used as an isolated occlusal feature, IO is not a valid diagnostic indicator for Class II division 1 malocclusions. An increased overjet per se, and not Class II malocclusions, appears to be a significant risk factor for UIT. These findings recommend discrimination between clinical conditions showing an isolated IO from comprehensive Class II malocclusions during diagnosis, analysis of treatment outcomes, and evaluation of the risk of upper incisor trauma. Copyright © 2010 Società Italiana di Ortodonzia SIDO. Published by Elsevier Srl. All rights reserved.

  10. Children and adolescents admitted to a university-level trauma centre in Denmark 2002-2011

    DEFF Research Database (Denmark)

    Ekström, Danny Stefan; Hviid Larsen, Rasmus; Lauritsen, Jens Martin

    2017-01-01

    INTRODUCTION: The epidemiology of children or adolescents admitted to a Scandinavian trauma centre is largely unknown. The aim of this paper was to describe the epidemiology and severity of potentially severely injured children and adolescents admitted to a university hospital trauma centre....... METHODS: This was a descriptive study of all children and adolescents aged 0-17 admitted to the university level trauma centre at Odense University Hospital, Denmark in the 2002-2011 period. Data were extracted from the Southern Danish Trauma Register and from medical records. RESULTS: A total of 950...

  11. A Statewide Collaboration: Ohio Level III Trauma Centers' Approach to the Development of a Benchmarking System.

    Science.gov (United States)

    Lang, Carrie L; Simon, Diane; Kilgore, Jane

    The American College of Surgeons Committee on Trauma revised the Resources for Optimal Care of the Injured Patient to include the criteria for trauma centers to participate in a risk-adjusted benchmarking system. Trauma Quality Improvement Program is currently the risk-adjusted benchmarking program sponsored by the American College of Surgeons, which will be required of all trauma centers to participate in early 2017. Prior to this, there were no risk-adjusted programs for Level III verified trauma centers. The Ohio Society of Trauma Nurse Leaders is a collaborative group made up of trauma program managers, coordinators, and other trauma leaders who meet 6 times a year. Within this group, a Level III Subcommittee was formed initially to provide a place for the Level III centers to discuss issues specific to the Level III centers. When the new requirement regarding risk-adjustment became official, the subcommittee agreed to begin reporting simple data points with the idea to risk adjust in the future.

  12. Prevalence of chest trauma, associated injuries and mortality: a level I trauma centre experience.

    Science.gov (United States)

    Veysi, Veysi T; Nikolaou, Vassilios S; Paliobeis, Christos; Efstathopoulos, Nicolas; Giannoudis, Peter V

    2009-10-01

    A review of prospectively collected data in our trauma unit for the years 1998-2003 was undertaken. Adult patients who suffered multiple trauma with an Injury Severity Score (ISS) of >/=16, admitted to hospital for more than 72 hours and with sustained blunt chest injuries were included in the study. Demographic details including pre-hospital care, trauma history, admission vital signs, blood transfusions, details of injuries and their abbreviated injury scores (AIS), operations, length of intensive care unit and hospital stays, Injury Severity Score (ISS) and mortality were analysed. Fulfilling the inclusion criteria with at least one chest injury were 1,164 patients. The overall mortality reached 18.7%. As expected, patients in the higher AIS groups had both a higher overall ISS and mortality rate with one significant exception; patients with minor chest injuries (AIS(chest) = 1) were associated with mortality comparable to injuries involving an AIS(chest) = 3. Additionally, the vast majority of polytraumatised patients with an AIS(chest) = 1 died in ICU sooner than patients of groups 2-5.

  13. Academic time at a level 1 trauma center: no resident, no problem?

    Science.gov (United States)

    Matsushima, Kazuhide; Dickinson, Rebecca M; Schaefer, Eric W; Armen, Scott B; Frankel, Heidi L

    2012-01-01

    Globally, the compliance of resident work-hour restrictions has no impact on trauma outcome. However, the effect of protected education time (PET), during which residents are unavailable to respond to trauma patients, has not been studied. We hypothesized that PET has no impact on the outcome of trauma patients. We conducted a retrospective review of relevant patients at an academic level I trauma center. During PET, a trauma attending and advanced practice providers (APPs) responded to trauma activations. PGY1, 3, and 4 residents were also available at all other times. The outcome of new trauma patient activations during Thursday morning 3-hours resident PET was compared with same time period on other weekdays (non-PET) using a univariate and multivariate analysis. From January 2005 to April 2010, a total of 5968 trauma patients were entered in the registry. Of these, 178 patients (2.98%) were included for study (37 PET and 141 non-PET). The mean injury severity score (ISS) was 16.2. Although no significant difference were identified in mortality, complications, or length of stay (LOS), we do see that length of emergency department stay (ED-LOS) tends to be longer during PET, although not significantly (314 vs 381 minutes, p = 0.74). On the multiple logistic regression model, PET was not a significant factor of complications, LOS, or ED-LOS. Few trauma activations occur during PET. New trauma activations can be staffed safely by trauma activations and APPs. However, there could be some delays in transferring patients to appropriate disposition. Additional study is required to determine the effect of PET on existing trauma inpatients. Copyright © 2012 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

  14. Level II Ergonomic Analyses, Dover AFB, DE

    Science.gov (United States)

    1999-02-01

    IERA-RS-BR-TR-1999-0002 UNITED STATES AIR FORCE IERA Level II Ergonomie Analyses, Dover AFB, DE Andrew Marcotte Marilyn Joyce The Joyce...Project (070401881, Washington, DC 20503. 1. AGENCY USE ONLY (Leave blank) 2. REPORT DATE 4. TITLE AND SUBTITLE Level II Ergonomie Analyses, Dover...1.0 INTRODUCTION 1-1 1.1 Purpose Of The Level II Ergonomie Analyses : 1-1 1.2 Approach 1-1 1.2.1 Initial Shop Selection and Administration of the

  15. Gunshot wounds to the face: level I urban trauma center: a 10-year level I urban trauma center experience.

    Science.gov (United States)

    Pereira, Clifford; Boyd, J Brian; Dickenson, Brian; Putnam, Brant

    2012-04-01

    Gunshot wounds (GSWs) to the face are an infrequent occurrence outside of a war zone. However, when they occur, they constitute a significant reconstructive challenge. We present our 10-year experience at an urban level I trauma center to define the patterns of injury, assess the morbidity and mortality, and estimate the cost to the health care system. A retrospective review was performed on all patients admitted to Harbor-UCLA Medical Center with GSWs to the head and neck region between January 1997 and January 2007. Those who had sustained GSWs to the face requiring operative intervention were closely reviewed. Between 1997 and 2007, a total of 702 patients were admitted to the Harbor UCLA Emergency Department having sustained GSWs to the head and neck region, of which 501 patients survived. Of the survivors, 28 patients (26 male, 2 female) sustained GSWs to their face requiring operative intervention. The mean age of these patients was 28 (±8.3) years. They generally presented within a few hours of the injury, but 1 individual arrived over 24 hours later. Low-velocity single gunshots (from handguns) were predominantly involved, with facial fractures occurring in all cases. Fractures were of a localized shattering type without the major displacement of bony complexes seen in motor vehicle accidents. Most required wound debridement and fracture fixation. A few patients (14.2%) underwent free tissue transfer for reconstruction (3 fibular flaps, 1 TRAM). Tracheostomy was performed in 35.7% of patients. Mean length of hospital stay was 8.3 (±7.1) days, with 50% of cases requiring admission to the intensive care unit. Mean length of intensive care unit stay was 5.2 (±5.7) days. The average cost per patient exceeded $100,000.

  16. Utilization of tracheostomy in craniomaxillofacial trauma at a level-1 trauma center.

    Science.gov (United States)

    Holmgren, Eric P; Bagheri, Shahrokh; Bell, R Bryan; Bobek, Sam; Dierks, Eric J

    2007-10-01

    The decision to perform a tracheostomy on patients with maxillofacial trauma is complex. There is little data exploring the role of tracheostomy in facial fracture management. We sought to profile the utilization of tracheostomy in the context of maxillofacial trauma at our institution by comparing patients who required tracheostomy with and without facial fractures versus those with facial fractures not requiring tracheostomy. All patients admitted to the Trauma Service at Legacy Emanuel Hospital and Health Center (LEHHC), Portland, OR, from 1993 to 2003 that sustained facial fractures or underwent tracheostomy were identified and data were retrospectively reviewed using patient charts and the trauma registry. Variables such as age, gender, death, injury severity score (ISS), facial injury severity score (FISS), Glasgow coma score (GCS), intensive care days (ICU), hospital length of stay (LOS), facial fracture profile, and oral and maxillofacial surgery (OMFS) operative intervention were tabulated and analyzed. Data were divided into 3 groups for comparison: group 1 (ffxT) consisted of patients who underwent a tracheostomy procedure and repair of their facial fracture during the SAME operation by the OMFS department (N = 125); group 2 (ffxNT) were those patients who had repair of their facial fractures by OMFS and did not require a tracheostomy (N = 224); and group 3 (NffxT) were patients who did not have facial fractures but received a tracheostomy during their hospitalization (N = 259). Ten-year data were used to analyze the ffxT and 5-year data were used to analyze the ffxNT and NffxT. Analysis of variance and chi2 testing was used for statistical analysis. A total of 18,187 patients were admitted to the trauma LEHHC Trauma Service during the study period, of which 1,079 (5.9%) patients sustained facial fractures and 788 (4.3%) required a tracheostomy. One hundred twenty-five patients (0.69% of total; 11.6% of facial fracture) received a tracheostomy at the

  17. A comparison of severely injured trauma patients admitted to level 1 trauma centres in Queensland and Germany

    NARCIS (Netherlands)

    Nijboer, Johanna M. M.; Wullschleger, Martin E.; Nielsen, Susan E.; McNamee, Anitia M.; Lefering, Rolf; ten Duis, Hendrik-Jan; Schuetz, Michael A.

    Background: The allocation of a trauma network in Queensland is still in the developmental phase. In a search for indicators to improve trauma care both locally as state-wide, a study was carried out comparing trauma patients in Queensland to trauma patients in Germany, a country with 82.4 million

  18. Geriatric Trauma Patients With Cervical Spine Fractures due to Ground Level Fall: Five Years Experience in a Level One Trauma Center.

    Science.gov (United States)

    Wang, Hao; Coppola, Marco; Robinson, Richard D; Scribner, James T; Vithalani, Veer; de Moor, Carrie E; Gandhi, Raj R; Burton, Mandy; Delaney, Kathleen A

    2013-04-01

    It has been found that significantly different clinical outcomes occur in trauma patients with different mechanisms of injury. Ground level falls (GLF) are usually considered "minor trauma" with less injury occurred in general. However, it is not uncommon that geriatric trauma patients sustain cervical spine (C-spine) fractures with other associated injuries due to GLF or less. The aim of this study is to determine the injury patterns and the roles of clinical risk factors in these geriatric trauma patients. Data were reviewed from the institutional trauma registry of our local level 1 trauma center. All patients had sustained C-spine fracture(s). Basic clinical characteristics, the distribution of C-spine fracture(s), and mechanism of injury in geriatric patients (65 years or older) were compared with those less than 65 years old. Furthermore, different clinical variables including age, gender, Glasgow coma scale (GCS), blood alcohol level, and co-existing injuries were analyzed by multivariate logistic regression in geriatric trauma patients due to GLF and internally validated by random bootstrapping technique. From 2006 - 2010, a total of 12,805 trauma patients were included in trauma registry, of which 726 (5.67%) had sustained C-spine fracture(s). Among all C-spine fracture patients, 19.15% (139/726) were geriatric patients. Of these geriatric patients 27.34% (38/139) and 53.96% (75/139) had C1 and C2 fractures compared with 13.63% (80/587) and 21.98% (129/587) in young trauma patients (P geriatric trauma patients 13.67% (19/139) and 18.71% (26/139) had C6 and C7 fractures compared with 32.03% (188/587) and 41.40% (243/587) in younger ones separately (P geriatric patients had sustained C-spine fractures due to GLF with more upper C-spine fractures (C1 and C2). Only 3.2% of those had positive blood alcohol levels compared with 52.9% of younger patients (P geriatric patients due to GLF had intracranial pathology (ICP) which was one of the most common co

  19. Child Maltreatment Trauma, Posttraumatic Stress Disorder, and Cortisol Levels in Women: A Literature Review.

    Science.gov (United States)

    Li, Yang; Seng, Julia S

    Studies of the relationship between cortisol and posttraumatic stress disorder (PTSD) have had inconsistent results. Gender, trauma type, and age at trauma exposure may explain the inconsistencies. The objective of the review was to examine cortisol levels in relation to PTSD in women with a history of child maltreatment trauma. A review of literature found 13 articles eligible for inclusion. Despite limiting focus to the relatively homogeneous population, the patterns of associations between PTSD and cortisol levels were still inconsistent. The reasons for the inconsistencies likely include highly varied methods across studies, small convenience samples, and unmeasured neuroendocrine hormones that may be stronger predictors of PTSD. The review does not point to a clear bio-behavioral target for psychiatric nursing intervention. It is important to continue to address the developmental and clinical stress response aspects of child maltreatment trauma-related PTSD without assuming that these stress responses are hypothalamic-pituitary-adrenal-axis driven.

  20. Blunt traumatic injury during pregnancy: a descriptive analysis from a level 1 trauma center.

    Science.gov (United States)

    Al-Thani, Hassan; El-Menyar, Ayman; Sathian, Brijesh; Mekkodathil, Ahammed; Thomas, Sam; Mollazehi, Monira; Al-Sulaiti, Maryam; Abdelrahman, Husham

    2018-03-27

    The precise incidence of trauma in pregnancy is not well-known, but trauma is estimated to complicate nearly 1 in 12 pregnancies and it is the leading non-obstetrical cause of maternal death. A retrospective study of all pregnant women presented to national level 1 trauma center from July 2013 to June 2015 was conducted. Descriptive and inferential statistics applied for data analysis. Across the study period, a total of 95 pregnant women were presented to the trauma center. The average incidence rate of traumatic injuries was 250 per 1000 women of childbearing age presented to the Hamad Trauma Center. The mean age of patients was 30.4 ± SD 5.6 years, with age ranging from 20 to 42 years. The mean gestational age at the time of injury was 24.7 ± 8.7 weeks which ranged from 5 to 37 weeks. The majority (47.7%) was in the third trimester of the pregnancy. In addition, the large majority of injuries was due to MVCs (74.7%) followed by falls (15.8%). Trauma during pregnancy is not an uncommon event particularly in the traffic-related crashes. As it is a complex condition for trauma surgeons and obstetrician, an appropriate management protocol and multidisciplinary team are needed to improve the outcome and save lives of both the mother and fetus.

  1. Effects of childhood trauma exposure and cortisol levels on cognitive functioning among breast cancer survivors.

    Science.gov (United States)

    Kamen, Charles; Scheiber, Caroline; Janelsins, Michelle; Jo, Booil; Shen, Hanyang; Palesh, Oxana

    2017-10-01

    Cognitive functioning difficultiesin breast cancer patients receiving chemotherapy are common, but not all women experience these impairments. Exposure to childhood trauma may impair cognitive functioning following chemotherapy, and these impairments may be mediated by dysregulation of hypothalamic-pituitary-adrenal (HPA) axis function and cortisol slope. This study evaluated the association between childhood trauma exposure, cortisol, and cognition in a sample of breast cancer survivors. 56 women completed measures of trauma exposure (the Traumatic Events Survey), salivary cortisol, and self-reported cognitive functioning (the Functional Assessment of Cancer Therapy - Cognitive). We examined correlations between childhood trauma exposure and cognitive functioning, then used linear regression to control for factors associated with cognition (age, education, time since chemotherapy, depression, anxiety, and insomnia), and the MacArthur approach to test whether cortisol levels mediated the relationship between trauma and cognitive functioning. 57.1% of the sample had experienced at least one traumatic event in childhood, with 19.6% of the sample witnessing a serious injury, 17.9% experiencing physical abuse, and 14.3% experiencing sexual abuse. Childhood trauma exposure and cognitive functioning were moderately associated (r=-0.29). This association remained even when controlling for other factors associated with cognition; the final model explained 47% of the variance in cognitive functioning. The association between childhood trauma and cognitive functioning was mediated by steeper cortisol slope (partial r=0.35, p=0.02). Childhood trauma exposure is associated with self-reported cognitive functioning among breast cancer survivors and is mediated by cortisol dysregulation. Trauma should be considered, among other factors, in programs aiming to address cognition in this population. Copyright © 2017 Elsevier Ltd. All rights reserved.

  2. Influence of podiatry on orthopedic surgery at a level I trauma center.

    Science.gov (United States)

    Jakoi, Andre M; Old, Andrew B; O'Neill, Craig A; Stein, Benjamin E; Stander, Eric P; Rosenblatt, Joseph; Herman, Martin J

    2014-06-01

    Level I trauma centers frequently see trauma at or below the ankle, which requires consultation with the orthopedic surgery department. However, as podiatry programs begin to firmly establish themselves in more Level I trauma centers, their consultations increase, ultimately taking those once seen by orthopedic surgery. A review of the literature demonstrates that this paradigm shift has yet to be discussed. The purpose of this study was to determine how many, if any, lower extremity fracture consultations a newly developed podiatry program would take from the orthopedic surgery department. A retrospective review was performed of emergency department records from January 2007 to December 2011. Seventeen different emergency department diagnoses were used to search the database. Ultimately, each patient's emergency department course was researched. Several trends were noted. First, if trauma surgery was involved, only the orthopedic surgery department was consulted for any injuries at or below the ankle. Second, the emergency department tended to consult the podiatry program only between the hours of 8 am and 6 pm. Third, as the podiatry program became more established, their number of consultations increased yearly, and, coincidentally, the orthopedic surgery department's consultations decreased. Finally, high-energy traumas involved only the orthopedic surgery department. Whether the orthopedic surgery department or podiatry program is consulted regarding trauma surgery is likely hospital dependent. Copyright 2014, SLACK Incorporated.

  3. Risk of symptomatic heterotopic ossification following plate osteosynthesis in multiple trauma patients: an analysis in a level-1 trauma centre

    Directory of Open Access Journals (Sweden)

    Pape Hans-Christoph

    2009-10-01

    Full Text Available Abstract Background Symptomatic heterotopic ossification (HO in multiple trauma patients may lead to follow up surgery, furthermore the long-term outcome can be restricted. Knowledge of the effect of surgical treatment on formation of symptomatic heterotopic ossification in polytrauma is sparse. Therefore, we test the effects of surgical treatment (plate osteosynthesis or intramedullary nailing on the formation of heterotopic ossification in the multiple trauma patient. Methods We retrospectively analysed prospectively documented data of blunt multiple trauma patients with long bone fractures which were treated at our level-1 trauma centre between 1997 and 2005. Patients were distributed to 2 groups: Patients treated by intramedullary nails (group IMN or plate osteosynthesis (group PLATE were compared. The expression and extension of symptomatic heterotopic ossifications on 3-6 months follow-up x-rays in antero-posterior (ap and lateral views were classified radiologically and the maximum expansion was measured in millimeter (mm. Additionally, ventilation time, prophylactic medication like indomethacine and incidence and correlation of head injuries were analysed. Results 101 patients were included in our study, 79 men and 22 women. The fractures were treated by intramedullary nails (group IMN n = 50 or plate osteosynthesis (group PLATE n = 51. Significantly higher radiologic ossification classes were detected in group PLATE (2.9 ± 1.3 as compared to IMN (2.2 ± 1.1; p = 0.013. HO size in mm ap and lateral showed a tendency towards larger HOs in the PLATE group. Additionally PLATE group showed a higher rate of articular fractures (63% vs. 28% in IMN while IMN demonstrated a higher rate of diaphyseal fractures (72% vs. 37% in PLATE; p = 0.003. Ventilation time, indomethacine and incidence of head injuries showed no significant difference between groups. Conclusion Fracture care with plate osteosynthesis in polytrauma patients is associated with

  4. Association of Prehospital Mode of Transport With Mortality in Penetrating Trauma: A Trauma System-Level Assessment of Private Vehicle Transportation vs Ground Emergency Medical Services.

    Science.gov (United States)

    Wandling, Michael W; Nathens, Avery B; Shapiro, Michael B; Haut, Elliott R

    2018-02-01

    Time to definitive care following injury is important to the outcomes of trauma patients. Prehospital trauma care is provided based on policies developed by individual trauma systems and is an important component of the care of injured patients. Given a paucity of systems-level trauma research, considerable variability exists in prehospital care policies across trauma systems, potentially affecting patient outcomes. To evaluate whether private vehicle prehospital transport confers a survival advantage vs ground emergency medical services (EMS) transport following penetrating injuries in urban trauma systems. Retrospective cohort study of data included in the National Trauma Data Bank from January 1, 2010, through December 31, 2012, comprising 298 level 1 and level 2 trauma centers that contribute data to the National Trauma Data Bank that are located within the 100 most populous metropolitan areas in the United States. Of 2 329 446 patients assessed for eligibility, 103 029 were included in this study. All patients were 16 years or older, had a gunshot wound or stab wound, and were transported by ground EMS or private vehicle. In-hospital mortality. Of the 2 329 446 records assessed for eligibility, 103 029 individuals at 298 urban level 1 and level 2 trauma centers were included in the analysis. The study population was predominantly male (87.6%), with a mean age of 32.3 years. Among those included, 47.9% were black, 26.3% were white, and 18.4% were Hispanic. Following risk adjustment, individuals with penetrating injuries transported by private vehicle were less likely to die than patients transported by ground EMS (odds ratio [OR], 0.38; 95% CI, 0.31-0.47). This association remained statistically significant on stratified analysis of the gunshot wound (OR,  0.45; 95% CI, 0.36-0.56) and stab wound (OR,  0.32; 95% CI, 0.20-0.52) subgroups. Private vehicle transport is associated with a significantly lower likelihood of death when compared with

  5. Quality of life and level of post-traumatic stress disorder among trauma patients

    DEFF Research Database (Denmark)

    Danielsson, F B; Schultz Larsen, M; Nørgaard, B

    2018-01-01

    BACKGROUND: The aim of this study was to assess outcome in long-term quality of life (QoL) and post-traumatic stress disorder (PTSD) among adult survivors of trauma. Secondary aim was to compare levels of the outcome with injury severity and specialization level of two trauma centres. METHODS...... Scale. PTSD symptoms were classified according to the Post-Traumatic Stress Disorder Checklist (PCL) and Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM-IV). RESULTS: A questionnaire was mailed to 774 patients at end of 2014 or early 2015, 455 were included for analysis; median...

  6. The effectiveness of a specialized trauma course in the knowledge base and level of job satisfaction in emergency nurses.

    Science.gov (United States)

    Bailey, Kate; Swinyer, Michelle; Bard, Michael; Sparrow, Vicki; Deegan, Jennifer; Small, Karen; Janssen, Robert; Bailey, Brian; Toschlog, Eric; Sagraves, Scott; Goettler, Claudia; Rotondo, Michael

    2005-01-01

    The purpose of this study is to evaluate the level of job satisfaction of the emergency department nurses that care for trauma patients. The hospital is a Level I trauma center and tertiary care center that provides multiple services to more than 1.2 million people in 29 counties. The Trauma Service and the Emergency Department (ED) must define and maintain the same expectations. The level of job satisfaction of the emergency department nurses will define the success of safe and effective patient care in a Level I Trauma Center.

  7. Radiation exposure in the young level 1 trauma patient: a retrospective review.

    Science.gov (United States)

    Gottschalk, Michael B; Bellaire, Laura L; Moore, Thomas

    2015-01-01

    Computed tomography (CT) has become an increasingly popular and powerful tool for clinicians managing trauma patients with life-threatening injuries, but the ramifications of increasing radiation burden on individual patients are not insignificant. This study examines a continuous series of 337 patients less than 40 years old admitted to a level 1 trauma center during a 4-month period. Primary outcome measures included number of scans; effective dose of radiation from radiographs and CT scans, respectively; and total effective dose from both sources over patients' hospital stays. Several variables, including hospital length of stay, initial Glasgow Coma Scale score, and Injury Severity Score, correlated with greater radiation exposure. Blunt trauma victims were more prone to higher doses than those with penetrating or combined penetrating and blunt trauma. Location and mechanism of injury were also found to correlate with radiation exposure. Trauma patients as a group are exposed to high levels of radiation from X-rays and CT scans, and CT scans contribute a very high proportion (91.3% ± 11.7%) of that radiation. Certain subgroups of patients are at a particularly high risk of exposure, and greater attention to cumulative radiation dose should be paid to patients with the above mentioned risk factors.

  8. Trauma Center Staffing, Infrastructure, and Patient Characteristics that Influence Trauma Center Need

    Directory of Open Access Journals (Sweden)

    Faul, Mark

    2014-11-01

    Full Text Available Introduction: The most effective use of trauma center resources helps reduce morbidity and mortality, while saving costs. Identifying critical infrastructure characteristics, patient characteristics and staffing components of a trauma center associated with the proportion of patients needing major trauma care will help planners create better systems for patient care.   Methods: We used the 2009 National Trauma Data Bank-Research Dataset to determine the proportion of critically injured patients requiring the resources of a trauma center within each Level I-IV trauma center (n=443. The outcome variable was defined as the portion of treated patients who were critically injured. We defined the need for critical trauma resources and interventions (“trauma center need” as death prior to hospital discharge, admission to the intensive care unit, or admission to the operating room from the emergency department as a result of acute traumatic injury. Generalized Linear Modeling (GLM was used to determine how hospital infrastructure, staffing Levels, and patient characteristics contributed to trauma center need.     Results: Nonprofit Level I and II trauma centers were significantly associated with higher levels of trauma center need. Trauma centers that had a higher percentage of transferred patients or a lower percentage of insured patients were associated with a higher proportion of trauma center need.  Hospital infrastructure characteristics, such as bed capacity and intensive care unit capacity, were not associated with trauma center need. A GLM for Level III and IV trauma centers showed that the number of trauma surgeons on staff was associated with trauma center need. Conclusion: Because the proportion of trauma center need is predominantly influenced by hospital type, transfer frequency, and insurance status, it is important for administrators to consider patient population characteristics of the catchment area when planning the

  9. Admission biomarkers of trauma-induced secondary cardiac injury predict adverse cardiac events and are associated with plasma catecholamine levels.

    Science.gov (United States)

    Naganathar, Sriveena; De'Ath, Henry D; Wall, Johanna; Brohi, Karim

    2015-07-01

    Secondary cardiac injury and dysfunction may be important contributors to poor outcomes in trauma patients, but the pathophysiology and clinical impact remain unclear. Early elevations in cardiac injury markers have been associated with the development of adverse cardiac events (ACEs), prolonged intensive care unit stays, and increased mortality. Studies of preinjury β-blocker use suggest a potential protective effect in critically ill trauma patients. This study aimed to prospectively examine the association of early biomarker evidence of trauma-induced secondary cardiac injury (TISCI) and ACEs and to examine the potential contribution of circulating catecholamines to its pathophysiology. Injured patients who met the study criteria were recruited at a single major trauma center. A blood sample was collected immediately on arrival. Serum epinephrine (E), norepinephrine (NE), and cardiac biomarkers including heart-related fatty acid binding protein (H-FABP) were assayed. Data were prospectively collected on ACEs. Of 300 patients recruited, 38 (13%) developed an ACE and had increased mortality (19% vs. 9%, p = 0.01) and longer intensive care unit stays (13 days, p < 0.001). H-FABP was elevated on admission in 56% of the patients, predicted the development of ACE, and was associated with higher mortality (14% vs. 5%, p = 0.01). Admission E and NE levels were strongly associated with elevations in H-FABP and ACEs (E, 274.0 pg/mL vs. 622.5 pg/mL, p < 0.001; NE, 1,063.2 pg/mL vs. 2,032.6 pg/mL, p < 0.001). Catecholamine effect on the development of TISCI or ACEs was not statistically independent of injury severity or depth of shock. Admission levels of H-FABP predict the development of ACEs and may be useful for prognosis and stratification of trauma patients. The development of TISCI and ACEs was associated with high admission levels of catecholamines, but their role in pathogenesis remains unclear. Clinical trials of adrenergic blockade may have the potential to

  10. Function of "nontrauma" surgeons in level I trauma centers in the United States.

    Science.gov (United States)

    Pate, J W

    1997-06-01

    Although the general "trauma" surgeon is usually the team leader in level I trauma centers, the use of surgical subspecialists and nonsurgeons is frequently ill-defined. This study was done to gain data in regard to actual use of subspecialists in busy centers. First, a survey of the patterns of staffing in 140 trauma centers was elicited by mail questionnaire, supplemented by telephone cells. Second, records of 400 consecutive patients at the Elvis Presley Trauma Center were reviewed to determine the use of subspecialists during the first 24 hours of care of individual patients. There were differences in the use of surgical subspecialists and nonsurgeons at different centers: in receiving, admitting, operating, and critical care areas and in privileges for admission and attending of inpatients. Consultation "guidelines" are used for many specific injuries. At our center, a mean of 1.92 subspecialists, in addition to general surgeons, were involved in the early care of each patient. Problems exist in many centers regarding the use of subspecialists, especially for management of facial and chest injuries. In some centers nonsurgeons function in the intensive care unit, and as admitting and attending physicians of trauma patients.

  11. District-level hospital trauma care audit filters: Delphi technique for defining context-appropriate indicators for quality improvement initiative evaluation in developing countries.

    Science.gov (United States)

    Stewart, Barclay T; Gyedu, Adam; Quansah, Robert; Addo, Wilfred Larbi; Afoko, Akis; Agbenorku, Pius; Amponsah-Manu, Forster; Ankomah, James; Appiah-Denkyira, Ebenezer; Baffoe, Peter; Debrah, Sam; Donkor, Peter; Dorvlo, Theodor; Japiong, Kennedy; Kushner, Adam L; Morna, Martin; Ofosu, Anthony; Oppong-Nketia, Victor; Tabiri, Stephen; Mock, Charles

    2016-01-01

    Prospective clinical audit of trauma care improves outcomes for the injured in high-income countries (HICs). However, equivalent, context-appropriate audit filters for use in low- and middle-income country (LMIC) district-level hospitals have not been well established. We aimed to develop context-appropriate trauma care audit filters for district-level hospitals in Ghana, was well as other LMICs more broadly. Consensus on trauma care audit filters was built between twenty panellists using a Delphi technique with four anonymous, iterative surveys designed to elicit: (i) trauma care processes to be measured; (ii) important features of audit filters for the district-level hospital setting; and (iii) potentially useful filters. Filters were ranked on a scale from 0 to 10 (10 being very useful). Consensus was measured with average percent majority opinion (APMO) cut-off rate. Target consensus was defined a priori as: a median rank of ≥9 for each filter and an APMO cut-off rate of ≥0.8. Panellists agreed on trauma care processes to target (e.g. triage, phases of trauma assessment, early referral if needed) and specific features of filters for district-level hospital use (e.g. simplicity, unassuming of resource capacity). APMO cut-off rate increased successively: Round 1--0.58; Round 2--0.66; Round 3--0.76; and Round 4--0.82. After Round 4, target consensus on 22 trauma care and referral-specific filters was reached. Example filters include: triage--vital signs are recorded within 15 min of arrival (must include breathing assessment, heart rate, blood pressure, oxygen saturation if available); circulation--a large bore IV was placed within 15 min of patient arrival; referral--if referral is activated, the referring clinician and receiving facility communicate by phone or radio prior to transfer. This study proposes trauma care audit filters appropriate for LMIC district-level hospitals. Given the successes of similar filters in HICs and obstetric care filters in LMICs

  12. Frequency of Sports Trauma in Elite National Level Greco-Roman Wrestling Competitions

    OpenAIRE

    Akbarnejad, Ali; Sayyah, Mansour

    2012-01-01

    Background Trauma is an inescapable part of sports competitions. It occurs more frequently in contact sports such as wrestling. Objectives The purpose of this study was to determine the frequency of injury in Greco-Roman style wrestling competitions at national level. Patients and Methods This descriptive epidemiological research included 50 Greco-Roman style wrestlers who participated in national level competitions between the years 2003 and 2008. A questionnaire was completed by each partic...

  13. Complications in the management of bladder trauma in a third level hospital.

    Science.gov (United States)

    Echeverría-García, Fernando Enrique; García-Perdomo, Herney Andrés; Barney, Erika

    2014-05-01

    To determine the frecuency of complications during the management of bladder trauma and its associated factors in a third level reference Hospital. A cross-sectional study of adult patients admitted in a reference Hospital from January 2006 to June 2011 with the diagnosis of bladder trauma. We identified demographic variables, type of trauma (blunt, penetrating), diagnostic method, associated traumatisms, management of bladder traumatism, frequency of complications and mortality. Univariate analysis was performed with frequency tables, measures of central tendency and dispersion. Similarly, bivariate analysis was performed to explore the association between variables. We used chi-square test for categorical variables and Student's t test to compare quantitative variables. We reviewed 40 medical records, which met the eligibility criteria. The median age was 27 years (range 16-;67) and 85% (34 patients) were male. Twenty-nine patients (72.5%) had penetrating injuries, being mainly firearm projectile (96.55%) and 11 patients (27.5%) blunt injuries. Most patients had intraoperative diagnosis (67.5%), while 25%, 5% and 2% were diagnosed by CT-cystography, cystoscopy and voiding cystography respectively. 70% (28 patients) had intraperitoneal bladder injuries. Of the forty patients enrolled, thirty six (90%) underwent surgery, while only four (10%) received conservative management. A total of ten patients (25%) had some type of complication. The most frequent was persistent hematuria (40%) followed by surgical site infection (30%), orchitis (20%), urinary tract infection (10%), urine leakage through the operative site, or to the peritoneal cavity (10%). No mortality was detected. On the bivariate logistic regression model type of trauma, number of injuries, performance of cystostomy, use of perivesical drainage tube, chest trauma and small bowel trauma, no association was found with the presence of complications. The frequency of complications was 25%. The presence of

  14. Video registration of trauma team performance in the emergency department: the results of a 2-year analysis in a Level 1 trauma center.

    Science.gov (United States)

    Lubbert, Pieter H W; Kaasschieter, Edgar G; Hoorntje, Lidewij E; Leenen, Loek P H

    2009-12-01

    Trauma teams responsible for the first response to patients with multiple injuries upon arrival in a hospital consist of medical specialists or resident physicians. We hypothesized that 24-hour video registration in the trauma room would allow for precise evaluation of team functioning and deviations from Advanced Trauma Life Support (ATLS) protocols. We analyzed all video registrations of trauma patients who visited the emergency room of a Level I trauma center in the Netherlands between September 1, 2000, and September 1, 2002. Analysis was performed with a score list based on ATLS protocols. From a total of 1,256 trauma room presentations, we found a total of 387 video registrations suitable for analysis. The majority of patients had an injury severity score lower than 17 (264 patients), whereas 123 patients were classified as multiple injuries (injury severity score >or=17). Errors in team organization (omission of prehospital report, no evident leadership, unorganized resuscitation, not working according to protocol, and no continued supervision of the patient) lead to significantly more deviations in the treatment than when team organization was uncomplicated. Video registration of diagnostic and therapeutic procedures by a multidisciplinary trauma team facilitates an accurate analysis of possible deviations from protocol. In addition to identifying technical errors, the role of the team leader can clearly be analyzed and related to team actions. Registration strongly depends on availability of video tapes, timely started registration, and hardware functioning. The results from this study were used to develop a training program for trauma teams in our hospital that specifically focuses on the team leader's functioning.

  15. Symptoms Moderating the Association Between Recent Suicide Attempts and Trauma Levels: Fan-Shaped Effects.

    Science.gov (United States)

    Afzali, Mohammad H; Birmes, Philippe; Vautier, Stéphane

    2015-01-01

    The present study focuses on variables moderating the incidence of recent suicide attempt in a large community sample (n = 39,617) of French citizens with various levels of trauma. Five trauma levels were established based on posttraumatic stress disorder items of the Mini International Neuropsychiatric Interview. Twenty-three symptoms were examined as potential moderating variables with a fan-shaped pattern. Seven symptoms regarding desire for death, self-harm intention, suicidal ideation, lifetime suicide attempt, depressed mood, loss of interest, and panic attack exhibited the fan-shaped pattern. The absence of these moderating symptoms decreases the incidence of suicide attempt and their presence leads to a gradual increase.

  16. Dissociative experiences in bipolar disorder II: Are they related to childhood trauma and obsessive-compulsive symptoms?

    Directory of Open Access Journals (Sweden)

    Gul Eryilmaz

    2015-04-01

    Full Text Available Objective The aim of this study is to investigate the presence of dissociative symptoms and whether they are related to childhood trauma and obsessive-compulsive symptoms in bipolar disorder type II (BD-II. Methods Thirty-three euthymic patients (HDRS<8, YMRS<5 and 50 healthy subjects were evaluated by SCID-I and SCID-NP. We excluded all first and second-axis comorbidities. All patients and healthy subjects were examined with the Dissociative Experiences Scale (DES, Childhood Trauma Questionnaire (CTQ-53, and Yale-Brown Obsessive-Compulsive Disorder scale (Y-BOCS. Results In pairwise comparisons between the BD-II and control groups, the total CTQ, emotional abuse, emotional neglect, DES, and total Y-BOCS scores in the BD-II group were significantly higher than those in the control group (p < 0.05. There were five cases with DES scores over 30 (15.2% and one case (2% in the control group. DES was weakly correlated with total CTQ and Y-BOCS in patients diagnosed with BD-II (r = 0.278, p < 0.05 and r = 0.217, p < 0.05, respectively. While there was no correlation between total CTQ and Y-BOCS, the CTQ sexual abuse subscale was found to be related to Y-BOCS (r = 0.330, p < 0.05. Discussion These results suggest that there is a relation between childhood traumas and obsessive-compulsive symptoms, or that dissociative symptoms are more associated with anxiety than obsessive symptoms, which prevents the increase of obsessive-compulsive symptoms in BD-II.

  17. Role of ERCP in pediatric blunt abdominal trauma: a case series at a level one pediatric trauma center.

    Science.gov (United States)

    Garvey, Erin M; Haakinson, Danielle J; McOmber, Mark; Notrica, David M

    2015-02-01

    There is no consensus regarding the appropriate use of endoscopic retrograde cholangiopancreatography (ERCP) in pediatric trauma. We report our experience with ERCP for management of pediatric pancreatic and biliary injury following blunt abdominal trauma. A retrospective chart review was performed for pediatric patients with blunt abdominal trauma from July 2008 through December 2012 at our pediatric trauma center. For patients who underwent ERCP, demographics, injury characteristics, diagnostic details, procedures performed, length of stay, total parenteral nutrition use, and complications were reviewed. There were 532 patients identified: 115 hepatic injuries, 25 pancreatic injuries and one gall bladder injury. Nine patients (mean age 7.8 years) underwent ERCP. Seven (78%) had pancreatic injuries, while two (22%) had bilateral hepatic duct injuries. The median time to diagnosis was one day (range, 0-12). Diagnostic ERCP only was performed in three patients, two of which proceeded to distal pancreatectomy. Five patients had stents placed (two biliary and three pancreatic) and four sphincterotomies were performed. Despite pancreatic stenting, one patient required distal pancreatectomy for persistent leak. Median length of stay was 11 days. Pediatric pancreatic and biliary ductal injuries following blunt abdominal trauma are uncommon. ERCP can safely provide definitive treatment for some patients. Copyright © 2015 Elsevier Inc. All rights reserved.

  18. Decreased dehydroepiandrosterone sulphate levels in adolescents with post-traumatic stress disorder after single sexual trauma.

    Science.gov (United States)

    Usta, Mirac Baris; Tuncel, Ozgur Korhan; Akbas, Seher; Aydin, Berna; Say, Gokce Nur

    2016-01-01

    Recent evidence shows that the hypothalamic-pituitary-adrenal (HPA) axis can be dysregulated in chronic sexual abuse victims with post-traumatic stress disorder (PTSD). We hypothesized that PTSD in adolescents exposed to a single sexual trauma may function as a chronic stressor leading to HPA-axis dysregulation. The objective of this study was to assess dehydroepiandrosterone sulphate (DHEA-S) and cortisol levels in female adolescents |with single sexual trauma-related PTSD compared to healthy controls. We assessed 20 female adolescent (age 12-18) single sexual trauma victims with PTSD from the Ondokuz Mayis University Department of Child and Adolescent Psychiatry between December 2013 and December 2014. PTSD symptoms were assessed using the Child Depression Inventory (CDI) and Child Posttraumatic Stress Reaction Index (CPSRI). Blood cortisol and DHEA-S were measured in 20 female adolescent sexual abuse victims with PTSD and 20 healthy adolescents after 12-h fasting using the chemiluminescence method. Compared to age-matched controls, female adolescent sexual abuse victims with PTSD had significantly lower DHEA-S levels (U = 70.00, Z = - 3.517, p = 0.01, r = 0.55). There was also a significant negative correlation between DHEA-S and CDI scores (Spearman r = - 0.522, p < 0.01). Decreased DHEA-S levels and correlation with depressive symptoms are evidence for a dysregulated HPA-axis in female adolescent single sexual trauma victims with PTSD. Further research is now recommended with large patient groups in order to maximize generalizations.

  19. Factors affecting mortality after penetrating cardiac injuries: 10-year experience at urban level I trauma center.

    Science.gov (United States)

    Mina, Michael J; Jhunjhunwala, Rashi; Gelbard, Rondi B; Dougherty, Stacy D; Carr, Jacquelyn S; Dente, Christopher J; Nicholas, Jeffrey M; Wyrzykowski, Amy D; Salomone, Jeffrey P; Vercruysse, Gary A; Feliciano, David V; Morse, Bryan C

    2017-06-01

    Despite the lethality of injuries to the heart, optimizing factors that impact mortality for victims that do survive to reach the hospital is critical. From 2003 to 2012, prehospital data, injury characteristics, and clinical patient factors were analyzed for victims with penetrating cardiac injuries (PCIs) at an urban, level I trauma center. Over the 10-year study, 80 PCI patients survived to reach the hospital. Of the 21 factors analyzed, prehospital cardiopulmonary resuscitation (odds ratio [OR] = 30), scene time greater than 10 minutes (OR = 58), resuscitative thoracotomy (OR = 19), and massive left hemothorax (OR = 15) had the greatest impact on mortality. Cardiac tamponade physiology demonstrated a "protective" effect for survivors to the hospital (OR = .08). Trauma surgeons can improve mortality after PCI by minimizing time to the operating room for early control of hemorrhage. In PCI patients, tamponade may provide a physiologic advantage (lower mortality) compared to exsanguination. Copyright © 2016 Elsevier Inc. All rights reserved.

  20. Trauma Quality Improvement: Reducing Triage Errors by Automating the Level Assignment Process.

    Science.gov (United States)

    Stonko, David P; O Neill, Dillon C; Dennis, Bradley M; Smith, Melissa; Gray, Jeffrey; Guillamondegui, Oscar D

    2018-04-12

    Trauma patients are triaged by the severity of their injury or need for intervention while en route to the trauma center according to trauma activation protocols that are institution specific. Significant research has been aimed at improving these protocols in order to optimize patient outcomes while striving for efficiency in care. However, it is known that patients are often undertriaged or overtriaged because protocol adherence remains imperfect. The goal of this quality improvement (QI) project was to improve this adherence, and thereby reduce the triage error. It was conducted as part of the formal undergraduate medical education curriculum at this institution. A QI team was assembled and baseline data were collected, then 2 Plan-Do-Study-Act (PDSA) cycles were implemented sequentially. During the first cycle, a novel web tool was developed and implemented in order to automate the level assignment process (it takes EMS-provided data and automatically determines the level); the tool was based on the existing trauma activation protocol. The second PDSA cycle focused on improving triage accuracy in isolated, less than 10% total body surface area burns, which we identified to be a point of common error. Traumas were reviewed and tabulated at the end of each PDSA cycle, and triage accuracy was followed with a run chart. This study was performed at Vanderbilt University Medical Center and Medical School, which has a large level 1 trauma center covering over 75,000 square miles, and which sees urban, suburban, and rural trauma. The baseline assessment period and each PDSA cycle lasted 2 weeks. During this time, all activated, adult, direct traumas were reviewed. There were 180 patients during the baseline period, 189 after the first test of change, and 150 after the second test of change. All were included in analysis. Of 180 patients, 30 were inappropriately triaged during baseline analysis (3 undertriaged and 27 overtriaged) versus 16 of 189 (3 undertriaged and 13

  1. Diversity in clinical management and protocols for the treatment of major bleeding trauma patients across European level I Trauma Centres

    NARCIS (Netherlands)

    Schäfer, Nadine; Driessen, Arne; Fröhlich, Matthias; Stürmer, Ewa K.; Maegele, Marc; Johansson, Pär I.; Ostrowski, Sisse R.; Stensballe, Jakob; Goslings, J. Carel; Juffermans, Nicole; Balvers, Kirsten; Neble, Sylvie; van Dieren, Susan; Gaarder, Christine; Naess, Pål A.; Kolstadbraten, Knut Magne; Brohi, Karim; Eaglestone, Simon; Rourke, Claire; Campbell, Helen; Curry, Nicola; Stanworth, Simon; Harrison, Michael; Buchanan, James; Soyel, Hamit; Gall, Lewis; Orr, Adrian; Char, Ahmed; Görlinger, Klaus; Schubert, Axel

    2015-01-01

    Background: Uncontrolled haemorrhage is still the leading cause of preventable death after trauma and the primary focus of any treatment strategy should be related to early detection and control of blood loss including haemostasis. Methods: For assessing management practices across six European

  2. Evaluation of amylase and lipase levels in blunt trauma abdomen patients

    Directory of Open Access Journals (Sweden)

    Subodh Kumar

    2012-01-01

    Full Text Available Background: There are studies to prove the role of amylase and lipase estimation as a screening diagnostic tool to detect diseases apart from acute pancreatitis. However, there is sparse literature on the role of serum and urine amylase, lipase levels, etc to help predict the specific intra-abdominal injury after blunt trauma abdomen (BTA. Aim: To elucidate the significance of elevation in the levels of amylase and lipase in serum and urine samples as reliable parameters for accurate diagnosis and management of blunt trauma to the abdomen. Materials and Methods: A prospective analysis was done on the trauma patients admitted in Jai Prakash Narayan Apex Trauma Center, AIIMS, with blunt abdomen trauma injuries over a period of six months. Blood and urine samples were collected on days 1, 3, and 5 of admission for the estimation of amylase and lipase, liver function tests, serum bicarbonates, urine routine microscopy for red blood cells, and complete hemogram. Clinical details such as time elapsed from injury to admission, type of injury, trauma score, and hypotension were noted. Patients were divided into groups according to the single or multiple organs injured and according to their hospital outcome (dead/discharged. Wilcoxon′s Rank sum or Kruskal-Wallis tests were used to compare median values in two/three groups. Data analysis was performed using STATA 11.0 statistical software. Results: A total of 55 patients with median age 26 (range, 6-80 years, were enrolled in the study. Of these, 80% were males. Surgery was required for 20% of the patients. Out of 55 patients, 42 had isolated single organ injury [liver or spleen or gastrointestinal tract (GIT or kidney]. Patients with pancreatic injury were excluded. In patients who suffered liver injuries, urine lipase levels on day 1, urine lipase/amylase ratio along with aspartate aminotransferase (AST, alanine aminotransferase (ALT, and alkaline phosphatase (ALP on days 1, 3, and 5, were found to

  3. Evaluation of amylase and lipase levels in blunt trauma abdomen patients.

    Science.gov (United States)

    Kumar, Subodh; Sagar, Sushma; Subramanian, Arulselvi; Albert, Venencia; Pandey, Ravindra Mohan; Kapoor, Nitika

    2012-04-01

    There are studies to prove the role of amylase and lipase estimation as a screening diagnostic tool to detect diseases apart from acute pancreatitis. However, there is sparse literature on the role of serum and urine amylase, lipase levels, etc to help predict the specific intra-abdominal injury after blunt trauma abdomen (BTA). To elucidate the significance of elevation in the levels of amylase and lipase in serum and urine samples as reliable parameters for accurate diagnosis and management of blunt trauma to the abdomen. A prospective analysis was done on the trauma patients admitted in Jai Prakash Narayan Apex Trauma Center, AIIMS, with blunt abdomen trauma injuries over a period of six months. Blood and urine samples were collected on days 1, 3, and 5 of admission for the estimation of amylase and lipase, liver function tests, serum bicarbonates, urine routine microscopy for red blood cells, and complete hemogram. Clinical details such as time elapsed from injury to admission, type of injury, trauma score, and hypotension were noted. Patients were divided into groups according to the single or multiple organs injured and according to their hospital outcome (dead/discharged). Wilcoxon's Rank sum or Kruskal-Wallis tests were used to compare median values in two/three groups. Data analysis was performed using STATA 11.0 statistical software. A total of 55 patients with median age 26 (range, 6-80) years, were enrolled in the study. Of these, 80% were males. Surgery was required for 20% of the patients. Out of 55 patients, 42 had isolated single organ injury [liver or spleen or gastrointestinal tract (GIT) or kidney]. Patients with pancreatic injury were excluded. In patients who suffered liver injuries, urine lipase levels on day 1, urine lipase/amylase ratio along with aspartate aminotransferase (AST), alanine aminotransferase (ALT), and alkaline phosphatase (ALP) on days 1, 3, and 5, were found to be significant. Day 1 serum amylase, AST, ALT, hemoglobin, and

  4. Extended focused assessment with sonography for trauma (EFAST) in the diagnosis of pneumothorax: experience at a community based level I trauma center.

    Science.gov (United States)

    Nandipati, Kalyana C; Allamaneni, Shyam; Kakarla, Ravindra; Wong, Alfredo; Richards, Neil; Satterfield, James; Turner, James W; Sung, Kae-Jae

    2011-05-01

    Early identification of pneumothorax is crucial to reduce the mortality in critically injured patients. The objective of our study is to investigate the utility of surgeon performed extended focused assessment with sonography for trauma (EFAST) in the diagnosis of pneumothorax. We prospectively analysed 204 trauma patients in our level I trauma center over a period of 12 (06/2007-05/2008) months in whom EFAST was performed. The patients' demographics, type of injury, clinical examination findings (decreased air entry), CXR, EFAST and CT scan findings were entered into the data base. Sensitivity, specificity, positive (PPV) and negative predictive values (NPV) were calculated. Of 204 patients (mean age--43.01+/-19.5 years, sex--male 152, female 52) 21 (10.3%) patients had pneumothorax. Of 21 patients who had pneumothorax 12 were due to blunt trauma and 9 were due to penetrating trauma. The diagnosis of pneumothorax in 204 patients demonstrated the following: clinical examination was positive in 17 patients (true positive in 13/21, 62%; 4 were false positive and 8 were false negative), CXR was positive in 16 (true positive in 15/19, 79%; 1 false positive, 4 missed and 2 CXR not performed before chest tube) patients and EFAST was positive in 21 patients (20 were true positive [95.2%], 1 false positive and 1 false negative). In diagnosing pneumothorax EFAST has significantly higher sensitivity compared to the CXR (P=0.02). Surgeon performed trauma room extended FAST is simple and has higher sensitivity compared to the chest X-ray and clinical examination in detecting pneumothorax. Published by Elsevier Ltd.

  5. Contemporary management of rectal injuries at Level I trauma centers: The results of an American Association for the Surgery of Trauma multi-institutional study.

    Science.gov (United States)

    Brown, Carlos V R; Teixeira, Pedro G; Furay, Elisa; Sharpe, John P; Musonza, Tashinga; Holcomb, John; Bui, Eric; Bruns, Brandon; Hopper, H Andrew; Truitt, Michael S; Burlew, Clay C; Schellenberg, Morgan; Sava, Jack; VanHorn, John; Eastridge, Pa-C Brian; Cross, Alicia M; Vasak, Richard; Vercruysse, Gary; Curtis, Eleanor E; Haan, James; Coimbra, Raul; Bohan, Phillip; Gale, Stephen; Bendix, Peter G

    2018-02-01

    Rectal injuries have been historically treated with a combination of modalities including direct repair, resection, proximal diversion, presacral drainage, and distal rectal washout. We hypothesized that intraperitoneal rectal injuries may be selectively managed without diversion and the addition of distal rectal washout and presacral drainage in the management of extraperitoneal injuries are not beneficial. This is an American Association for the Surgery of Trauma multi-institutional retrospective study from 2004 to 2015 of all patients who sustained a traumatic rectal injury and were admitted to one of the 22 participating centers. Demographics, mechanism, location and grade of injury, and management of rectal injury were collected. The primary outcome was abdominal complications (abdominal abscess, pelvic abscess, and fascial dehiscence). After exclusions, there were 785 patients in the cohort. Rectal injuries were intraperitoneal in 32%, extraperitoneal in 58%, both in 9%, and not documented in 1%. Rectal injury severity included the following grades I, 28%; II, 41%; III, 13%; IV, 12%; and V, 5%. Patients with intraperitoneal injury managed with a proximal diversion developed more abdominal complications (22% vs 10%, p = 0.003). Among patients with extraperitoneal injuries, there were more abdominal complications in patients who received proximal diversion (p = 0.0002), presacral drain (p = 0.004), or distal rectal washout (p = 0.002). After multivariate analysis, distal rectal washout [3.4 (1.4-8.5), p = 0.008] and presacral drain [2.6 (1.1-6.1), p = 0.02] were independent risk factors to develop abdominal complications. Most patients with intraperitoneal injuries undergo direct repair or resection as well as diversion, although diversion is not associated with improved outcomes. While 20% of patients with extraperitoneal injuries still receive a presacral drain and/or distal rectal washout, these additional maneuvers are independently associated with a three

  6. The Intensive Care Unit Perspective of Becoming a Level I Trauma Center: Challenges of Strategy, Leadership, and Operations Management.

    Science.gov (United States)

    Savel, Richard H; Cohen, Wess; Borgia, Dena; Simon, Ronald J

    2018-01-01

    The primary purpose of this narrative is to elucidate the numerous significant changes that occur at the intensive care unit (ICU) level as a medical center pursues becoming a Level I trauma center. Specifically, we will focus on the following important areas: (1) leadership and strategy issues behind the decision to move forward with becoming a trauma center; (2) preparation needed to take a highly functioning surgical ICU and align it for the inevitable changes that happen as trauma go-live occurs; (3) intensivist staffing changes; (4) roles for and training of advanced practice practitioners; (5) graduate medical education issues; (6) optimizing interactions with closely related services; (7) nursing, staffing, and training issues; (8) bed allocation issues; and (9) reconciling the advantages of a "unified adult critical care service" with the realities of the central relationship between trauma and surgical critical care.

  7. The Intensive Care Unit Perspective of Becoming a Level I Trauma Center: Challenges of Strategy, Leadership, and Operations Management

    Directory of Open Access Journals (Sweden)

    Richard H Savel

    2018-01-01

    Full Text Available The primary purpose of this narrative is to elucidate the numerous significant changes that occur at the intensive care unit (ICU level as a medical center pursues becoming a Level I trauma center. Specifically, we will focus on the following important areas: (1 leadership and strategy issues behind the decision to move forward with becoming a trauma center; (2 preparation needed to take a highly functioning surgical ICU and align it for the inevitable changes that happen as trauma go-live occurs; (3 intensivist staffing changes; (4 roles for and training of advanced practice practitioners; (5 graduate medical education issues; (6 optimizing interactions with closely related services; (7 nursing, staffing, and training issues; (8 bed allocation issues; and (9 reconciling the advantages of a “unified adult critical care service” with the realities of the central relationship between trauma and surgical critical care.

  8. The level of knowledge of the advanced trauma life support protocol ...

    African Journals Online (AJOL)

    2012-04-17

    Apr 17, 2012 ... nonspecialist doctors who are involved in the care of trauma victims in Enugu, Nigeria. ... trauma care in our environment for us to compare them with the ATLS. .... Geneva: World Health Organization; 2002. 3. Madubueze CC ...

  9. Successful Conviction of Intoxicated Drivers at a Level I Trauma Center

    Directory of Open Access Journals (Sweden)

    James F. Holmes

    2014-07-01

    Full Text Available Introduction: Conviction rates for drivers driving under the influence (DUI and in motor vehicle collisions (MVC presenting to trauma centers are based primarily on data from the 1990s. Our goal was to identify DUI conviction rates of intoxicated drivers in MVCs presenting to a trauma center and to identify factors associated with the failure to obtain a DUI conviction. Methods: Retrospective study of adults (>18 years presenting to a trauma center emergency department (ED in 2007. Eligible subjects were drivers involved in a MVC with an ED blood alcohol level (BAL ≥ 80mg/dL. Subjects were matched to their Department of Motor Vehicle (DMV records to identify DUI convictions from the collision, the legal blood alcohol concentration (BAC, and arresting officer’s impression of the driver’s sobriety. We entered potential variables predictive of failure to obtain a DUI conviction into a regression model. Results: The 241 included subjects had a mean age of 34.1 ± 12.8 years, and 185 (77% were male. Successful DUI convictions occurred in 142/241 (58.9%, 95% CI 52.4, 65.2% subjects. In a regression model, Injury Severity Score > 15 (odds ratio = 2.70 (95% CI 1.06, 6.85 and a lower ED BAL from 80 to 200mg/dL (odds ratio = 5.03 (95% CI 1.69, 14.9 were independently associated with a failure to obtain a DUI conviction. Conclusion: Slightly more than half of drivers who present to an ED after a MVC receive a DUI conviction. The most severely injured subjects and those with lower BALs are least likely to be convicted of a DUI.

  10. Epidemiology, demographics, and outcomes of craniomaxillofacial gunshot wounds in a level I trauma center.

    Science.gov (United States)

    Tholpady, Sunil S; DeMoss, Patrick; Murage, Kariuki P; Havlik, Robert J; Flores, Roberto L

    2014-07-01

    Gunshot injuries to the craniomaxillofacial region are a challenge to the trauma and reconstructive surgeon. Although management of these injuries has been standardized and early rather than late intervention is advocated, the patient characteristics before, during, and after have been poorly elucidated. A prospectively maintained Level I trauma center database was queried as to gunshot wounds of the craniomaxillofacial skeleton. Over a five-year period (2007-2011), 168 patients were identified with these injuries. Charts were reviewed as to demographics, presentations, and outcomes and these were tested for significant relationships with hospital length of stay, numbers and types of procedures, morbidity, and mortality. Gunshot wounds to the craniofacial skeleton resulted in 71 deaths in this patient population. Those that died were significantly older, presented with a lower GCS, had a shorter LOS, and a higher INR than those that lived. Subgroup analysis of mechanism demonstrated mortality was more likely to occur as a result of self-inflicted injury in whites and due to assault in the African-American population. Data gathered from this study disputes some commonly held beliefs regarding the epidemiology of gunshot injuries and should allow for better characterization of which outcomes are consistent with which presentations. Published by Elsevier Ltd.

  11. Emergency CT for assessment and management of blunt traumatic splenic injuries at a Level 1 Trauma Center: 13-year study.

    Science.gov (United States)

    Margari, Sergio; Garozzo Velloni, Fernanda; Tonolini, Massimo; Colombo, Ettore; Artioli, Diana; Allievi, Niccolò Ettore; Sammartano, Fabrizio; Chiara, Osvaldo; Vanzulli, Angelo

    2018-05-12

    To determine the relationship between multidetector computed tomography (MDCT) findings, management strategies, and ultimate clinical outcomes in patients with splenic injuries secondary to blunt trauma. This Institutional Review Board-approved study collected 351 consecutive patients admitted at the Emergency Department (ED) of a Level I Trauma Center with blunt splenic trauma between October 2002 and November 2015. Their MDCT studies were retrospectively and independently reviewed by two radiologists to grade splenic injuries according to the American Association for the Surgery of Trauma (AAST) organ injury scale (OIS) and to detect intraparenchymal (type A) or extraparenchymal (type B) active bleeding and/or contained vascular injuries (CVI). Clinical data, information on management, and outcome were retrieved from the hospital database. Statistical analysis relied on Student's t, chi-squared, and Cohen's kappa tests. Emergency multiphase MDCT was obtained in 263 hemodynamically stable patients. Interobserver agreement for both AAST grading of injuries and vascular lesions was excellent (k = 0.77). Operative management (OM) was performed in 160 patients (45.58% of the whole cohort), and high-grade (IV and V) OIS injuries and type B bleeding were statistically significant (p trauma event, without significant increase of mortality. Both intraparenchymal and extraparenchymal active bleeding were predictive of NOM failure (p splenic traumas and contributes to the shift toward NOM in hemodynamically stable patients.

  12. Technical and financial feasibility of an inferior vena cava filter retrieval program at a level one trauma center.

    Science.gov (United States)

    Charlton-Ouw, Kristofer M; Leake, Samuel S; Sola, Cristina N; Sandhu, Harleen K; Albarado, Rondel; Holcomb, John B; Miller, Charles C; Safi, Hazim J; Azizzadeh, Ali

    2015-01-01

    Considering new guidelines for retrievable inferior vena cava filters (IVCFs), we examine our initial experience after establishing a comprehensive filter removal program in our level 1 trauma center. We evaluated the technical and financial feasibility of this program and barriers to IVCF retrieval, including insurance status and costs, in trauma patients. Trauma patients receiving IVCFs from May 2011 to 2013 were consented and prospectively enrolled in the study program. Retrieval rates were assessed for the years before study initiation. Primary outcome was IVCF retrieval. Hospital financial data for retrieval were examined and univariate analysis performed. Hospital cost-to-charge and payment-to-charge ratios were assessed. Before study initiation from April 2009 to 2011, 66 IVCFs were placed in trauma patients with only 2 retrievals in 2 years. During the study period, 247 trauma patients had IVCF placement of which 111 (45%) were enrolled. The main reason for nonenrollment was lack of referral by the implanting team. Retrieval was attempted in 100 outpatients with success in 85 (85%). Patients enrolled in the program were more likely to have their filters removed (73% vs. 18%; odds ratio, 12.6; 95% confidence interval, 6.6-24.3; P financially feasible without loss to the health care system even in regions with high rates of uninsured. A major barrier to successful filter retrieval was lack of patient referral into the program by implanting physicians. Hospital administration and physician outreach are important determinants of successful IVCF retrieval in trauma patients. Published by Elsevier Inc.

  13. Long-term effects of conflict-related sexual violence compared with non-sexual war trauma in female World War II survivors: a matched pairs study.

    Science.gov (United States)

    Kuwert, Philipp; Glaesmer, Heide; Eichhorn, Svenja; Grundke, Elena; Pietrzak, Robert H; Freyberger, Harald J; Klauer, Thomas

    2014-08-01

    The aim of the study was to compare the long-term effects of conflict-related sexual violence experienced at the end of World War II (WWII) with non-sexual WWII trauma (e.g., being exposed to shell shock or physical violence). A total of 27 elderly wartime rape survivors were compared to age- and gender-matched control subjects who were drawn from a larger sample of subjects over 70 years of age who had experienced WWII-related trauma. A modified version of the Posttraumatic Diagnostic Scale was used to assess trauma characteristics and posttraumatic stress disorder (PTSD) symptoms and the Brief Symptom Inventory-18 was used to assess current psychopathology. Additionally, measures of posttraumatic growth (Posttraumatic Growth Inventory) and social acknowledgement as a trauma survivor (Social Acknowledgement Questionnaire) were used to assess two mediating variables in post-trauma conditions of rape victims. Women exposed to conflict-related sexual violence reported greater severity of PTSD-related avoidance and hyperarousal symptoms, as well as anxiety, compared with female long-term survivors of non-sexual WWII trauma. The vast majority (80.9 %) of these women also reported severe sexual problems during their lifetimes relative to 19.0 % of women who experienced non-sexual war trauma. Women exposed to conflict-related sexual violence also reported greater posttraumatic growth, but less social acknowledgement as trauma survivors, compared to survivors of non-sexual war trauma. The results were consistent with emerging neurobiological research, which suggests that different traumas may be differentially associated with long-term posttraumatic sequelae in sexual assault survivors than in other survivor groups and highlights the need to treat (or better prevent) deleterious effects of conflict-related sexual violence in current worldwide crisis zones.

  14. Declining trend in the use of repeat computed tomography for trauma patients admitted to a level I trauma center for traffic-related injuries

    Energy Technology Data Exchange (ETDEWEB)

    Psoter, Kevin J., E-mail: kevinp2@u.washington.edu [Department of Epidemiology, University of Washington, Box 357236, Seattle, WA 98195 (United States); Roudsari, Bahman S., E-mail: roudsari@u.washington.edu [Department of Radiology, Comparative Effectiveness, Cost and Outcomes Research Center, University of Washington, 325 Ninth Avenue, Box 359960, Seattle, WA 98104 (United States); Graves, Janessa M., E-mail: janessa@u.washington.edu [Department of Pediatrics, Harborview Injury Prevention and Research Center, University of Washington, 325 Ninth Avenue, Box 359960, Seattle, WA 98104 (United States); Mack, Christopher, E-mail: cdmack@uw.edu [Harborview Injury Prevention and Research Center, University of Washington, 325 Ninth Avenue, Box 359960, Seattle, WA 98104 (United States); Jarvik, Jeffrey G., E-mail: jarvikj@u.washington.edu [Department of Radiology and Department of Neurological Surgery, Comparative Effectiveness, Cost and Outcomes Research Center, University of Washington, 325 Ninth Avenue, Box 359960, Seattle, WA 98104 (United States)

    2013-06-15

    Objective: To evaluate the trend in utilization of repeat (i.e. ≥2) computed tomography (CT) and to compare utilization patterns across body regions for trauma patients admitted to a level I trauma center for traffic-related injuries (TRI). Materials and Methods: We linked the Harborview Medical Center trauma registry (1996–2010) to the billing department data. We extracted the following variables: type and frequency of CTs performed, age, gender, race/ethnicity, insurance status, injury mechanism and severity, length of hospitalization, intensive care unit (ICU) admission and final disposition. TRIs were defined as motor vehicle collisions, motorcycle, bicycle and pedestrian-related injuries. Logistic regression was used to evaluate the association between utilization of different body region repeat (i.e. ≥2) CTs and year of admission, adjusting for patient and injury-related characteristics that could influence utilization patterns. Results: A total of 28,431 patients were admitted for TRIs over the study period and 9499 (33%) received repeat CTs. From 1996 to 2010, the proportion of patients receiving repeat CTs decreased by 33%. Relative to 2000 and adjusting for other covariates, patients with TRIs admitted in 2010 had significantly lower odds of undergoing repeat head (OR = 0.61; 95% CI: 0.49–0.76), pelvis (OR = 0.37; 95% CI: 0.27–0.52), cervical spine (OR = 0.23; 95% CI: 0.12–0.43), and maxillofacial CTs (OR = 0.24; 95% CI: 0.10–0.57). However, they had higher odds of receiving repeat thoracic CTs (OR = 1.86; 95% CI: 1.02–3.38). Conclusion: A significant decrease in the utilization of repeat CTs was observed in trauma patients presenting with traffic-related injuries over a 15-year period.

  15. Comments About a Chameleon Theory: Level I/Level II.

    Science.gov (United States)

    Horn, John; Stankov, Lazar

    1982-01-01

    Jensen's ideas about two levels of intellectual abilities are criticized as being oversimplified. More than two levels of intellectual abilities and relationships between variables reflecting more than racial and socioeconomic status (SES) differences are suggested, arguing that Jensen's statements about race and SES differences are not properly…

  16. Propofol Infusion Syndrome: A Retrospective Analysis at a Level 1 Trauma Center

    Directory of Open Access Journals (Sweden)

    James H. Diaz

    2014-01-01

    Full Text Available Objectives. The propofol infusion syndrome (PRIS, a rare, often fatal, condition of unknown etiology, is defined by development of lipemic serum, metabolic acidosis, rhabdomyolysis, hepatomegaly, cardiac arrhythmias, and acute renal failure. Methods. To identify risk factors for and biomarkers of PRIS, a retrospective chart review of all possible PRIS cases during a 1-year period was conducted at a level 1 trauma hospital in ICU patients over 18 years of age receiving continuous propofol infusions for ≥3 days. Additional study inclusion criteria included vasopressor support and monitoring of serum triglycerides and creatinine. Results. Seventy-two patients, 61 males (84.7% and 11 females (15.3%, satisfied study inclusion criteria; and of these, 3 males met the study definition for PRIS, with 1 case fatality. PRIS incidence was 4.1% with a case-fatality rate of 33%. The mean duration of propofol infusion was 6.96 days. A positive linear correlation was observed between increasing triglyceride levels and infusion duration, but no correlation was observed between increasing creatinine levels and infusion duration. Conclusions. Risk factors for PRIS were confirmed as high dose infusions over prolonged periods. Increasing triglyceride levels may serve as reliable biomarkers of impending PRIS, if confirmed in future investigations with larger sample sizes.

  17. Appetitive aggression as a resilience factor against trauma disorders: appetitive aggression and PTSD in German World War II veterans.

    Directory of Open Access Journals (Sweden)

    Roland Weierstall

    Full Text Available Repeated exposure to traumatic stressors such as combat results in chronic symptoms of PTSD. However, previous findings suggest that former soldiers who report combat-related aggression to be appetitive are more resilient to develop PTSD. Appetitive Aggression should therefore prevent widespread mental suffering in perpetrators of severe atrocities even after decades.To test the long-term relationship between trauma-related illness and attraction to aggression, we surveyed a sample of 51 German male World-War II veterans (age: M = 86.7, SD = 2.8. War-related appetitive aggression was assessed with the Appetitive Aggression Scale (AAS. Current- and lifetime PTSD symptoms were assessed with the PSS-I. In a linear regression analysis accounting for 31% of the variance we found that veterans that score higher on the AAS show lower PSS-I symptom severity scores across their whole post-war lifetime (β = - .31, p = .014. The effect size and power were sufficient (f(2 = 0.51, (1-β = .99. The same was true for current PTSD (β = - .27, p = .030.Appetitive Aggression appears to be a resilience factor for negative long-term effects of combat experiences in perpetrators of violence. This result has practical relevance for preventing trauma-related mental suffering in Peace Corps and for designing adequate homecoming reception for veterans.

  18. Surgical strategies in polytraumatized patients with femoral shaft fractures - comparing a German and an Australian level I trauma centre.

    Science.gov (United States)

    Andruszkow, Hagen; Dowrick, Adam S; Frink, Michael; Zeckey, Christian; Krettek, Christian; Hildebrand, Frank; Edwards, Elton R; Mommsen, Philipp

    2013-08-01

    Femoral shaft fractures are one of the most common injuries in multiple trauma patients. Due to their prognostic relevance, there is an ongoing controversial discussion as to the optimal treatment strategy in terms of Damage Control Orthopaedics (DCO) and Early Total Care (ETC). We aimed to describe the differences in fracture management and clinical outcome of multiple trauma patients with concomitant femoral shaft fractures treated at a German and an Australian level I trauma centre using the same inclusion criteria. Polytraumatized patients (ISS ≥ 16) with a femoral shaft fracture aged ≥ 16 years treated at a German and an Australian trauma centre between 2003 and 2007 were included. According to ETC and DCO management principles, we evaluated demographic parameters as well as posttraumatic complications and clinical outcome. Seventy-three patients were treated at the German and 134 patients at the Australian trauma centre. DCO was performed in case of increased injury severity in both hospitals. Prolonged mechanical ventilation time, and length of ICU and hospital stay were demonstrated in DCO treatment regardless of the trauma centre. No differences concerning posttraumatic complications and survival were found between both centres. Survival of patients after DCO was similar to those managed using ETC despite a greater severity of injury and lower probability of survival. There was no difference in the incidence of ARDS. DCO was, however, associated with a greatly increased length of time on mechanical ventilation and length of stay in the ICU. We found no differences concerning patient demographics or clinical outcomes in terms of incidence of ARDS, MODS, or mortality. As such, we propose that comparability between German and Australian trauma populations is justified. Despite a higher ISS in the DCO group, there were no differences in posttraumatic complications and survival depending on ETC or DCO treatment. Further research is required to confirm

  19. Comparison of Helicopter Emergency Medical Services Transport Types and Delays on Patient Outcomes at Two Level I Trauma Centers.

    Science.gov (United States)

    Nolan, Brodie; Tien, Homer; Sawadsky, Bruce; Rizoli, Sandro; McFarlan, Amanda; Phillips, Andrea; Ackery, Alun

    2017-01-01

    Helicopter emergency medical services (HEMS) have become an engrained component of trauma systems. In Ontario, transportation for trauma patients is through one of three ways: scene call, modified scene call, or interfacility transfer. We hypothesize that differences exist between these types of transports in both patient demographics and patient outcomes. This study compares the characteristics of patients transported by each of these methods to two level 1 trauma centers and assesses for any impact on morbidity or mortality. As a secondary outcome reasons for delay were identified. A local trauma registry was used to identify and abstract data for all patients transported to two trauma centers by HEMS over a 36-month period. Further chart abstraction using the HEMS patient care reports was done to identify causes of delay during HEMS transport. During the study period HEMS transferred a total of 911 patients of which 139 were scene calls, 333 were modified scene calls and 439 were interfacility transfers. Scene calls had more patients with an ISS of less than 15 and had more patients discharged home from the ED. Modified scene calls had more patients with an ISS greater than 25. The most common delays that were considered modifiable included the sending physician doing a procedure, waiting to meet a land EMS crew, delays for diagnostic imaging and confirming disposition or destination. Differences exist between the types of transports done by HEMS for trauma patients. Many identified reasons for delay to HEMS transport are modifiable and have practical solutions. Future research should focus on solutions to identified delays to HEMS transport. Key words: helicopter emergency medical services; trauma; prehospital care; delays.

  20. Motorcycle-related hospitalization of adolescents in a Level I trauma center in southern Taiwan: a cross-sectional study.

    Science.gov (United States)

    Liang, Chi-Cheng; Liu, Hang-Tsung; Rau, Cheng-Shyuan; Hsu, Shiun-Yuan; Hsieh, Hsiao-Yun; Hsieh, Ching-Hua

    2015-08-28

    The aim of this study was to investigate and compare the injury pattern, mechanisms, severity, and mortality of adolescents and adults hospitalized for treatment of trauma following motorcycle accidents in a Level I trauma center. Detailed data regarding patients aged 13-19 years (adolescents) and aged 30-50 years (adults) who had sustained trauma due to a motorcycle accident were retrieved from the Trauma Registry System between January 1, 2009 and December 31, 2012. The Pearson's chi-squared test, Fisher's exact test, or the independent Student's t-test were performed to compare the adolescent and adult motorcyclists and to compare the motorcycle drivers and motorcycle pillion. Analysis of Abbreviated Injury Scale (AIS) scores revealed that the adolescent patients had sustained higher rates of facial, abdominal, and hepatic injury and of cranial, mandibular, and femoral fracture but lower rates of thorax and extremity injury; hemothorax; and rib, scapular, clavicle, and humeral fracture compared to the adults. No significant differences were found between the adolescents and adults regarding Injury Severity Score (ISS), New Injury Severity Score (NISS), Trauma-Injury Severity Score (TRISS), mortality, length of hospital stay, or intensive care unit (ICU) admission rate. A significantly greater percentage of adolescents compared to adults were found not to have worn a helmet. Motorcycle riders who had not worn a helmet were found to have a significantly lower first Glasgow Coma Scale (GCS) score, and a significantly higher percentage was found to present with unconscious status, head and neck injury, and cranial fracture compared to those who had worn a helmet. Adolescent motorcycle riders comprise a major population of patients hospitalized for treatment of trauma. This population tends to present with a higher injury severity compared to other hospitalized trauma patients and a bodily injury pattern differing from that of adult motorcycle riders, indicating the

  1. The Effect of Lactate, Albumin, C-reactive Protein, PaO2/FiO2 and Glucose Levels of Trauma Patients at the Time of Administration to Intensive Care

    Directory of Open Access Journals (Sweden)

    Eren Yılmaz

    2014-12-01

    Full Text Available Objective: Blood analyses are preferred in the observation of cases requiring intensive care unit (ICU following a trauma. The purpose of this study was to examine the relationship of albumin, C-reactive protein (CRP, PaO2/FiO2 and glucose levels of trauma patients at time of admission with mortality. Material and Method: The patients who were admitted into ICU following a trauma between the years of 2010 and 2012 were retrospectively evaluated. 200 trauma cases were included in the study. Their demographic data, APACHE II scores, Glasgow Coma Scales (GCS, and arterial blood gas in the lactate and PaO2/FiO2 ratio, CRP, glucose and albumin levels in the first collected arterial blood gas, as well as, the presence of thoracic, cardiac, renal, abdominal and head trauma, length of ICU stay and mortality were recorded. Results: Of the patients included in the study 84% were male, with an average age of 38.3 and an average APACHE II score of 16.6. 64% suffered from head trauma and the average GCS was calculated to be 11.2. The patients were observed in the ICU for an average of 18.7 days and the rate of mortality was 33.5%. GCS, PaO2/FiO2, age and elevated lactate levels increased mortality as independent risk factors. Conclusion: It has been concluded that parameters like age and the first GCS, lactate, glucose, albumin and PaO2/FiO2 at time of acceptance into the ICU were found to be related with mortality.

  2. The impact of a standardized consultation form for facial trauma on billing and evaluation and management levels.

    Science.gov (United States)

    Levesque, Andre Y; Tauber, David M; Lee, Johnson C; Rodriguez-Feliz, Jose R; Chao, Jerome D

    2014-02-01

    Facial trauma is among the most frequent consultations encountered by plastic surgeons. Unfortunately, the reimbursement from these consultations can be low, and qualified plastic surgeons may exclude facial trauma from their practice. An audit of our records found insufficient documentation to justify higher evaluation and management (EM) levels of service resulting in lower reimbursement. Utilizing a standardized consultation form can improve documentation resulting in higher billing and EM levels. A facial trauma consultation form was developed in conjunction with the billing department. Three plastic surgery residents completed 30 consultations without the aid of the consult form followed by 30 consultations with the aid of the form. The EM levels and billing data for each consultation were obtained from the billing department for analysis. The 2 groups were compared using χ2 analysis and t tests to determine statistical significance. Using our standardized consultation form, the mean EM level increased from 2.97 to 3.60 (P = 0.002). In addition, the mean billed amount increased from $391 to $501 per consult (P = 0.051) representing a 28% increase in billing. In our institution, the development and implementation of a facial trauma consultation form has resulted in more complete documentation and a subsequent increase in EM level and billed services.

  3. Blood levels of histone-complexed DNA fragments are associated with coagulopathy, inflammation and endothelial damage early after trauma

    DEFF Research Database (Denmark)

    Johansson, Pär I; Windeløv, Nis A; Rasmussen, Lars S

    2013-01-01

    Tissue injury increases blood levels of extracellular histones and nucleic acids, and these may influence hemostasis, promote inflammation and damage the endothelium. Trauma-induced coagulopathy (TIC) may result from an endogenous response to the injury that involves the neurohumoral, inflammatory...

  4. Increased circulating D-lactate levels predict risk of mortality after hemorrhage and surgical trauma in baboons.

    Science.gov (United States)

    Sobhian, Babak; Kröpfl, Albert; Hölzenbein, Thomas; Khadem, Anna; Redl, Heinz; Bahrami, Soheyl

    2012-05-01

    Patients with hemorrhagic shock and/or trauma are at risk of developing colonic ischemia associated with bacterial translocation that may lead to multiple organ failure and death. Intestinal ischemia is difficult to diagnose noninvasively. The present retrospective study was designed to determine whether circulating plasma D-lactate is associated with mortality in a clinically relevant two-hit model in baboons. Hemorrhagic shock was induced in anesthetized baboons (n = 24) by controlled bleeding (mean arterial pressure, 40 mmHg), base excess (maximum -5 mmol/L), and time (maximum 3 h). To mimic clinical setting more closely, all animals underwent a surgical trauma after resuscitation including midshaft osteotomy stabilized with reamed femoral interlocking nailing and were followed for 7 days. Hemorrhagic shock/surgical trauma resulted in 66% mortality by day 7. In nonsurvivor (n = 16) hemorrhagic shock/surgical trauma baboons, circulating D-lactate levels were significantly increased (2-fold) at 24 h compared with survivors (n = 8), whereas the early increase during hemorrhage and resuscitation declined during the early postresuscitation phase with no difference between survivors and nonsurvivors. Moreover, D-lactate levels remained elevated in the nonsurvival group until death, whereas it decreased to baseline in survivors. Prediction of death (receiver operating characteristic test) by D-lactate was accurate with an area under the curve (days 1-3 after trauma) of 0.85 (95% confidence interval, 0.72-0.93). The optimal D-lactate cutoff value of 25.34 μg/mL produced sensitivity of 73% to 99% and specificity of 50% to 83%. Our data suggest that elevation of plasma D-lactate after 24 h predicts an increased risk of mortality after hemorrhage and trauma.

  5. Acute cervical spine injuries: prospective MR imaging assessment at a level 1 trauma center.

    Science.gov (United States)

    Katzberg, R W; Benedetti, P F; Drake, C M; Ivanovic, M; Levine, R A; Beatty, C S; Nemzek, W R; McFall, R A; Ontell, F K; Bishop, D M; Poirier, V C; Chong, B W

    1999-10-01

    To determine the weighted average sensitivity of magnetic resonance (MR) imaging in the prospective detection of acute neck injury and to compare these findings with those of a comprehensive conventional radiographic assessment. Conventional radiography and MR imaging were performed in 199 patients presenting to a level 1 trauma center with suspected cervical spine injury. Weighted sensitivities and specificities were calculated, and a weighted average across eight vertebral levels from C1 to T1 was formed. Fourteen parameters indicative of acute injury were tabulated. Fifty-eight patients had 172 acute cervical injuries. MR imaging depicted 136 (79%) acute abnormalities and conventional radiography depicted 39 (23%). For assessment of acute fractures, MR images (weighted average sensitivity, 43%; CI: 21%, 66%) were comparable to conventional radiographs (weighted average sensitivity, 48%; CI: 30%, 65%). MR imaging was superior to conventional radiography in the evaluation of pre- or paravertebral hemorrhage or edema, anterior or posterior longitudinal ligament injury, traumatic disk herniation, cord edema, and cord compression. Cord injuries were associated with cervical spine spondylosis (P < .05), acute fracture (P < .001), and canal stenosis (P < .001). MR imaging is more accurate than radiography in the detection of a wide spectrum of neck injuries, and further study is warranted of its potential effect on medical decision making, clinical outcome, and cost-effectiveness.

  6. What Are the Costs of Trauma Center Readiness? Defining and Standardizing Readiness Costs for Trauma Centers Statewide.

    Science.gov (United States)

    Ashley, Dennis W; Mullins, Robert F; Dente, Christopher J; Garlow, Laura; Medeiros, Regina S; Atkins, Elizabeth V; Solomon, Gina; Abston, Dena; Ferdinand, Colville H

    2017-09-01

    Trauma center readiness costs are incurred to maintain essential infrastructure and capacity to provide emergent services on a 24/7 basis. These costs are not captured by traditional hospital cost accounting, and no national consensus exists on appropriate definitions for each cost. Therefore, in 2010, stakeholders from all Level I and II trauma centers developed a survey tool standardizing and defining trauma center readiness costs. The survey tool underwent minor revisions to provide further clarity, and the survey was repeated in 2013. The purpose of this study was to provide a follow-up analysis of readiness costs for Georgia's Level I and Level II trauma centers. Using the American College of Surgeons Resources for Optimal Care of the Injured Patient guidelines, four readiness cost categories were identified: Administrative, Clinical Medical Staff, Operating Room, and Education/Outreach. Through conference calls, webinars and face-to-face meetings with financial officers, trauma medical directors, and program managers from all trauma centers, standardized definitions for reporting readiness costs within each category were developed. This resulted in a survey tool for centers to report their individual readiness costs for one year. The total readiness cost for all Level I trauma centers was $34,105,318 (avg $6,821,064) and all Level II trauma centers was $20,998,019 (avg $2,333,113). Methodology to standardize and define readiness costs for all trauma centers within the state was developed. Average costs for Level I and Level II trauma centers were identified. This model may be used to help other states define and standardize their trauma readiness costs.

  7. Cumulative effective radiation dose received by blunt trauma patients arriving to a military level I trauma center from point of injury and interhospital transfers.

    Science.gov (United States)

    Van Arnem, Kerri A; Supinski, David P; Tucker, Jonathan E; Varney, Shawn

    2016-12-01

    Trauma patients sustaining blunt injuries are exposed to multiple radiologic studies. Evidence indicates that the risk of cancer from exposure to ionizing radiation rises in direct proportion to the cumulative effective dose (CED) received. The purpose of this study is to quantify the amount of ionizing radiation accumulated when arriving directly from point of injury to San Antonio Military Medical Center (SAMMC), a level I trauma center, compared with those transferred from other facilities. A retrospective record review was conducted from 1st January 2010 through 31st December 2012. The SAMMC trauma registry, electronic medical records, and the digital radiology imaging system were searched for possible candidates. The medical records were then analyzed for sex, age, mechanism of injury, received directly from point of injury (direct group), transfer from another medical facility (transfer group), computed tomographic scans received, dose-length product, CED of radiation, and injury severity score. A diagnostic imaging physicist then calculated the estimated CED each subject received based on the dose-length product of each computed tomographic scan. A total of 300 patients were analyzed, with 150 patients in the direct group and 150 patients in the transfer group. Both groups were similar in age and sex. Patients in the transfer group received a significantly greater CED of radiation compared with the direct group (mean, 37.6 mSv vs 28 mSv; P=.001). The radiation received in the direct group correlates with a lifetime attributable risk (LAR) of 1 in 357 compared with the transfer group with an increase in LAR to 1 in 266. Patients transferred to our facility received a 34% increase in ionizing radiation compared with patients brought directly from the injury scene. This increased dose of ionizing radiation contributes to the LAR of cancer and needs to be considered before repeating imaging studies. III. Published by Elsevier Inc.

  8. Range and specificity of war-related trauma to posttraumatic stress; depression and general health perception: displaced former World War II children in late life.

    Science.gov (United States)

    Strauss, Kristin; Dapp, Ulrike; Anders, Jennifer; von Renteln-Kruse, Wolfgang; Schmidt, Silke

    2011-02-01

    Dose-response relation of war experiences and posttraumatic stress, depression and poor health functioning in late life is well documented in war-affected populations. The influence of differing trauma types experienced by war-affected population in the study of dose-response relation of war trauma and psychological maladaptation in late life has not been investigated. We examined a subgroup of displaced elders and investigated whether specific trauma types were associated with differential health outcomes. From representative practitioner lists, matched groups of former displaced and non-displaced World War II children were assigned, yielding a total sample of 417 participants (response rate 50%). Measurement encompassed a self-report survey including the Impact of Event Scale-Revised, the Patient Health Questionnaire and the Harvard Trauma Questionnaire. Consistent dose-relation between war-related experiences and posttraumatic stress or depressive symptoms in late life was found for both, displaced and non-displaced elders, whereas a gradient for poor health perception was only found in displaced people. Trauma types derived from principal component analysis showed differential associations with health outcomes. Human Right Violations emerged as risk factor for posttraumatic stress symptoms and Deprivation & Threat to Life as risk factor for depressive symptoms. Poor self-rated health was associated with multiple trauma types. Non-random recruitment, retrospective design and use of self-report. Posttraumatic stress and depression are associated with war-related experiences more than 60 years after World War II. Results suggest that different trauma types lead to unique variants of syndrome configurations, which may result from different etiological factors. © 2010 Elsevier B.V. All rights reserved.

  9. Levels of Cd (II, Mn (II, Pb (II, Cu (II, and Zn (II in Common Buzzard (Buteo buteo from Sicily (Italy by Derivative Stripping Potentiometry

    Directory of Open Access Journals (Sweden)

    P. Licata

    2010-01-01

    Full Text Available The purpose of this study was to determine the concentrations of heavy metals (Cd, Pb, Cu, Mn, and Zn in different organs (liver, kidney, muscle, lung, skin, and feathers of buzzards (Buteo buteo, utilized as a “biological indicator” for environmental contamination, from different areas of Sicily and to investigate the relationships between birds sex, age, and weight and metal levels in these samples. All samples of common buzzards were collected at the “Recovery Center of Wild Fauna” of Palermo, through the Zooprophilactic Institute. Potentiometric stripping analysis (PSA was used to determine the content of Cd(II, Cu(II, Mn(II, Pb(II, and Zn(II in bird tissues. For toxic metals, the highest levels of Pb were in liver and those of Cd in lung; Zn levels were higher than Cu and Mn in all tissues analyzed. The concentrations in liver, lung, kidney, and muscle could be considered as an indicative of chronic exposure to metals while the presence of metals in skin could be consequential to storing and elimination processes. The found concentrations of metals in the studied matrices required a highly sensitive method for their determination and a simple sample preparation procedure, and the proposed method was well suited for this purpose.

  10. Retrospective Review of Air Transportation Use for Upper Extremity Amputations at a Level-1 Trauma Center.

    Science.gov (United States)

    Grantham, W Jeffrey; To, Philip; Watson, Jeffry T; Brywczynski, Jeremy; Lee, Donald H

    2016-08-01

    Air transportation to tertiary care centers of patients with upper extremity amputations has been utilized in hopes of reducing the time to potential replantation; however, this mode of transportation is expensive and not all patients will undergo replantation. The purpose of this study is to review the appropriateness and cost of air transportation in upper extremity amputations. Consecutive patients transported by aircraft with upper extremity amputations in a 7-year period at a level-1 trauma center were retrospectively reviewed. The distance traveled was recorded, along with the times of the injury, referral, transportation duration, arrival, and start of the operation. The results of the transfer were defined as replantation or revision amputation. Overall, 47 patients were identified with 43 patients going to the operating room, but only 14 patients (30%) undergoing replantation. Patients arrived at the tertiary hand surgery center with a mean time of 182.3 minutes following the injury, which includes 105.2 minutes of transportation time. The average distance traveled was 105.4 miles (range, 22-353 miles). The time before surgery of those who underwent replantation was 154.6 minutes. The average cost of transportation was $20,482. Air transportation for isolated upper extremity amputations is costly and is not usually the determining factor for replantation. The type of injury and patients' expectations often dictate the outcome, and these may be better determined at the time of referral with use of telecommunication photos, discussion with a hand surgeon, and patient counseling. III.

  11. Energy Levels, wavelengths and hyperfine structure measurements of Sc II

    Science.gov (United States)

    Hala, Fnu; Nave, Gillian

    2018-01-01

    Lines of singly ionized Scandium (Sc II) along with other Iron group elements have been observed [1] in the region surrounding the massive star Eta Carinae [2,3] called the strontium filament (SrF). The last extensive analysis of Sc II was the four-decade old work of Johansson & Litzen [4], using low-resolution grating spectroscopy. To update and extend the Sc II spectra, we have made observation of Sc/Ar, Sc/Ne and Sc/Ge/Ar hollow cathode emission spectrum on the NIST high resolution FT700 UV/Vis and 2 m UV/Vis/IR Fourier transform spectrometers (FTS). More than 850 Sc II lines have been measured in the wavelength range of 187 nm to 3.2 μm. connecting a total of 152 energy levels. The present work also focuses to resolve hyperfine structure (HFS) in Sc II lines. We aim to obtain accurate transition wavelengths, improved energy levels and HFS constants of Sc II. The latest results from work in progress will be presented.Reference[1] Hartman H, Gull T, Johansson S and Smith N 2004 Astron. Astrophys. 419 215[2] Smith N, Morse J A and Gull T R 2004 Astrophys. J. 605 405[3] Davidson K and Humphreys R M 1997 Annu. Rev. Astron. Astrophys. 35[4] Johansson S and Litzén U 1980 Phys. Scr. 22 49

  12. Abdominal trauma in infants and children: prompt identification and early management of serious and life-threatening injuries. Part II: Specific injuries and ED management.

    Science.gov (United States)

    Rothrock, S G; Green, S M; Morgan, R

    2000-06-01

    Evaluation of children with suspected abdominal trauma could be a difficult task. Unique anatomic and physiologic features render vital sign assessment and the physical examination less useful than in the adult population. Awareness of injury patterns and associations will improve the early diagnosis of abdominal trauma. Clinicians must have a complete understanding of common and atypical presentations of children with significant abdominal injuries. Knowledge of the utility and limitations of available laboratory and radiologic adjuncts will assist in accurately identifying abdominal injury. While other obvious injuries (eg, facial, cranial, and extremity trauma) can distract physicians from less obvious abdominal trauma, an algorithmic approach to evaluating and managing children with multisystem trauma will improve overall care and help to identify and treat abdominal injuries in a timely fashion. Finally, physicians must be aware of the capabilities of their own facility to handle pediatric trauma. Protocols must be in place for expediting the transfer of children who require a higher level of care. Knowledge of each of these areas will help to improve the overall care and outcome of children with abdominal trauma.

  13. Trauma Simulation Training Increases Confidence Levels in Prehospital Personnel Performing Life-Saving Interventions in Trauma Patients

    Directory of Open Access Journals (Sweden)

    Christine M. Van Dillen

    2016-01-01

    Full Text Available Introduction. Limited evidence is available on simulation training of prehospital care providers, specifically the use of tourniquets and needle decompression. This study focused on whether the confidence level of prehospital personnel performing these skills improved through simulation training. Methods. Prehospital personnel from Alachua County Fire Rescue were enrolled in the study over a 2- to 3-week period based on their availability. Two scenarios were presented to them: a motorcycle crash resulting in a leg amputation requiring a tourniquet and an intoxicated patient with a stab wound, who experienced tension pneumothorax requiring needle decompression. Crews were asked to rate their confidence levels before and after exposure to the scenarios. Timing of the simulation interventions was compared with actual scene times to determine applicability of simulation in measuring the efficiency of prehospital personnel. Results. Results were collected from 129 participants. Pre- and postexposure scores increased by a mean of 1.15 (SD 1.32; 95% CI, 0.88–1.42; P<0.001. Comparison of actual scene times with simulated scene times yielded a 1.39-fold difference (95% CI, 1.25–1.55 for Scenario 1 and 1.59 times longer for Scenario 2 (95% CI, 1.43–1.77. Conclusion. Simulation training improved prehospital care providers’ confidence level in performing two life-saving procedures.

  14. eFAST for Pneumothorax: Real-Life Application in an Urban Level 1 Center by Trauma Team Members.

    Science.gov (United States)

    Maximus, Steven; Figueroa, Cesar; Whealon, Matthew; Pham, Jacqueline; Kuncir, Eric; Barrios, Cristobal

    2018-02-01

    The focused assessment with sonography for trauma (FAST) examination has become the standard of care for rapid evaluation of trauma patients. Extended FAST (eFAST) is the use of ultrasonography for the detection of pneumothorax (PTX). The exact sensitivity and specificity of eFAST detecting traumatic PTX during practical "real-life" application is yet to be investigated. This is a retrospective review of all trauma patients with a diagnosis of PTX, who were treated at a large level 1 urban trauma center from March 2013 through July 2014. Charts were reviewed for results of imaging, which included eFAST, chest X-ray, and CT scan. The requirement of tube thoracostomy and mechanism of injury were also analyzed. A total of 369 patients with a diagnosis of PTX were identified. A total of 69 patients were excluded, as eFAST was either not performed or not documented, leaving 300 patients identified with PTX. A total of 113 patients had clinically significant PTX (37.6%), requiring immediate tube thoracostomy placement. eFAST yielded a positive diagnosis of PTX in 19 patients (16.8%), and all were clinically significant, requiring tube thoracostomy. Chest X-ray detected clinically significant PTX in 105 patients (92.9%). The literature on the utility of eFAST for PTX in trauma is variable. Our data show that although specific for clinically significant traumatic PTX, it has poor sensitivity when performed by clinicians with variable levels of ultrasound training. We conclude that CT is still the gold standard in detecting PTX, and clinicians performing eFAST should have adequate training.

  15. CT Imaging of facial trauma. The role of different types of reconstruction. Part II - soft tissues

    International Nuclear Information System (INIS)

    Myga-Porosilo, J.; Sraga, W.; Borowiak, H.; Jackowska, Z.; Kluczewska, E.; Skrzelewski, S.

    2011-01-01

    Background: Injury to facial soft tissues as a complication of skeleton fractures is an important problem among patients with facial trauma. The aim of this work was to assess the value of multiplanar and three-dimensional (3D) reconstruction computed tomography (CT) images obtained by using multi-detector row technology in spiral data acquisition in patients with facial injuries of soft tissue. Material/Methods: Sixty-seven patients diagnosed with injury to the facial skeleton underwent a CT scan with the use of GE Hispeed Qx/i scanner. For each patient: a two-dimensional (2D) multiplanar reconstruction (MPR), maximum intensity projection (MIP), and 3D volume rendering (VR) were conducted. Post-injury lesions of soft tissues were assessed. During the assessment of the post-injury lesions of soft tissues, the following features were evaluated: Extra ocular muscle and fat tissue herniation through fractures in the medial and inferior orbital walls. Fluid in the sinuses and in the nasal cavity. Subcutaneous tissue emphysema. Results: For subcutaneous emphysema and sinus fluid imaging, both the axial and the 2D image reconstruction proved comparably effective. However, 2D reconstructions were superior to transverse plane images with regard to herniations into fractures of the inferior orbital wall. 3D reconstruction has no importance in diagnosing soft tissue injuries. Conclusions: Multiplanar CT reconstructions increase the effectiveness of imaging of orbital tissue herniations, especially in case of fractures in the inferior orbital wall. In suspected soft tissue herniations, as well as prior to surgical treatment, spiral CT with 2D multiplanar reconstructions should be the method of choice. (authors)

  16. Precision lifetime measurements of Ar II 4p doublet levels

    International Nuclear Information System (INIS)

    Marger, D.; Schmoranzer, H.

    1990-01-01

    The lifetimes of the Ar II 4p doublet fine-structure levels 4p 2 D 0 5/2 , 4p' 2 F 0 5/2 and 4p' 2 F 0 7/2 were measured by beam-dye laser spectroscopy. The experimental uncertainty was reduced to below 1%. (orig.)

  17. [Changes in 2,3-diphosphoglycerate Levels in Blood and Brain Tissue after Craniocerebral Trauma and Cardiac Surgery].

    Science.gov (United States)

    Hausdörfer, J; Heller, W; Junger, H; Oldenkott, P; Stunkat, R

    1976-10-01

    The response of the 2,3-diphosphoglycerate (DPG) levels in the blood and brain tissue to a craniocerebral trauma of varying severity was studied in anaesthetized rats. A trauma producing cerebral contusion was followed within two hours by a highly significant rise in DPG concentration in the blood as compared with the control animals or only mildly traumatized rats. The DPG levels in the brain tissue showed no significant differences. Similar changes in DPG concentration were observed in the blood of patients with craniocerebral injuries. The DPG-mediated increased release of oxygen to the tissues represents a compensatory mechanism and is pathognomic for craniocerebral trauma. Patients undergoing surgery with extracorporeal circulation lack this mechanism for counteracting hypoxaemia; already during thoracotomy the DPG concentration in the blood fell significantly and did not reach its original level until 72 hours after the operation. In stored, ACD stabilized, blood the DPG concentration gradually decreases. Estimations carried out over 28 days showed a continuous statistically significant loss of DPG. After 24 hours the DPG levels in stored blood had already dropped to the lower limits of normal - a fact that has to be taken into account in massive blood transfusions.

  18. A multi-level modeling approach examining PTSD symptom reduction during prolonged exposure therapy: moderating effects of number of trauma types experienced, having an HIV-related index trauma, and years since HIV diagnosis among HIV-positive adults.

    Science.gov (United States)

    Junglen, Angela G; Smith, Brian C; Coleman, Jennifer A; Pacella, Maria L; Boarts, Jessica M; Jones, Tracy; Feeny, Norah C; Ciesla, Jeffrey A; Delahanty, Douglas L

    2017-11-01

    People living with HIV (PLWH) have extensive interpersonal trauma histories and higher rates of posttraumatic stress disorder (PTSD) than the general population. Prolonged exposure (PE) therapy is efficacious in reducing PTSD across a variety of trauma samples; however, research has not examined factors that influence how PTSD symptoms change during PE for PLWH. Using multi-level modeling, we examined the potential moderating effect of number of previous trauma types experienced, whether the index trauma was HIV-related or not, and years since HIV diagnosis on PTSD symptom reduction during a 10-session PE protocol in a sample of 51 PLWH. In general, PTSD symptoms decreased linearly throughout the PE sessions. Experiencing more previous types of traumatic events was associated with a slower rate of PTSD symptom change. In addition, LOCF analyses found that participants with a non-HIV-related versus HIV-related index trauma had a slower rate of change for PTSD symptoms over the course of PE. However, analyses of raw data decreased this finding to marginal. Years since HIV diagnosis did not impact PTSD symptom change. These results provide a better understanding of how to tailor PE to individual clients and aid clinicians in approximating the rate of symptom alleviation. Specifically, these findings underscore the importance of accounting for trauma history and index trauma type when implementing a treatment plan for PTSD in PLWH.

  19. Outcome of penetrating chest injuries in an urban level I trauma center in the Netherlands.

    Science.gov (United States)

    Heus, C; Mellema, J J; Giannakopoulos, G F; Zuidema, W P

    2015-04-25

    Most patients with penetrating chest injuries benefit from early treatment with chest tube drainage or surgery. Although penetrating chest injury is not uncommon, few descriptive studies are published, especially in Europe. The aim of this study was to review our experience and further improve our management of penetrating chest injuries in a level I trauma center in the Netherlands. All patients with penetrating chest injury between August 2004 and December 2012 were included. Demographics, mechanism of injury, physiological parameters, Injury Severity Scores (ISS), surgical and non-surgical treatment, length of intensive care unit (ICU) stay, length of hospital stay (LOS), complications and rate of mortality were collected. A total of 159 patients were analyzed. Patients included 116 (73 %) stab wounds and 34 (21 %) gunshot wounds. In 27 patients (17 %), cardiac injury was seen. The mean ISS was 12. Almost half of all patients (49 %) were treated with only chest tube drainage. Alternatively, surgical treatment was performed in 24 % of all cases. Anterolateral incision was most frequently used to gain access to the thoracic cavity. The mean LOS was 9 days. Among all patients, 17 % were admitted to the ICU with a mean stay of 3 days. In 18 (11 %) patients, one or more complications occurred. The 30-day mortality was 7.5 %. Patients presenting with penetrating chest injury are not uncommon in the Netherlands and can mostly be treated conservatively. In one-fourth of the patients, surgical treatment is performed. A structural and vigorous approach is needed for good clinical outcome.

  20. HIV infection duration, social support and the level of trauma symptoms in a sample of HIV-positive Polish individuals.

    Science.gov (United States)

    Rzeszutek, Marcin; Oniszczenko, Włodzimierz; Żebrowska, Magdalena; Firląg-Burkacka, Ewa

    2015-01-01

    The aim of this study was to investigate the relationship between the average HIV infection duration and the level of quantitatively rated post-traumatic stress disorder (PTSD) symptoms and social support dimensions in a sample of 562 Polish HIV+ adults. Possible moderating effects of social support on the relationship between the average HIV infection duration and the level of PTSD symptoms were also analysed. The results of this study suggest that the average HIV infection duration may intensify PTSD symptoms and deteriorate the perceived availability of social support in HIV+ individuals. However, a positive relationship between HIV infection duration and the level of trauma symptoms was observed only in the group of HIV+ individuals with low perceived available social support, but not in the group of HIV-infected individuals with high perceived available social support. This research provided some new insight into the psychological and social aspects of living with HIV. In particular, our results suggest that although HIV infection duration may intensify trauma symptoms and deteriorate social support, perceived available social support may act as a buffer against HIV-related trauma symptoms.

  1. Trauma care in Scotland: effect of rurality on ambulance travel times and level of destination healthcare facility.

    Science.gov (United States)

    Yeap, E E; Morrison, J J; Apodaca, A N; Egan, G; Jansen, J O

    2014-06-01

    The aim of this study was to determine the effect of rurality on the level of destination healthcare facility and ambulance response times for trauma patients in Scotland. We used a retrospective analysis of pre-hospital data routinely collected by the Scottish Ambulance Service from 2009-2010. Incident locations were categorised by rurality, using the Scottish urban/rural classification. The level of destination healthcare facility was coded as either a teaching hospital, large general hospital, general hospital, or other type of facility. A total of 64,377 incidents met the inclusion criteria. The majority of incidents occurred in urban areas, which mostly resulted in admission to teaching hospitals. Incidents from other areas resulted in admission to a lower-level facility. The majority of incidents originating in very remote small towns and very remote rural areas were treated in a general hospital. Median call-out times and travel times increased with the degree of rurality, although with some exceptions. Trauma is relatively rare in rural areas, but patients injured in remote locations are doubly disadvantaged by prolonged pre-hospital times and admission to a hospital that may not be adequately equipped to deal with their injuries. These problems may be overcome by the regionalisation of trauma care, and enhanced retrieval capability.

  2. The prevalence and impact of prescription controlled substance use among injured patients at a Level I trauma center.

    Science.gov (United States)

    Cannon, Robert; Bozeman, Matthew; Miller, Keith Roy; Smith, Jason Wayne; Harbrecht, Brian; Franklin, Glen; Benns, Matthew

    2014-01-01

    There has been increasing attention focused on the epidemic of prescription drug use in the United States, but little is known about its effects in trauma. The purpose of this study was to define the prevalence of prescription controlled substance use among trauma patients and determine its effects on outcome. A retrospective review of all patients admitted to a Level 1 trauma center from January 1, 2011, to December 31, 2011, was performed. Patients dying within 24 hours or without home medication reconciliations were excluded. Data review included preexisting benzodiazepine or narcotic use, sex, age, mechanism of injury, Injury Severity Scores (ISSs), intensive care unit (ICU) and overall length of stay, ventilator days, and overall cost. SAS version 9.3 was used for the analysis, and p ≤ 0.05 was considered significant. A total of 1,700 patients met inclusion criteria. Of these, 340 (20.0%) were on prescription narcotics and/or benzodiazepines at the time of admission. Patients in the narcotic/benzodiazepine group were significantly older (48 years vs. 43 years) and more likely to be women (43.7% vs. 28.9%). There was no difference in mechanism, ISS, or the presence of head injury between groups. Both ICU length of stay (3.3 days vs. 2.1 days) and total length of stay (7.8 days vs. 6.1 days) were significantly longer in patients on outpatient narcotics and/or benzodiazepines. Excluding severely injured patients, the need for mechanical ventilation was also increased among outpatient controlled substance users (15.8% vs. 11.0%). There is a substantial prevalence of preexisting controlled substance use (20%) among patients at our Level 1 trauma center. Preexisting controlled substance use is associated with longer total hospital and ICU stays. Among mildly to moderately injured patients, preinjury controlled substance is also associated with the need for mechanical ventilation. Prognostic study, level III.

  3. Levels of evidence in pelvic trauma: a bibliometric analysis of the top 50 cited papers.

    Science.gov (United States)

    White-Gibson, Ailbhe; O'Neill, Barry; Cooper, David; Leonard, Michael; O'Daly, Brendan

    2018-05-12

    Scientific research is an essential aspect in the ongoing development of medical education and improved patient care. Dissemination of findings is a pivotal goal of any health research study. The number of citations that a published article receives is reflective of the importance that paper has on clinical practice. To date, it is unknown which journals are most frequently cited as influencing the management of pelvic trauma. The aim of this study was to identify the top 50 publications relating to the management of pelvic trauma. The database of the Science Citation Index of the Institute for Scientific Information (1945 to 2016) was reviewed to identify the 50 papers most commonly cited. A total of 1535 papers were included. Of these, 31 papers were cited over 100 times with the top 50 cited 69 times or more. The top 50 were subjected to further analysis to identify the authors and institutions involved. The majority of these publications originated in the USA, followed by Canada. The most cited paper is "pelvic ring fractures-should they be fixed", published by Tile in 1988. We have identified and analysed the publications that have contributed most to the assessment and management of pelvic trauma over the past 50 years. We have also identified the researchers and institutions which have most influenced the evidence-based approach currently employed in the management of pelvic trauma.

  4. Relativistic transition rates for sextet levels in Cr II

    International Nuclear Information System (INIS)

    Aashamar, K.; Luke, T.M.

    1994-01-01

    Configuration interaction calculations have been carried out to obtain rates for electric dipole transitions and lifetimes for the 1s 2 2s 2 2p 6 3s 2 3p 6 3d 4 4d and 5s 6 D and 4d 6 F levels in Cr II. Up to 40 configurations have been included so correlation effects should be well accounted for. Relativistic interactions are included through the use of the Breit-Pauli hamiltonian to obtain the level wave functions and energies. Strong mixing of the 4d levels occurs and this leads to substantial departures from earlier nonrelativistic calculations that assume LS coupling for these states. Results include the actual compositions of both even and odd parity levels where significant mixing occurs and the rates for all transitions that are allowed to lower levels from these 4d and 5s levels. (orig.)

  5. Using Trauma and Injury Severity Score (TRISS)-based analysis in the development of regional risk adjustment tools to trend quality in a voluntary trauma system: the experience of the Trauma Foundation of Northeast Ohio.

    Science.gov (United States)

    Mancuso, C; Barnoski, A; Tinnell, C; Fallon, W

    2000-04-01

    Presently, no trauma system exists in Ohio. Since 1993, all hospitals in Cuyahoga County (CUY), northeast Ohio (n = 22) provide data to a trauma registry. In return, each received hospital-specific data, comparison data by trauma care level and a county-wide aggregate summary. This report describes the results of this approach in our region. All cases were entered by paper abstract or electronic download. Interrater reliability audits and z score analysis was performed by using the Major Trauma Outcome Study and the CUY 1994 baseline groups. Risk adjustment of mortality data was performed using statistical modeling and logistic regression (Trauma and Injury Severity Score, Major Trauma Outcome Study, CUY). Trauma severity measures were defined. In 1995, 3,375 patients were entered. Two hundred ninety-one died (8.6%). Severity measures differed by level of trauma care, indicating differences in case mix. Probability of survival was lowest in the Level I centers, highest in the acute care hospitals. Outcomes z scores demonstrated survival differences for all levels. In a functioning trauma system, the most severely injured patients should be cared for at the trauma centers. A low volume at acute care hospitals is desirable. By using Trauma and Injury Severity Score with community-specific constants, NE Ohio is accomplishing these goals. The Level I performance data are an interesting finding compared with the data from the Level II centers in the region

  6. Emergency radiology and mass casualty incidents-report of a mass casualty incident at a level 1 trauma center.

    Science.gov (United States)

    Bolster, Ferdia; Linnau, Ken; Mitchell, Steve; Roberge, Eric; Nguyen, Quynh; Robinson, Jeffrey; Lehnert, Bruce; Gross, Joel

    2017-02-01

    The aims of this article are to describe the events of a recent mass casualty incident (MCI) at our level 1 trauma center and to describe the radiology response to the event. We also describe the findings and recommendations of our radiology department after-action review. An MCI activation was triggered after an amphibious military vehicle, repurposed for tourist activities, carrying 37 passengers, collided with a charter bus carrying 45 passengers on a busy highway bridge in Seattle, WA, USA. There were 4 deaths at the scene, and 51 patients were transferred to local hospitals following prehospital scene triage. Nineteen patients were transferred to our level 1 trauma center. Eighteen casualties arrived within 72 min. Sixteen arrived within 1 h of the first patient arrival, and 1 casualty was transferred 3 h later having initially been assessed at another hospital. Eighteen casualties (94.7 %) underwent diagnostic imaging in the emergency department. Of these 18 casualties, 15 had a trauma series (portable chest x-ray and x-ray of pelvis). Whole-body trauma computed tomography scans (WBCT) were performed on 15 casualties (78.9 %), 12 were immediate and performed during the initial active phase of the MCI, and 3 WBCTs were delayed. The initial 12 WBCTs were completed in 101 min. The mean number of radiographic studies performed per patient was 3 (range 1-8), and the total number of injuries detected was 88. The surge in imaging requirements during an MCI can be significant and exceed normal operating capacity. This report of our radiology experience during a recent MCI and subsequent after-action review serves to provide an example of how radiology capacity and workflow functioned during an MCI, in order to provide emergency radiologists and response planners with practical recommendations for implementation in the event of a future MCI.

  7. Outcomes of endovascular management of acute thoracic aortic emergencies in an academic level 1 trauma center.

    Science.gov (United States)

    Echeverria, Angela B; Branco, Bernardino C; Goshima, Kay R; Hughes, John D; Mills, Joseph L

    2014-12-01

    Thoracic aortic emergencies account for 10% of thoracic-related admissions in the United States and remain associated with high morbidity and mortality rates. Open repair has declined owing to the emergence of thoracic endovascular aortic repair (TEVAR), but data on emergency TEVAR use for acute aortic pathology remain limited. We therefore reviewed our experience. We retrospectively evaluated emergency descending thoracic aortic endovascular interventions performed at a single academic level 1 trauma center between January 2005 and August 2013 including all cases of traumatic aortic injury, ruptured descending thoracic aneurysm, penetrating atherosclerotic ulcer, aortoenteric fistula, and acute complicated type B dissection. Demographics, clinical data, and outcomes were extracted. Stepwise logistic regression was used to identify independent risk factors for death. During the study period, 51 patients underwent TEVAR; 22 cases (43.1%) were performed emergently (11 patients [50.0%] traumatic aortic injury; 4 [18.2%] ruptured descending thoracic aneurysm; 4 [18.2%] complicated type B dissection; 2 [9.1%] penetrating aortic ulcer; and 1 [4.5%] aortoenteric fistula). Overall, 72.7% (n = 16) were male with a mean age of 54.8 ± 15.9 years. Nineteen patients (86.4%) required only a single TEVAR procedure, whereas 2 (9.1%) required additional endovascular therapy, and 1 (4.5%) open thoracotomy. Four traumatic aortic injury patients required exploratory laparotomy for concomitant intra-abdominal injuries. During a mean hospital length of stay of 18.9 days (range, 1 to 76 days), 3 patients (13.6%) developed major complications. In-hospital mortality was 27.2%, consisting of 6 deaths from traumatic brain injury (1); exsanguination in the operating room before repair could be achieved (2); bowel ischemia (1) and multisystem organ failure (1); and family withdrawal of care (1). A stepwise logistic regression model identified 24-hour packed red blood cell requirements ≥4

  8. Diagnostic and Predictive Values of Thirst, Angiotensin II, and Vasopressin During Trauma Resuscitation

    Science.gov (United States)

    2010-09-01

    and plasma AVP and AT2 levels across a broader spectrum of hemorrhagic shock severity may be warranted. The authors wish to thank the medical, nursing ...301. 2. Olsson K. Central control of vasopressin release and thirst. Acta Paediatr Scand Suppl. 1983;305:36–9. Pr eh os p E m er g C ar e D ow nl oa

  9. High levels of soluble VEGF receptor 1 early after trauma are associated with shock, sympathoadrenal activation, glycocalyx degradation and inflammation in severely injured patients

    DEFF Research Database (Denmark)

    Ostrowski, Sisse R; Sørensen, Anne Marie; Windeløv, Nis Agerlin

    2012-01-01

    The level of soluble vascular endothelial growth factor receptor 1 (sVEGFR1) is increased in sepsis and strongly associated with disease severity and mortality. Endothelial activation and damage contribute to both sepsis and trauma pathology. Therefore, this study measured sVEGFR1 levels in trauma...... patients upon hospital admission hypothesizing that sVEGFR1 would increase with higher injury severity and predict a poor outcome....

  10. High plasma levels of high mobility group box 1 is associated with the risk of sepsis in severe blunt chest trauma patients: a prospective cohort study.

    Science.gov (United States)

    Wang, Xiao-Wen; Karki, Avash; Zhao, Xing-Ji; Xiang, Xiao-Yong; Lu, Zhi-Qian

    2014-08-02

    High mobility group box 1 (HMGB1) is a late mediator of systemic inflammation. Extracellular HMGB1 play a central pathogenic role in critical illness. The purpose of the study was to investigate the association between plasma HMGB1 concentrations and the risk of poor outcomes in patients with severe blunt chest trauma. The plasma concentrations of HMGB1 in patients with severe blunt chest trauma (AIS ≥ 3) were measured by a quantitative enzyme-linked immunosorbent assay at four time points during seven days after admission, and the dynamic release patterns were monitored. The biomarker levels were compared between patients with sepsis and non-sepsis, and between patients with multiple organ dysfunction syndrome (MODS) and non-MODS. The related factors of prognosis were analyzed by using multivariate logistic regression analysis. The short-form 36 was used to evaluate the quality of life of patients at 12 months after injury. Plasma HMGB1 levels were significantly higher both in sepsis and MODS group on post-trauma day 3, 5, and 7 compared with the non-sepsis and non-MODS groups, respectively. Multivariate analysis showed that HMGB1 levels and ISS were independent risk factors for sepsis and MODS in patients with severe blunt chest trauma. Plasma HMGB1 levels were significantly elevated in patients with severe blunt chest trauma. HMGB1 levels were associated with the risk of poor outcome in patients with severe blunt chest trauma. Daily HMGB1 levels measurements is a potential useful tool in the early identification of post-trauma complications. Further studies are needed to determine whether HMGB1 intervention could prevent the development of sepsis and MODS in patients with severe blunt chest trauma.

  11. Wavelengths, energy levels and hyperfine structure of Mn II and Sc II.

    Science.gov (United States)

    Nave, Gillian; Pickering, Juliet C.; Townley-Smith, Keeley I. M.; Hala, .

    2015-08-01

    For many decades, the Atomic Spectroscopy Groups at the National Institute of Standards and Technology (NIST) and Imperial College London (ICL) have measured atomic data of astronomical interest. Our spectrometers include Fourier transform (FT) spectrometers at NIST and ICL covering the region 1350 Å to 5.5 μm and a 10.7-m grating spectrometer at NIST covering wavelengths from 300 - 5000 Å. Sources for these spectra include high-current continuous and pulsed hollow cathode (HCL) lamps, Penning discharges, and sliding spark discharges. Recent work has focused on the measurement and analysis of wavelengths, energy levels, and hyperfine structure (HFS) constants for iron-group elements. The analysis of FT spectra of Cr I, Mn I, and Mn II is being led by ICL and is described in a companion poster [1]. Current work being led by NIST includes the analysis of HFS in Mn II, analysis of Mn II in the vacuum ultraviolet, and a comprehensive analysis of Sc II.Comprehensive HFS constants for Mn II are needed for the interpretation of stellar spectra and incorrect abundances may be obtained when HFS is omitted. Holt et al. [2] have measured HFS constants for 59 levels of Mn II using laser spectroscopy. We used FT spectra of Mn/Ni and Mn/Cu HCLs covering wavelength ranges from 1350 Å to 5.4 μm to confirm 26 of the A constants of Holt et al. and obtain values for roughly 40 additional levels. We aim to obtain HFS constants for the majority of lines showing significant HFS that are observed in chemically-peculiar stars.Spectra of Sc HCLs have been recorded from 1800 - 6700 Å using a vacuum ultraviolet FT spectrometer at NIST. Additional measurements to cover wavelengths above 6700 Å and below 1800 Å are in progress. The spectra are being analyzed by NIST and Alighar Muslim University, India in order to derive improved wavelengths, energy levels, and hyperfine structure parameters.This work was partially supported by NASA, the STFC and PPARC (UK), the Royal Society of the UK

  12. Is case triaging a useful tool for emergency surgeries? A review of 106 trauma surgery cases at a level 1 trauma center in South Africa.

    Science.gov (United States)

    Chowdhury, Sharfuddin; Nicol, Andrew John; Moydien, Mahammed Riyaad; Navsaria, Pradeep Harkison; Montoya-Pelaez, Luis Felipe

    2018-01-01

    The optimal timing for emergency surgical interventions and implementation of protocols for trauma surgery is insufficient in the literature. The Groote Schuur emergency surgery triage (GSEST) system, based on Cape Triaging Score (CTS), is followed at Groote Schuur Hospital (GSH) for triaging emergency surgical cases including trauma cases. The study aimed to look at the effect of delay in surgery after scheduling based on the GSEST system has an impact on outcome in terms of postoperative complications and death. Prospective audit of patients presenting to GSH trauma center following penetrating or blunt chest, abdominal, neck and peripheral vascular trauma who underwent surgery over a 4-month period was performed. Post-operative complications were graded according to Clavien-Dindo classification of surgical complications. One-hundred six patients underwent surgery during the study period. One-hundred two (96.2%) cases were related to penetrating trauma. Stab wounds comprised 71 (67%) and gunshot wounds (GSW) 31 (29.2%) cases. Of the 106 cases, 6, 47, 40, and 13 patients were booked as red, orange, yellow, and green, respectively. The median delay for green, yellow, and orange cases was within the expected time. The red patients took unexpectedly longer (median delay 48 min, IQR 35-60 min). Thirty-one (29.3%) patients developed postoperative complications. Among the booked red, orange, yellow, and green cases, postoperative complications developed in 3, 18, 9, and 1 cases, respectively. Only two (1.9%) postoperative deaths were documented during the study period. There was no statistically significant association between operative triage and post-operative complications ( p  = 0.074). Surgical case categorization has been shown to be useful in prioritizing emergency trauma surgical cases in a resource constraint high-volume trauma center.

  13. Incidence and etiology of mortality in polytrauma patients in a Dutch level I trauma center.

    Science.gov (United States)

    El Mestoui, Zainab; Jalalzadeh, Hamid; Giannakopoulos, Georgios F; Zuidema, Wietse P

    2017-02-01

    Earlier studies assessing mortality in polytrauma patients have focused on improving trauma care and reducing complications during hospital stay. The same studies have shown that the complication rate in these patients is high, often resulting in death. The aim of this study was to assess the incidence and causes of mortality in polytrauma patients in our institute. Secondarily, we assessed the donation and autopsy rates and outcome in these patients. All polytrauma patients (injury severity score≥16) transported to and treated in our institute during a period of 6 years were retrospectively analyzed. We included all patients who died during hospital stay. Prehospital and in-hospital data were collected on patients' condition, diagnostics, and treatment. The chance of survival was calculated according to the TRISS methodology. Patients were categorized according to the complications during treatment and causes of death. Logistic regression analysis was used to design a prediction model for mortality in major trauma. A statistical analysis was carried out. Of the 1073 polytrauma patients who were treated in our institute during the study period, 205 (19.1%) died during hospital stay. The median age of the deceased patients was 58.8 years and 125 patients were men. Their mean injury severity score was 30.4. The most common mechanism of injury involved fall from height, followed by bicycle accidents. Almost 50% of the patients underwent an emergency intervention. Almost 92% of the total population died because of the effects of the accident (primary trauma). Of these, 24% died during primary assessment in the emergency department. Most patients died because of the effects of severe head injury (63.4%), followed by exsanguination (17.6%). The most common type of complications causing death during treatment was respiratory failure (6.3%), followed by multiple organ failure (1.5%). Autopsy was performed in 10.4%. Organ donation procedure was performed in 14

  14. The CMS Level-1 trigger for LHC Run II

    Science.gov (United States)

    Tapper, A.

    2018-02-01

    During LHC Run II the centre-of-mass energy of pp collisions has increased from 8 TeV up to 13 TeV and the instantaneous luminosity has progressed towards 2 × 1034 cm-2s-1. In order to guarantee a successful and ambitious physics programme under these conditions, the CMS trigger system has been upgraded. The upgraded CMS Level-1 trigger is designed to improve performance at high luminosity and large number of simultaneous inelastic collisions per crossing. The trigger design, implementation and commissioning are summarised, and performance results are described.

  15. Improvement in the workflow efficiency of treating non-emergency outpatients by using a WLAN-based real-time location system in a level I trauma center.

    Science.gov (United States)

    Stübig, Timo; Suero, Eduardo; Zeckey, Christian; Min, William; Janzen, Laura; Citak, Musa; Krettek, Christian; Hüfner, Tobias; Gaulke, Ralph

    2013-01-01

    Patient localization can improve workflow in outpatient settings, which might lead to lower costs. The existing wireless local area network (WLAN) architecture in many hospitals opens up the possibility of adopting real-time patient tracking systems for capturing and processing position data; once captured, these data can be linked with clinical patient data. To analyze the effect of a WLAN-based real-time patient localization system for tracking outpatients in our level I trauma center. Outpatients from April to August 2009 were included in the study, which was performed in two different stages. In phase I, patient tracking was performed with the real-time location system, but acquired data were not displayed to the personnel. In phase II tracking, the acquired data were automatically collected and displayed. Total treatment time was the primary outcome parameter. Statistical analysis was performed using multiple linear regression, with the significance level set at 0.05. Covariates included sex, age, type of encounter, prioritization, treatment team, number of residents, and radiographic imaging. 1045 patients were included in our study (540 in phase I and 505 in phase 2). An overall improvement of efficiency, as determined by a significantly decreased total treatment time (23.7%) from phase I to phase II, was noted. Additionally, significantly lower treatment times were noted for phase II patients even when other factors were considered (increased numbers of residents, the addition of imaging diagnostics, and comparison among various localization zones). WLAN-based real-time patient localization systems can reduce process inefficiencies associated with manual patient identification and tracking.

  16. Esophageal button battery ingestions: decreasing time to operative intervention by level I trauma activation.

    Science.gov (United States)

    Russell, Robert T; Griffin, Russell L; Weinstein, Elizabeth; Billmire, Deborah F

    2014-09-01

    The incidence of button battery ingestions is increasing and injury due to esophageal impaction begins within minutes of exposure. We changed our management algorithm for suspected button battery ingestions with intent to reduce time to evaluation and operative removal. A retrospective study was performed to identify and evaluate time to treatment and outcome for all esophageal button battery ingestions presenting to a major children's hospital emergency room from February 1, 2010 through February 1, 2012. During the first year, standard emergency room triage (ST) was used. During the second year, the triage protocol was changed and Trauma I triage (TT) was used. 24 children had suspected button battery ingestions with 11 having esophageal impaction. One esophageal impaction was due to 2 stacked coins. Time from arrival in emergency room to battery removal was 183minutes in ST group (n=4) and 33minutes in TT group (n=7) (p=0.04). One patient in ST developed a tracheoesophageal fistula. There were no complications in the TT group. The use of Trauma 1 activations for suspected button battery ingestions has led to more expedient evaluation and shortened time to removal of impacted esophageal batteries. Copyright © 2014 Elsevier Inc. All rights reserved.

  17. The trauma ecosystem: The impact and economics of new trauma centers on a mature statewide trauma system.

    Science.gov (United States)

    Ciesla, David J; Pracht, Etienne E; Leitz, Pablo T; Spain, David A; Staudenmayer, Kristan L; Tepas, Joseph J

    2017-06-01

    Florida serves as a model for the study of trauma system performance. Between 2010 and 2104, 5 new trauma centers were opened alongside 20 existing centers. The purpose of this study was to explore the impact of trauma system expansion on system triage performance and trauma center patients' profiles. A statewide data set was queried for all injury-related discharges from adult acute care hospitals using International Classification of Diseases, Ninth Revision (ICD-9) codes for 2010 and 2014. The data set, inclusion criteria, and definitions of high-risk injury were chosen to match those used by the Florida Department of Health in its trauma registry. Hospitals were classified as existing Level I (E1) or Level II (E2) trauma centers and new E2 (N2) centers. Five N2 centers were established 11.6 to 85.3 miles from existing centers. Field and overall trauma system triage of high-risk patients was less accurate with increased overtriage and no change in undertriage. Annual volume at N2 centers increased but did not change at E1 and E2 centers. In 2014, Patients at E1 and E2 centers were slightly older and less severely injured, while those at N2 centers were substantially younger and more severely injured than in 2010. The injured patient-payer mix changed with a decrease in self-pay and commercial patients and an increase in government-sponsored patients at E1 and E2 centers and an increase in self-pay and commercial patients with a decrease in government-sponsored patients at N2 centers. Designation of new trauma centers in a mature system was associated with a change in established trauma center demographics and economics without an improvement in trauma system triage performance. These findings suggest that the health of an entire trauma system network must be considered in the design and implementation of a regional trauma system. Therapeutic/care management study, level IV; epidemiological, level IV.

  18. Mortality in severe trauma patients attended by emergency services in Navarre, Spain: validation of a new prediction model and comparison with the Revised Injury Severity Classification Score II.

    Science.gov (United States)

    Ali Ali, Bismil; Lefering, Rolf; Fortún Moral, Mariano; Belzunegui Otano, Tomás

    2018-01-01

    To validate the Mortality Prediction Model of Navarre (MPMN) to predict death after severe trauma and compare it to the Revised Injury Severity Classification Score II (RISCII). Retrospective analysis of a cohort of severe trauma patients (New Injury Severity Score >15) who were attended by emergency services in the Spanish autonomous community of Navarre between 2013 and 2015. The outcome variable was 30-day all-cause mortality. Risk was calculated with the MPMN and the RISCII. The performance of each model was assessed with the area under the receiver operating characteristic (ROC) curve and precision with respect to observed mortality. Calibration was assessed with the Hosmer-Lemeshow test. We included 516 patients. The mean (SD) age was 56 (23) years, and 363 (70%) were males. Ninety patients (17.4%) died within 30 days. The 30-day mortality rates predicted by the MPMN and RISCII were 16.4% and 15.4%, respectively. The areas under the ROC curves were 0.925 (95% CI, 0.902-0.952) for the MPMN and 0.941 (95% CI, 0.921-0.962) for the RISCII (P=0.269, DeLong test). Calibration statistics were 13.6 (P=.09) for the MPMN and 8.9 (P=.35) for the RISCII. Both the MPMN and the RISCII show good ability to discriminate risk and predict 30-day all-cause mortality in severe trauma patients.

  19. Association between increased blood interleukin-6 levels on emergency department arrival and prolonged length of intensive care unit stay for blunt trauma.

    Science.gov (United States)

    Taniguchi, Masashi; Nakada, Taka-Aki; Shinozaki, Koichiro; Mizushima, Yasuaki; Matsuoka, Tetsuya

    2016-01-01

    Systemic immune response to injury plays a key role in the pathophysiological mechanism of blunt trauma. We tested the hypothesis that increased blood interleukin-6 (IL-6) levels of blunt trauma patients on emergency department (ED) arrival are associated with poor clinical outcomes, and investigated the utility of rapid measurement of the blood IL-6 level. We enrolled 208 consecutive trauma patients who were transferred from the scene of an accident to a level I trauma centre in Japan and admitted to the intensive care unit (ICU). Blood IL-6 levels on ED arrival were measured by using a rapid measurement assay. The primary outcome variable was prolonged ICU stay (length of ICU stay > 7 days). The secondary outcomes were 28-day mortality, probability of survival and Abbreviated Injury Scale (AIS) scores. Patients with prolonged ICU stay had significantly higher blood IL-6 levels on ED arrival than the patients without prolonged ICU stay (P tool to improve assessment of injury severity and prediction of clinical outcomes in the initial phase of trauma care.

  20. Twenty-years of splenic preservation at a level 1 pediatric trauma center.

    Science.gov (United States)

    Bairdain, Sigrid; Litman, Heather J; Troy, Michael; McMahon, Maria; Almodovar, Heidi; Zurakowski, David; Mooney, David P

    2015-05-01

    Splenic preservation is the standard of care for hemodynamically stable children with splenic injuries. We report a 20-year single-institutional series of children with splenic injuries managed without a splenectomy. Children evaluated and treated for blunt splenic injury at Boston Children's Hospital from 1994 to 2014 were extracted from the trauma registry. Demographics, clinical characteristics, complications, and outcomes were reviewed. Three time-periods were evaluated based upon the development and modification of splenic injury clinical pathway guidelines (CPGs). Survival was defined as being discharged from the hospital alive. 502 suffered isolated splenic injuries. The median AAST grade of splenic injury increased across the three CPG time periods (psplenic-injury related mortalities occurred. Hospital length of stay decreased significantly secondary to splenic injury CPGs (psplenic injury, no patient died or underwent splenectomy. Hospital length of stay decreased across time, despite an increase in the severity of splenic injuries encountered. Splenectomy has become so unusual in the management of hemodynamically stable children with a splenic injury that it may no longer be a legitimate outcome marker. Copyright © 2015 Elsevier Inc. All rights reserved.

  1. The CMS Level-1 Calorimeter Trigger for LHC Run II

    CERN Document Server

    Zabi, Alexandre; Cadamuro, Luca; Davignon, Olivier; Romanteau, Thierry; Strebler, Thomas; Cepeda, Maria Luisa; Sauvan, Jean-baptiste; Wardle, Nicholas; Aggleton, Robin Cameron; Ball, Fionn Amhairghen; Brooke, James John; Newbold, David; Paramesvaran, Sudarshan; Smith, D; Taylor, Joseph Ross; Fountas, Konstantinos; Baber, Mark David John; Bundock, Aaron; Breeze, Shane Davy; Citron, Matthew; Elwood, Adam Christopher; Hall, Geoffrey; Iles, Gregory Michiel; Laner Ogilvy, Christian; Penning, Bjorn; Rose, A; Shtipliyski, Antoni; Tapper, Alexander; Durkin, Timothy John; Harder, Kristian; Harper, Sam; Shepherd-Themistocleous, Claire; Thea, Alessandro; Williams, Thomas Stephen; Dasu, Sridhara Rao; Dodd, Laura Margaret; Klabbers, Pamela Renee; Levine, Aaron; Ojalvo, Isabel Rose; Ruggles, Tyler Henry; Smith, Nicholas Charles; Smith, Wesley; Svetek, Ales; Forbes, R; Tikalsky, Jesra Lilah; Vicente, Marcelo

    2017-01-01

    Results from the completed Phase 1 Upgrade of the Compact Muon Solenoid (CMS) Level-1 Calorimeter Trigger are presented. The upgrade was completed in two stages, with the first running in 2015 for proton and Heavy Ion collisions and the final stage for 2016 data taking. The Level-1 trigger has been fully commissioned and has been used by CMS to collect over 43 fb-1 of data since the start of the Large Hadron Collider (LHC) Run II. The new trigger has been designed to improve the performance at high luminosity and large number of simultaneous inelastic collisions per crossing (pile-up). For this purpose it uses a novel design, the Time Multiplexed Trigger (TMT), which enables the data from an event to be processed by a single trigger processor at full granularity over several bunch crossings. The TMT design is a modular design based on the uTCA standard. The trigger processors are instrumented with Xilinx Virtex-7 690 FPGAs and 10 Gbps optical links. The TMT architecture is flexible and the number of trigger p...

  2. Trend and Demographic Characteristics of Maxillofacial Fractures in Level I Trauma Center.

    Science.gov (United States)

    Emodi, Omri; Wolff, Amir; Srouji, Hanna; Bahouth, Hany; Noy, Dani; Abu El Naaj, Imad; Rachmiel, Adi

    2018-03-01

    The aim of this study was to analyze the pattern and treatment of craniomaxillofacial injuries in the northern part of Israel, within a Jewish majority and large Arab minority population. A 5-year retrospective study evaluated patients treated for craniomaxillofacial fractures. Fracture cause, type, site, and patient demographics were evaluated. Patient age ranged from 1 to 94 years with an average age of 36.7 years; 52% of the victims were Jews and 48% Arabs. There was male predilection in both sectors (78.3% vs 21.7%). The main site of injury was the zygomatic bone (33.5%) followed by nasal bone, orbital, mandible, frontal sinus, and maxillary fractures. The main etiology of injuries was falls (45.4%) with significantly more falls reported by females (52.1% vs 43.2% in males). Motor vehicle accidents caused injuries more frequent in males. Arabs experienced CMF fractures at a younger age compared to Jews (27.8 and 44.8 average age, respectively). In the elderly, the trend reversed where Jews were more prone to craniomaxillofacial fractures. Compared to their weight in the population, the Arab sector experiences more craniomaxillofacial injuries. The Jewish elderly population tends to reside in nursing homes where they are more susceptible to accidental falls, whereas young Arab males are more exposed to motor vehicle accidents and interpersonal violence. Falls were the main cause of injuries particularly in women. This may reflect the women's fear of reporting domestic violence. We believe that increased government investments in infrastructures and education will lower the incidence of craniomaxillofacial trauma and balance the gap between both sectors and sexes.

  3. The impact of morbid obesity on solid organ injury in children using the ATOMAC protocol at a pediatric level I trauma center.

    Science.gov (United States)

    Vaughan, Nathan; Tweed, Jeff; Greenwell, Cynthia; Notrica, David M; Langlais, Crystal S; Peter, Shawn D St; Leys, Charles M; Ostlie, Daniel J; Maxson, R Todd; Ponsky, Todd; Tuggle, David W; Eubanks, James W; Bhatia, Amina; Greenwell, Cynthia; Garcia, Nilda M; Lawson, Karla A; Motghare, Prasenjeet; Letton, Robert W; Alder, Adam C

    2017-02-01

    Obesity is an epidemic in the pediatric population. Childhood obesity in trauma has been associated with increased incidence of long-bone fractures, longer ICU stays, and decreased closed head injuries. We investigated for differences in the likelihood of failure of non-operative management (NOM), and injury grade using a subset of a multi-institutional, prospective database of pediatric patients with solid organ injury (SOI). We prospectively collected data on all pediatric patients (hepatic injury (36.8% versus 15.3%, P=0.048) but not a significant difference in likelihood of severe (grade 4 or 5) splenic injury (15.3% versus 10.5%, P=0.736). Obese patients had a higher mean ISS (22.5 versus 16.1, P=0.021) and mean abdominal AIS (3.5 versus 2.9, P=0.024). Obesity is a risk factor for more severe abdominal injury, specifically liver injury, but without an associated increase in failure of NOM. This may be explained by the presence of hepatic steatosis making the liver more vulnerable to injury. A protocol based upon physiologic parameters was associated with a low rate of failure regardless of the pediatric obesity status. Level II prognosis. Copyright © 2016 Elsevier Inc. All rights reserved.

  4. Variations of the blood gas levels and thermodilutional parameters during ICP monitoring after severe head trauma in children.

    Science.gov (United States)

    Lubrano, Riccardo; Elli, Marco; Stoppa, Francesca; Di Traglia, Mario; Di Nardo, Matteo; Perrotta, Daniela; David, Piero; Paoli, Sara; Cecchetti, Corrado

    2015-08-01

    The purpose of this study was to define, in children following head trauma and GSC ≤ 8, at which level of intracranial pressure (ICP), the thermodilutional, and gas analytic parameters implicated in secondary cerebral insults shows initial changes. We enrolled in the study 56 patients: 30 males and 26 females, mean age 71 ± 52 months. In all children, volumetric hemodynamic and blood gas parameters were monitored following initial resuscitation and every 4 h thereafter or whenever a hemodynamic deterioration was suspected. During the cumulative hospital stay, a total of 1050 sets of measurements were done. All parameters were stratified in seven groups according to ICP (group A1 = 0-5 mmHg, group A2 = 6-10 mmHg, group A3 = 11-15 mmHg, group A4 16-20 mmHg, group A5 21-25 mmHg, group A6 26-30 mmHg, group A7 >31 mmHg). Mean values of jugular oxygen saturation (SJO2), jugular oxygen partial pressure (PJO2), extravascular lung water (EVLWi), pulmonary vascular permeability (PVPi), fluid overload (FO), and cerebral extraction of oxygen (CEO2) vary significantly from A3 (11-15 mmHg) to A4 (16-20 mmHg). They relate to ICP in a four-parameter sigmoidal function (4PS function with: r(2) = 0.90), inflection point of 15 mmHg of ICP, and a maximum curvature point on the left horizontal asymptote at 13 mmHg of ICP. Mean values of SJO2, PJO2, EVLWi, PVPi, FO, and CEO2 become pathologic at 15 mmHg of ICP; however, the curve turns steeper at 13 mmHg, possibly a warning level in children for the development of post head trauma secondary insult.

  5. Spinopelvic dissociation: multidetector computed tomographic evaluation of fracture patterns and associated injuries at a single level 1 trauma center.

    Science.gov (United States)

    Gupta, Pushpender; Barnwell, Jonathan C; Lenchik, Leon; Wuertzer, Scott D; Miller, Anna N

    2016-06-01

    The objective of the present study is to evaluate multidetector computed tomographic (MDCT) fracture patterns and associated injuries in patients with spinopelvic dissociation (SPD). Our institutional trauma registry database was reviewed from Jan. 1, 2006, to Sept. 30, 2012, specifically evaluating patients with sacral fractures. MDCT scans of patients with sacral fractures were reviewed to determine the presence of SPD. SPD cases were characterized into the following fracture patterns: U-shaped, Y-shaped, T-shaped, H-shaped, and burst. The following MDCT features were recorded: level of the horizontal fracture, location of vertical fracture, kyphosis between major fracture fragments, displacement of fracture fragment, narrowing of central spinal canal, narrowing of neural foramina, and extension into sacroiliac joints. Quantitative evaluation of the sacral fractures was performed in accordance with the consensus statement by the Spine Trauma Study Group. Medical records were reviewed to determine associated pelvic and non-pelvic fractures, bladder and bowel injuries, nerve injuries, and type of surgical intervention. Twenty-one patients had SPD, of whom 13 were men and eight were women. Mean age was 41.8 years (range 18.8 to 87.7). Five fractures (24 %) were U-shaped, six (29 %) H-shaped, four (19 %) Y-shaped, and six (29 %) burst. Nine patients (43 %) had central canal narrowing, and 19 (90 %) had neural foramina narrowing. Eleven patients (52 %) had kyphotic angulation between major fracture fragments, and seven patients (33 %) had either anterior (24 %) or posterior (10 %) displacement of the proximal fracture fragment. Fourteen patients (67 %) had associated pelvic fractures, and 20 (95 %) had associated non-pelvic fractures. Two patients (10 %) had associated urethral injuries, and one (5 %) had an associated colon injury. Seven patients (33 %) had associated nerve injuries. Six patients (29 %) had surgical fixation while 15 (71 %) were

  6. Variability in interhospital trauma data coding and scoring: A challenge to the accuracy of aggregated trauma registries.

    Science.gov (United States)

    Arabian, Sandra S; Marcus, Michael; Captain, Kevin; Pomphrey, Michelle; Breeze, Janis; Wolfe, Jennefer; Bugaev, Nikolay; Rabinovici, Reuven

    2015-09-01

    Analyses of data aggregated in state and national trauma registries provide the platform for clinical, research, development, and quality improvement efforts in trauma systems. However, the interhospital variability and accuracy in data abstraction and coding have not yet been directly evaluated. This multi-institutional, Web-based, anonymous study examines interhospital variability and accuracy in data coding and scoring by registrars. Eighty-two American College of Surgeons (ACS)/state-verified Level I and II trauma centers were invited to determine different data elements including diagnostic, procedure, and Abbreviated Injury Scale (AIS) coding as well as selected National Trauma Data Bank definitions for the same fictitious case. Variability and accuracy in data entries were assessed by the maximal percent agreement among the registrars for the tested data elements, and 95% confidence intervals were computed to compare this level of agreement to the ideal value of 100%. Variability and accuracy in all elements were compared (χ testing) based on Trauma Quality Improvement Program (TQIP) membership, level of trauma center, ACS verification, and registrar's certifications. Fifty registrars (61%) completed the survey. The overall accuracy for all tested elements was 64%. Variability was noted in all examined parameters except for the place of occurrence code in all groups and the lower extremity AIS code in Level II trauma centers and in the Certified Specialist in Trauma Registry- and Certified Abbreviated Injury Scale Specialist-certified registrar groups. No differences in variability were noted when groups were compared based on TQIP membership, level of center, ACS verification, and registrar's certifications, except for prehospital Glasgow Coma Scale (GCS), where TQIP respondents agreed more than non-TQIP centers (p = 0.004). There is variability and inaccuracy in interhospital data coding and scoring of injury information. This finding casts doubt on the

  7. Trauma team activation: Not just for trauma patients

    Directory of Open Access Journals (Sweden)

    Phoenix Vuong

    2017-01-01

    Full Text Available Specialized trauma teams have been shown to improve outcomes in critically injured patients. At our institution, an the American College of Surgeons Committee on trauma level I Trauma center, the trauma team activation (TTA criteria includes both physiologic and anatomic criteria, but any attending physician can activate the trauma team at their discretion outside criteria. As a result, the trauma team has been activated for noninjured patients meeting physiologic criteria secondary to nontraumatic hemorrhage. We present two cases in which the trauma team was activated for noninjured patients in hemorrhagic shock. The utilization of the TTA protocol and subsequent management by the trauma team are reviewed as we believe these were critical factors in the successful recovery of both patients. Beyond the primary improved survival outcomes of severely injured patients, trauma center designation has a “halo effect” that encompasses patients with nontraumatic hemorrhage.

  8. Circulating levels of platelet α-granule cytokines in trauma patients

    DEFF Research Database (Denmark)

    Windeløv, Nis Agerlin; Ostrowski, Sisse Rye; Johansson, Per Ingemar

    2015-01-01

    p 4 (p = 0.02). GPVI and PMPs levels correlated with TGFβ1 and PF4 whereas we found no significant association between cytokine levels and measures of haemostasis. By multivariate regression, a high WBC count was associated with high levels of TGFβ1 (p = 0.01) and β......TGs (p 4 (p = 0.03). CONCLUSION: Severely injured patients had higher levels of βTGs and TGFβ1 but lower levels of the PF4; a high WBC count predicted this anti-inflammatory profile of platelet cytokines....

  9. Workplace Disruption following Psychological Trauma: Influence of Incident Severity Level on Organizations' Post-Incident Response Planning and Execution.

    Science.gov (United States)

    DeFraia, G S

    2016-04-01

    Psychologically traumatic workplace events (known as critical incidents), which occur globally, are increasing in prevalence within the USA. Assisting employers in their response is a growing practice area for occupational medicine, occupational social work, industrial psychology and other occupational health professions. Traumatic workplace events vary greatly in their level of organizational disruption. To explore whether extent of workplace disruption influences organizations' decisions for post-incident response planning and plan execution. Administrative data mining was employed to examine practice data from a workplace trauma response unit in the USA. Bivariate analyses were conducted to test whether scores from an instrument measuring extent of workplace disruption associated with organizational decisions regarding post-incident response. The more severe and disruptive the incident, the more likely organizations planned for and followed through to deliver on-site interventions. Following more severe incidents, organizations were also more likely to deliver group sessions and to complete follow-up consultations to ensure ongoing worker recovery. Increasing occupational health practitioners' knowledge of varying levels of organizational disruption and familiarity with a range of organizational response strategies improves incident assessment, consultation and planning, and ensures interventions delivered are consistent with the level of assistance needed on both worker and organizational levels.

  10. Workplace Disruption following Psychological Trauma: Influence of Incident Severity Level on Organizations' Post-Incident Response Planning and Execution

    Directory of Open Access Journals (Sweden)

    GS DeFraia

    2016-04-01

    Full Text Available Background: Psychologically traumatic workplace events (known as critical incidents, which occur globally, are increasing in prevalence within the USA. Assisting employers in their response is a growing practice area for occupational medicine, occupational social work, industrial psychology and other occupational health professions. Traumatic workplace events vary greatly in their level of organizational disruption. Objective: To explore whether extent of workplace disruption influences organizations' decisions for post-incident response planning and plan execution. Methods: Administrative data mining was employed to examine practice data from a workplace trauma response unit in the USA. Bivariate analyses were conducted to test whether scores from an instrument measuring extent of workplace disruption associated with organizational decisions regarding post-incident response. Results: The more severe and disruptive the incident, the more likely organizations planned for and followed through to deliver on-site interventions. Following more severe incidents, organizations were also more likely to deliver group sessions and to complete follow-up consultations to ensure ongoing worker recovery. Conclusion: Increasing occupational health practitioners' knowledge of varying levels of organizational disruption and familiarity with a range of organizational response strategies improves incident assessment, consultation and planning, and ensures interventions delivered are consistent with the level of assistance needed on both worker and organizational levels.

  11. Utility of serum pancreatic enzyme levels in diagnosing blunt trauma to the pancreas: a prospective study with systematic review.

    Science.gov (United States)

    Mahajan, Abhishek; Kadavigere, Rajagopal; Sripathi, Smiti; Rodrigues, Gabriel Sunil; Rao, Vedula Rajanikanth; Koteshwar, Prakashini

    2014-09-01

    Reliability of serum pancreatic enzyme levels in predicting pancreatic injuries has been a parameter of interest and the present recommendations on its utility are based primarily on anecdotal observations. The aim of this study was to evaluate the utility of serum pancreatic enzyme assessment in predicting blunt pancreatic injury with imaging and surgical correlation and compare our results with a systematic review of literature till date. A prospective cohort study conducted over 4 years in a tertiary care referral centre with 164 consecutive patients who presented to the emergency department with a history of blunt abdominal trauma and had serum pancreatic enzyme assessment, USG and subsequent diagnostic CECT were analyzed. The CT findings and AAST grade of pancreatic injury, various intra-abdominal injuries and time elapsed since injury and other associated factors were correlated with serum pancreatic enzyme levels. For systematic review of literature MEDLINE database was searched between 1940 and 2012, also the related citations and bibliographies of relevant articles were analyzed and 40 articles were included for review. We compared our results with the systematic critique of literature till date to formulate recommendations. 33(21%) patients had pancreatic injury documented on CT and were graded according to AAST. Statistically significant elevated serum amylase levels were observed in patients with pancreatic and bowel injuries. However, elevated serum lipase was observed specifically in patients with pancreatic injury with or without bowel injury. Combined serum amylase and lipase showed 100% specificity, 85% sensitivity in predicting pancreatic injury. Elevated (n=28, 85%) vs. normal (n=5, 15%) serum amylase and lipase levels showed sole statistically significant association with time elapse since injury to admission, with a cutoff of 3h. Based on our results and the systematic review of the literature till date we conclude, persistently elevated or

  12. CRISIS UNDER THE RADAR: ILLICIT AMPHETAMINE USE IS REACHING EPIDEMIC PROPORTIONS AND CONTRIBUTING TO RESOURCE OVER-UTILIZATION AT A LEVEL 1 TRAUMA CENTER.

    Science.gov (United States)

    Gemma, Vincent A; Chapple, Kristina A; Goslar, Pamela W; Israr, Sharjeel; Petersen, Scott R; Weinberg, Jordan A

    2018-05-21

    Trauma centers reported illicit amphetamine use in approximately 10% of trauma admissions in the previous decade. From experience at a trauma center located in a southwestern metropolis, our perception is that illicit amphetamine use is on the rise, and that these patients utilize in-hospital resources beyond what would be expected for their injuries. The purpose of this study was to document the incidence of illicit amphetamine use among our trauma patients and to evaluate its impact on resource utilization. We conducted a retrospective cohort study using 7 consecutive years of data (starting July 2010) from our institution's trauma registry. Toxicology screenings were used to categorize patients into one of three groups: illicit amphetamine, other drugs, or drug free. Adjusted linear and logistic regression models were used to predict hospital cost, length of stay, ICU admission and ventilation between drug groups. Models were conducted with combined injury severity (ISS) and then repeated for ISS <9, ISS 9-15 and ISS 16 and above. 8,589 patients were categorized into the following three toxicology groups: 1255 (14.6%) illicit amphetamine, 2214 (25.8%) other drugs, and 5120 (59.6%) drug free. Illicit amphetamine use increased threefold over the course of the study (from 7.85% to 25.0% of annual trauma admissions). Adjusted linear models demonstrated that illicit amphetamine among patients with ISS<9 was associated with 4.6% increase in hospital cost (P=.019) and 7.4% increase in LOS (P=.043). Logistic models revealed significantly increased odds of ventilation across all ISS groups and increased odds of ICU admission when all ISS groups were combined (P=.001) and within the ISS<9 group (P=.002). Hospital resource utilization of amphetamine patients with minor injuries is significant. Trauma centers with similar epidemic growth in proportion of amphetamine patients face a potentially significant resource strain relative to other centers. Prognostic and

  13. Retrospective analysis of facial dog bite injuries at a Level I trauma center in the Denver metro area.

    Science.gov (United States)

    Gurunluoglu, Raffi; Glasgow, Mark; Arton, Jamie; Bronsert, Michael

    2014-05-01

    Facial dog bite injuries pose a significant public health problem. Seventy-five consecutive patients (45 males, 30 females) treated solely by plastic surgery service for facial dog bite injuries at a Level I trauma center in the Denver Metro area between 2006 and 2012 were retrospectively reviewed. The following information were recorded: breed, relationship of patient to dog, location and number of wounds, the duration between injury and surgical repair and dog bite incident, type of repair, and antibiotic prophylaxis. Primary end points measured were wound infection, the need for revision surgery, and patient satisfaction. Ninety-eight wounds in the head and neck region were repaired (46 children; mean age, 6.8 years) and (29 adults; mean age, 47.3 years). Twelve different breeds were identified. There was no significant association between the type of dog breed and the number of bite injuries. The duration between injury and repair ranged from 4 hours to 72 hours (mean [SD], 13.7 [10.9] hours). The majority of bite wounds (76 of 98) involved the cheek, lip, nose, and chin region. Direct repair was the most common surgical approach (60 of 98 wounds) (p reconstruction versus direct repair according to dog breed (p = 0.25). Ten wounds required grafting. Twenty-five wounds were managed by one-stage or two-stage flaps. Only three patients (3.06 %) underwent replantation/revascularization of amputated partial lip (n = 2) and of cheek (n = 1). There was one postoperative infection. Data from five-point Likert scale were available for fifty-two patients. Forty patients were satisfied (5) with the outcome, while five patients were somewhat satisfied (4), and seven were neutral. Availability of the plastic surgery service at a Level I trauma center is vital for the optimal treatment of facial dog bite injuries. Direct repair and reconstruction of facial dog bite injuries at the earliest opportunity resulted in good outcomes as evidenced by the satisfaction survey data and

  14. The relationships of working conditions, recent stressors and childhood trauma with salivary cortisol levels

    NARCIS (Netherlands)

    Holleman, M.; Vreeburg, S.A.; Dekker, J.J.M.; Penninx, B.W.J.H.

    2012-01-01

    Background: An etiological model has been suggested where stress leads to high cortisol levels and hypothalamic-pituitary-adrenal (HPA) axis dysregulation, resulting in somatic diseases and psychopathology. To evaluate this model we examined the association of different stressors (working

  15. The relationships of working conditions, recent stressors and childhood trauma with salivary cortisol levels

    NARCIS (Netherlands)

    Holleman, Michiel; Vreeburg, Sophie A.; Dekker, Jack J. M.; Penninx, Brenda W. J. H.

    Background: An etiological model has been suggested where stress leads to high cortisol levels and hypothalamic-pituitary-adrenal (HPA) axis dysregulation, resulting in somatic diseases and psychopathology. To evaluate this model we examined the association of different stressors (working

  16. The wrong and wounding road: Paediatric polytrauma admitted to a level 1 trauma intensive care unit over a 5-year period.

    Science.gov (United States)

    Naidoo, Natasha; Muckart, David J J

    2015-09-19

    Injury in childhood is a major cause of potentially preventable morbidity and mortality. In order to implement effective preventive strategies, epidemiological data on mechanisms of injury and outcome are essential. To assess the causation, severity of injury, morbidity and mortality of paediatric trauma admitted to a level 1 trauma intensive care unit (TICU). Children were defined as being 25 in 98 patients (54.1%), 16-25 in 51 (28.2%), 9-15 in 9 (4.9%) and 25. Of the 26 patients who died, 88.4% had a head injury, 46.2% an extremity injury, 38.5% an external injury, 34.6% abdominal or chest injuries, 19.2% neck injury and 11.5% facial injury. Motor vehicle-related injuries, especially PMVCs, dominate severe paediatric trauma and there is an urgent need for more road traffic education and stringent measures to decrease the incidence and associated morbidity and mortality.

  17. Low hemorrhage-related mortality in trauma patients in a Level I trauma center employing transfusion packages and early thromboelastography-directed hemostatic resuscitation with plasma and platelets

    DEFF Research Database (Denmark)

    Johansson, Pär I; Sørensen, Anne Marie Møller; Larsen, Claus F

    2013-01-01

    (ISS), transfusion therapy, and mortality were registered. Hemostatic resuscitation was based on a massive transfusion protocol encompassing transfusion packages and thromboelastography (TEG)-guided therapy. RESULTS: A total of 182 patients were included (75% males, median age 43 years, ISS of 17, 92....... Nonsurvivors had lower clot strength by kaolin-activated TEG and TEG functional fibrinogen and lower kaolin-tissue factor-activated TEG α-angle and lysis after 30 minutes compared to survivors. None of the TEG variables were independent predictors of massive transfusion or mortality. CONCLUSION: Three......-fourths of the patients transfused with plasma or PLTs within 24 hours received these in the first 2 hours. Hemorrhage caused 14% of the deaths. We introduced transfusion packages and early TEG-directed hemostatic resuscitation at our hospital 10 years ago and this may have contributed to reducing hemorrhagic trauma...

  18. TRAUMA SURGERY

    African Journals Online (AJOL)

    interest in developing an appropriate and sustainable trauma system in South ... trauma evolved with the social instability which accompanied political change in the ... increased use of military style assault weapons resulted in severe injuries ...

  19. Resistance of Gram-positive bacteria to nisin is not determined by Lipid II levels

    NARCIS (Netherlands)

    Kramer, NE; Smid, EJ; Kok, J; de Kruijff, B; Kuipers, OP; Breukink, E; Kramer, Naomi E.; Smid, Eddy J.

    2004-01-01

    Lipid II is essential for nisin-mediated pore formation at nano-molar concentrations. We tested whether nisin resistance could result from different Lipid II levels, by comparing the maximal Lipid II pool in Micrococcus flavus (sensitive) and Listeria monocytogenes (relatively insensitive) and their

  20. High Circulating Adrenaline Levels at Admission Predict Increased Mortality After Trauma

    DEFF Research Database (Denmark)

    Johansson, Pär Ingemar; Stensballe, Jakob; Rasmussen, Lars Simon

    2012-01-01

    partial thromboplastin time, international normalized ratio, hematology, biochemistry, circulating adrenaline and noradrenaline, 11 biomarkers of tissue and endothelial damage, glycocalyx degradation, natural anticoagulation and fibrinolysis (histone-complexed DNA fragments, high-mobility group box 1......:: The adrenaline level was increased in nonsurvivors (p = 0.026), it was independently associated with increased activated partial thromboplastin time (p = 0.034) and syndecan-1 (p = 0.007), a marker of glycocalyx degradation, and it correlated with biomarkers of tissue and endothelial damage (histone......-complexed DNA, high-mobility group box 1, soluble thrombomodulin) and hyperfibrinolysis (tissue-type plasminogen activator, d-dimer). Furthermore, nonsurvivors had higher syndecan-1, tissue factor pathway inhibitor, and d-dimer levels (all p adrenaline was independently associated with 30...

  1. Pharmacist's impact on acute pain management during trauma resuscitation.

    Science.gov (United States)

    Montgomery, Kayla; Hall, A Brad; Keriazes, Georgia

    2015-01-01

    The timely administration of analgesics is crucial to the comprehensive management of trauma patients. When an emergency department (ED) pharmacist participates in trauma resuscitation, the pharmacist acts as a medication resource for trauma team members and facilitates the timely administration of analgesics. This study measured the impact of a pharmacist on time to first analgesic dose administered during trauma resuscitation. All adult (>18 years) patients who presented to this level II trauma center via activation of the trauma response system between January 1, 2009, and May 31, 2013, were screened for eligibility. For inclusion, patients must have received intravenous fentanyl, morphine, or hydromorphone in the trauma bay. The time to medication administration was defined as the elapsed time from ED arrival to administration of first analgesic. There were 1328 trauma response system activations during the study period; of which 340 patients were included. The most common analgesic administered was fentanyl (62% in both groups). When a pharmacist was participating, the mean time to first analgesic administered was decreased (17 vs 21 minutes; P = .03). Among the 78% of patients with documented pain scores, the overall mean reduction in pain scores from ED arrival to ED discharge was similar between the 2 groups. There was a 2.4 point reduction with a pharmacist versus 2.7 without a pharmacist, using a 0 to 10 numeric pain rating scale. The participation of a clinical pharmacist during trauma resuscitation significantly decreased the time to first analgesic administration in trauma patients. The results of this study supplement the literature supporting the integration of clinical ED pharmacists on trauma teams.

  2. A trauma network with centralized and local health care structures: Evaluating the effectiveness of the first certified Trauma Network of the German Society of Trauma Surgery.

    Science.gov (United States)

    Ernstberger, Antonio; Koller, Michael; Zeman, Florian; Kerschbaum, Maximilian; Hilber, Franz; Diepold, Eva; Loss, Julika; Herbst, Tanja; Nerlich, Michael

    2018-01-01

    Trauma is a global burden of disease and one of the main causes of death worldwide. Therefore, many countries around the world have implemented a wide range of different initiatives to minimize mortality rates after trauma. One of these initiatives is the bundling of treatment expertise in trauma centers and the establishment of trauma networks. Germany has a decentralized system of trauma care medical centers. Severely injured patients ought to receive adequate treatment in both level I and level II centers. This study investigated the effectiveness of a decentralized network and the question whether level I and level II centers have comparable patient outcome. In 2009, the first trauma network DGU® in Germany was certified in the rural area of Eastern Bavaria. All patients admitted to the 25 participating hospitals were prospectively included in this network in the framework of a study sponsored by the German Federal Ministry of Education and Research between March 2012 and February 2014. 2 hospitals were level I centers (maximal care centers), 8 hospitals were level II centers, and 15 hospitals were level III centers. The criterion for study inclusion was an injury severity score (ISS) ≥ 16 for patients´ primarily admitted to a level I or a level II center. Exclusion criteria were transferal to another hospital within 48 h, an unknown revised injury severity classification II score (RISC II), or primary admittance to a level III center (n = 52). 875 patients were included in the study. Univariate analyses were used regarding the preclinical and clinical parameters, the primary endpoint mortality rate, and the secondary endpoints length of stay, organ failure, and neurological outcome (GOS). The primary endpoint was additionally evaluated by means of multivariable analysis. Indices for injury severity (GCS, AISHead, ISS, and NISS) as well as the predicted probability of death (RISC II) were higher in level I centers than in level II centers. No significant

  3. New levels of Ta II with energies higher than 72,000 cm−1

    International Nuclear Information System (INIS)

    Uddin, Zaheer; Windholz, Laurentius

    2014-01-01

    We studied the hyperfine structure of Tantalum lines appearing in a high-resolution Fourier transform spectrum. Hundreds of lines of Ta in this spectrum are still unclassified; most of them, especially in the UV region, belong to Ta II. When investigating such lines we found 14 new levels of Ta II. These new levels are the highest-lying known Ta II levels and do not belong to the already known configurations. - Highlights: • We report the discovery of 14 even energy levels of the first ion of Tantalum (Ta II). • Their energy ranges from 72,000 to 81,000 cm −1 . • For comparison, up to now only even levels between 0 and 44,000 cm −1 were known. • These levels belong to up to now unknown electron configurations. • With help of these levels, approximately 100 spectral lines of Ta II can be classified

  4. Injuries of the Medial Clavicle: A Cohort Analysis in a Level-I-Trauma-Center. Concomitant Injuries. Management. Classification.

    Science.gov (United States)

    Bakir, Mustafa Sinan; Merschin, David; Unterkofler, Jan; Guembel, Denis; Langenbach, Andreas; Ekkernkamp, Axel; Schulz-Drost, Stefan

    2017-01-01

    Introduction: Although shoulder girdle injuries are frequent, those of the medial clavicle are widely unexplored. An applied classification is less used just as a standard management. Methods: A retrospective analysis of medial clavicle injuries (MCI) during a 5-year-term in a Level-1-Trauma-Center. We analyzed amongst others concomitant injuries, therapy strategies and the classification following the AO standards. Results: 19 (2.5%) out of 759 clavicula injuries were medial ones (11 A, 6 B and 2 C-Type fractures) thereunder 27,8% were displaced and thus operatively treated Locked plate osteosynthesis was employed in unstable fractures and a reconstruction of the ligaments at the sternoclavicular joint (SCJ) in case of their disruption. 84,2% of the patients sustained relevant concomitant injuries. Numerous midshaft fractures were miscoded as medial fracture, which limited the study population. Conclusions: MCI resulted from high impact mechanisms of injury, often with relevant dislocation and concomitant injuries. Concerning medial injury's complexity, treatment should occur in specialized hospitals. Unstable fractures and injuries of the SCJ ligaments should be considered for operative treatment. Midshaft fractures should be clearly distinguished from the medial ones in ICD-10-coding. Further studies are required also regarding a subtyping of the AO classification for medial clavicle fractures including ligamental injuries. Celsius.

  5. Association Between Helicopter vs Ground Emergency Medical Services and Survival for Adults With Major Trauma

    Science.gov (United States)

    Galvagno, Samuel M.; Haut, Elliott R.; Zafar, S. Nabeel; Millin, Michael G.; Efron, David T.; Koenig, George J.; Baker, Susan P.; Bowman, Stephen M.; Pronovost, Peter J.; Haider, Adil H.

    2012-01-01

    Context Helicopter emergency medical services and their possible effect on outcomes for traumatically injured patients remain a subject of debate. Because helicopter services are a limited and expensive resource, a methodologically rigorous investigation of its effectiveness compared with ground emergency medical services is warranted. Objective To assess the association between the use of helicopter vs ground services and survival among adults with serious traumatic injuries. Design, Setting, and Participants Retrospective cohort study involving 223 475 patients older than 15 years, having an injury severity score higher than 15, and sustaining blunt or penetrating trauma that required transport to US level I or II trauma centers and whose data were recorded in the 2007–2009 versions of the American College of Surgeons National Trauma Data Bank. Interventions Transport by helicopter or ground emergency services to level I or level II trauma centers. Main Outcome Measures Survival to hospital discharge and discharge disposition. Results A total of 61 909 patients were transported by helicopter and 161 566 patients were transported by ground. Overall, 7813 patients (12.6%) transported by helicopter died compared with 17 775 patients (11%) transported by ground services. Before propensity score matching, patients transported by helicopter to level I and level II trauma centers had higher Injury Severity Scores. In the propensity score–matched multivariable regression model, for patients transported to level I trauma centers, helicopter transport was associated with an improved odds of survival compared with ground transport (odds ratio [OR], 1.16; 95% CI, 1.14–1.17; P<.001; absolute risk reduction [ARR], 1.5%). For patients transported to level II trauma centers, helicopter transport was associated with an improved odds of survival (OR, 1.15; 95% CI, 1.13–1.17; P < .001; ARR, 1.4%). A greater proportion (18.2%) of those transported to level I trauma centers

  6. Determination of serum insulinlike growth factor II levels in coronary heart disease patient and its significance

    International Nuclear Information System (INIS)

    Fan Bifu; Ji Naijun; Mei Yibin; Wang Chengyao; Zhao Junfei; Guan Lihua; Gao Meiying; Li Jiangao

    2002-01-01

    Objective: To explore the changes and clinical significance of serum insulinlike growth factor II (IGF II) levels in coronary heart disease (CHD) patients. Methods: The serum IGF II levels were determined by radioimmunoassay in 68 patients with coronary heart disease (CHD) and 30 controls with only mild non-cardiac diseases. Results: Compared with the controls, the serum IGF II level in CHD patients were increased significantly (0.66 ± 0.13 μg/L vs 0.51 ± 0.11 μg/L; t = 5.506, p 0.05). Level in patients dies in hospital (n = 9) were much higher than those in patients recovered (n = 59) (t = 2.402, p < 0.05). Conclusion: Serum IGF II levels seems to be related to the seriousness of CHD; the actual mechanism remains to be defined

  7. Temporal evaluation of computed tomographic scans at a Level 1 trauma department in a central South African hospital

    Directory of Open Access Journals (Sweden)

    Tony Tiemesmann

    2016-03-01

    Objectives: The present study analyses the authors’ institution’s multi-detector computed tomography (MDCT scan process as part of the imaging turnaround time of trauma patients. It is intended to serve as a baseline for the institution, to offer a comparison with institutions worldwide and to improve service delivery. Method: Relevant categorical data were collected from the trauma patient register and radiological information system (RIS from 01 February 2013 to 31 January 2014. A population of 1107 trauma patients who received a MDCT scan was included in the study. Temporal data were analysed as a continuum with reference to triage priority, time of day, type of CT scan and admission status. Results: The median trauma arrival to MDCT scan time (TTS and reporting turnaround time (RTAT were 69 (39–126 and 86 (53–146 minutes respectively. TTS was subdivided into the time when the patient arrived at trauma to the radiology referral (TTRef and submission of the radiology request, to the arrival at the MDCT (RefTS location. TTRef was statistically significantly longer than RefTS (p < 0.0001. RTAT was subdivided into the arrival at the MDCT to the start of the radiology report (STR and time taken to complete the report (RT. STR was statistically significantly longer than RT (p < 0.0001. Conclusion: The time to scan (TTS was comparable to, but unfortunately the report turnaround time (RTAT lagged behind, the findings of some first-world institutions.

  8. Prevalence of alcohol among nonfatally injured road accident casualties in two level III trauma centers in northern Ghana.

    Science.gov (United States)

    Damsere-Derry, James; Palk, Gavan; King, Mark

    2018-02-17

    Alcohol use is pervasive among motorists on the road in Ghana; however, we do not know the extent to which this behavior is implicated in road accidents in this country. The main objective of this research was to establish the prevalence of alcohol in the blood of nonfatally injured casualties in the emergency departments (EDs) in northern Ghana. Participants were injured road traffic crash victims, namely, pedestrians, cyclists, motorcyclists, and drivers seeking treatment at an ED. The study sites were 2 level III trauma centers located in Wa and Bolgatanga. Participants were screened for alcohol followed by breath tests for positive participants using breathalyzers. Two hundred and sixty-two accident victims visited EDs, 58% of whom were in Wa. Among the victims, 41% were hospitalized and 57% experienced slight injuries. The vast majority (76%) of the casualties were motorcyclists, 13% were pedestrians, 8% were cyclists, and 2% were drivers. Casualties who had detectable alcohol in their blood were predominantly vulnerable road users. In all, 34% of participants had detectable blood alcohol concentrations (BACs) and the mean BAC for all casualties who tested positive and could give definitive BACs was 0.2265 (226 mg/dl). The prevalence of alcohol use was 53% among cyclists, 34% among motorcyclists, 21% among pedestrians, and 17% among drivers. Male casualties were more likely to test positive for alcohol than females. In addition, the prevalence of alcohol was significantly higher among injured casualties in Bolgatanga compared to Wa. There was a high prevalence of alcohol use among nonfatally injured casualties in northern Ghana and injury severity increased with BAC. AUDIT screening in the hospital, alcohol consumption guideline, road safety education with an emphasis on minimizing or eliminating alcohol consumption, and enhanced enforcement of the BAC limit among motorists are recommended.

  9. Journey to a safe environment: fall prevention in an emergency department at a level I trauma center.

    Science.gov (United States)

    Alexander, Danette; Kinsley, Terry L; Waszinski, Christine

    2013-07-01

    Predicting which patients will fall is a challenging task, especially in the often unpredictable setting of an emergency department of a Level I Trauma Center. Unfortunately, there is a great potential for falls to occur in this environment. Fall risk assessment tools used in inpatient settings do not adequately capture the risk factors of patients presenting to the emergency department. The ability to accurately identify patients at risk for falling at the point of entry is the first step toward preventing patient harm. Once patients are identified as at risk for a fall, the next challenge is to be sure that they do not fall. We created the KINDER1 Fall Risk Assessment Tool for use in the emergency department. This instrument was specifically designed for the rapid identification of patients at risk for a fall as well as the re-evaluation of patients for fall risk throughout their stay in the emergency department. Once we had an appropriate assessment tool, our next challenge was for staff to consistently apply fall prevention interventions. Performing a mini-root cause analysis on each fall showed trends and in turn led to the design and implementation of specific fall prevention interventions to motivate the nursing staff to focus on fall prevention that the ED nursing leadership used to select change strategies. With improved identification of fall risk patients and consistent application of innovative prevention strategies, we were able to show a trend toward reduction of falls and fall-related injuries in our emergency department. Copyright © 2013 Emergency Nurses Association. Published by Mosby, Inc. All rights reserved.

  10. Bed wise cost analysis of in-patient treatment of brachial plexus injury at a Level I trauma Center in India

    OpenAIRE

    Pandey, Nityanand; Gupta, Deepak; Mahapatra, Ashok; Harshvardhan, Rajesh

    2014-01-01

    Aim: The aim was to calculate, in monetary terms, total cost incurred by a Level I trauma center in providing in-patient care to brachial plexus injury patients during their preoperative and the postoperative stay. Subjects and Methods: All patients of brachial plexus injury admitted and discharged between January and December 2010 were included in the study. Total cost per bed was calculated under several cost heads in pre- and post-operative ward care. Intra-operative costs were excluded. R...

  11. Geographic distribution of trauma centers and injury-related mortality in the United States.

    Science.gov (United States)

    Brown, Joshua B; Rosengart, Matthew R; Billiar, Timothy R; Peitzman, Andrew B; Sperry, Jason L

    2016-01-01

    Regionalized trauma care improves outcomes; however, access to care is not uniform across the United States. The objective was to evaluate whether geographic distribution of trauma centers correlates with injury mortality across state trauma systems. Level I or II trauma centers in the contiguous United States were mapped. State-level age-adjusted injury fatality rates per 100,000 people were obtained and evaluated for spatial autocorrelation. Nearest neighbor ratios (NNRs) were generated for each state. A NNR less than 1 indicates clustering, while a NNR greater than 1 indicates dispersion. NNRs were tested for difference from random geographic distribution. Fatality rates and NNRs were examined for correlation. Fatality rates were compared between states with trauma center clustering versus dispersion. Trauma center distribution and population density were evaluated. Spatial-lag regression determined the association between fatality rate and NNR, controlling for state-level demographics, population density, injury severity, trauma system resources, and socioeconomic factors. Fatality rates were spatially autocorrelated (Moran's I = 0.35, p center distribution. Fatality rate and NNR were correlated (ρ = 0.34, p = 0.03). Clustered states had a lower median injury fatality rate compared with dispersed states (56.9 [IQR, 46.5-58.9] vs. 64.9 [IQR, 52.5-77.1]; p = 0.04). Dispersed compared with clustered states had more counties without a trauma center that had higher population density than counties with a trauma center (5.7% vs. 1.2%, p distribution of trauma centers correlates with injury mortality, with more clustered state trauma centers associated with lower fatality rates. This may be a result of access relative to population density. These results may have implications for trauma system planning and require further study to investigate underlying mechanisms. Therapeutic/care management study, level IV.

  12. Facial trauma

    Science.gov (United States)

    Maxillofacial injury; Midface trauma; Facial injury; LeFort injuries ... Hockberger RS, Walls RM, eds. Rosen's Emergency Medicine: Concepts and Clinical Practice . 8th ed. Philadelphia, PA: Elsevier ...

  13. Minimal acceptable care as a vital component to Missouri's trauma system.

    Science.gov (United States)

    Helling, Thomas S

    2002-07-01

    Immediate attention to life-threatening injuries and expeditious transfer of major and complex wounds to tertiary care trauma centers are the cornerstones of any trauma system. Rapid assessment and "minimalization" of care should be the buzz-word of rural (Level III) and suburban (Level II) trauma centers in order to provide quickest treatment of injuries by timely referral of patients for definitive attention. This concept is called minimal acceptable care and may serve to improve patient outcome by reducing the interval to ultimate treatment and avoidance of duplication of services.

  14. The Validity and Reliability Work of the Scale That Determines the Level of the Trauma after the Earthquake

    Science.gov (United States)

    Tanhan, Fuat; Kayri, Murat

    2013-01-01

    In this study, it was aimed to develop a short, comprehensible, easy, applicable, and appropriate for cultural characteristics scale that can be evaluated in mental traumas concerning earthquake. The universe of the research consisted of all individuals living under the effects of the earthquakes which occurred in Tabanli Village on 23.10.2011 and…

  15. Feasibility and profitability of a radiology department providing trauma US as part of a trauma alert team.

    Science.gov (United States)

    Nunes, L W; Simmons, S; Kozar, R; Kinback, R; Hallowell, M J; Mulhern, C

    2001-01-01

    The purpose of this study was to assess the feasibility and profitability of a radiology department providing a six-point trauma ultrasound (US) examination for abdominal or pelvic free fluid as part of a trauma alert team. The study included 191 trauma alerts, which generated 156 US examinations. A radiologist and a departmental technologist carried beepers and responded to level I and II traumas. A departmental secretary or technologist recorded when the responding technologist exited and re-entered the department and if US was performed. If performed, the US examination evaluated the four abdominal and pelvic quadrants and the suprapubic and subxiphoid regions. For 64 patients, the responding technologist recorded the times of the trauma alert, emergency room arrival, US start and finish, and return to the radiology department. Median response, wait, scan duration, and return times were 2, 8, 5, and 7 minutes, respectively. Median costs for the technician, physician, archiving, transcription, and equipment were $8.17, $30.85, $0.97, $4.80, and $41.22, respectively. Reimbursement per examination averaged $110.60. Sensitivity analyses that varied the time spent (median vs mean), US non-use rate (10%-18%), and years of depreciation (5-7 years) yielded net results ranging from a $36.60 profit to a $6.12 loss per examination. A radiology department can profitably respond to trauma alerts and provide a six-point trauma US examination for free fluid.

  16. Pediatric Lower Extremity Lawn Mower Injuries and Reconstruction: Retrospective 10-Year Review at a Level 1 Trauma Center.

    Science.gov (United States)

    Branch, Leslie G; Crantford, John C; Thompson, James T; Tannan, Shruti C

    2017-11-01

    From 2004 to 2013, there were 9341 lawn mower injuries in children under 20 years old. The incidence of lawn mower injuries in children has not decreased since 1990 despite implementation of various different prevention strategies. In this report, the authors review the results of pediatric lawn mower-related lower-extremity injuries treated at a tertiary care referral center as well as review the overall literature. A retrospective review was performed at a level 1 trauma center over a 10-year period (2005-2015). Patients younger than 18 years who presented to the emergency room with lower extremity lawn mower injuries were included. Of the 27 patients with lower-extremity lawn mower injuries during this period, the mean age at injury was 5.5 years and Injury Severity Score was 7.2. Most (85%) patients were boys and the predominant type of mower causing injury was a riding lawn mower (96%). Injury occurred in patients who were bystanders in 78%, passengers in 11%, and operators in 11%. Mean length of stay was 12.2 days, and mean time to reconstruction was 7.9 days. Mean number of surgical procedures per patient was 4.1. Amputations occurred in 15 (56%) cases with the most common level of amputation being distal to the metatarsophalangeal joint (67%). Reconstructive procedures ranged from direct closure (41%) to free tissue transfer (7%). Major complications included infection (7%), wound dehiscence (11%), and delayed wound healing (15%). Mean follow up was 23.6 months and 100% of the patients were ambulatory after injury. The subgroup of patients with the most severe injuries, highest number of amputations, and need for overall surgical procedures were patients aged 2 to 5 years. A review of the literature also showed consistent findings. This study demonstrates the danger and morbidity that lawn mowers present to the pediatric population, particularly children aged 2 to 5 years. Every rung of the so-called reconstructive ladder is used in caring for these

  17. The practicality of including the systemic inflammatory response syndrome in the definition of polytrauma: experience of a level one trauma centre.

    Science.gov (United States)

    Butcher, Nerida E; Balogh, Zsolt J

    2013-01-01

    The systemic inflammatory response syndrome (SIRS) has been advocated as a significant predictor of outcome in trauma. Recent trauma literature has proposed SIRS as a surrogate for physiological derangements characteristic of polytrauma with some authors recommending its inclusion into the definition of polytrauma. The practicality of daily SIRS collection outside of specifically designed prospective trials is unknown. The purpose of this study was to assess the availability of SIRS variables and its appropriateness for inclusion into a definition of polytrauma. We hypothesised SIRS variables would be readily available and easy to collect, thus represent an appropriate inclusion into the definition of polytrauma. A prospective observational study of all trauma team activation patients over 7-months (August 2009 to February 2010) at a University affiliated level-1 urban trauma centre. SIRS data (temperature>38°C or 90 bpm; RR>20/min or a PaCO(2)12.0×10(9)L(-1), or 10 immature bands) collected from presentation, at 24 h intervals until 72 h post injury. Inclusion criteria were all patients generating a trauma team activation response age >16. 336 patients met inclusion criteria. In 46% (155/336) serial SIRS scores could not be calculated due to missing data. Lowest rates of missing data observed on admission [3% (11/336)]. Stratified by ISS>15 (132/336), in 7% (9/132) serial SIRS scores could not be calculated due to missing data. In 123 patients ISS>15 with complete data, 81% (100/123) developed SIRS. For Abbreviated Injury Scale (AIS)>2 in at least 2 body regions (64/336) in 5% (3/64) serial SIRS scores could not be calculated, with 92% (56/61) of patients with complete data developing SIRS. For Direct ICU admissions [25% (85/336)] 5% (4/85) of patients could not have serial SIRS calculated [mean ISS 15(±11)] and 90% (73/81) developed SIRS at least once over 72 h. Based on the experience of our level-1 trauma centre, the practicability of including SIRS into the

  18. The impact of specialist trauma service on major trauma mortality.

    Science.gov (United States)

    Wong, Ting Hway; Lumsdaine, William; Hardy, Benjamin M; Lee, Keegan; Balogh, Zsolt J

    2013-03-01

    Trauma services throughout the world have had positive effects on trauma-related mortality. Australian trauma services are generally more consultative in nature rather than the North American model of full trauma admission service. We hypothesized that the introduction of a consultative specialist trauma service in a Level I Australian trauma center would reduce mortality of the severely injured. A 10-year retrospective study (January 1, 2002-December 31, 2011) was performed on all trauma patients admitted with an Injury Severity Score (ISS) > 15. Patients were identified from the trauma registry, and data for age, sex, mechanism of injury, ISS, survival to discharge, and length of stay were collected. Mortality was examined for patients with severe injury (ISS > 15) and patients with critical injury (ISS > 24) and compared for the three periods: 2002-2004 (without trauma specialist), 2005-2007 (with trauma specialist), and 2008-2011 (with specialist trauma service). A total of 3,869 severely injured (ISS > 15) trauma patients were identified during the 10-year period. Of these, 2,826 (73%) were male, 1,513 (39%) were critically injured (ISS > 24), and more than 97% (3,754) were the victim of blunt trauma. Overall mortality decreased from 12.4% to 9.3% (relative risk, 0.75) from period one to period three and from 25.4% to 20.3% (relative risk, 0.80) for patients with critical injury. A 0.46% per year decrease (p = 0.018) in mortality was detected (odds ratio, 0.63; p 24), the trend was (0.61% per year; odds ratio, 0.68; p = 0.039). The introduction of a specialist trauma service decreased the mortality of patients with severe injury, the model of care should be considered to implement state- and nationwide in Australia. Epidemiologic study, level III.

  19. Geographic Distribution of Trauma Centers and Injury Related Mortality in the United States

    Science.gov (United States)

    Brown, Joshua B.; Rosengart, Matthew R.; Billiar, Timothy R.; Peitzman, Andrew B.; Sperry, Jason L.

    2015-01-01

    Background Regionalized trauma care improves outcomes; however access to care is not uniform across the US. The objective was to evaluate whether geographic distribution of trauma centers correlates with injury mortality across state trauma systems. Methods Level I/II trauma centers in the contiguous US were mapped. State-level age-adjusted injury fatality rates/100,000people were obtained and evaluated for spatial autocorrelation. Nearest neighbor ratios (NNR) were generated for each state. A NNR1 indicates dispersion. NNR were tested for difference from random geographic distribution. Fatality rates and NNR were examined for correlation. Fatality rates were compared between states with trauma center clustering versus dispersion. Trauma center distribution and population density were evaluated. Spatial-lag regression determined the association between fatality rate and NNR, controlling for state-level demographics, population density, injury severity, trauma system resources, and socioeconomic factors. Results Fatality rates were spatially autocorrelated (Moran's I=0.35, pcenter distribution. Fatality rate and NNR were correlated (ρ=0.34, p=0.03). Clustered states had a lower median injury fatality rate compared to dispersed states (56.9 [IQR 46.5–58.9] versus 64.9 [IQR 52.5–77.1], p=0.04). Dispersed compared to clustered states had more counties without a trauma center that had higher population density than counties with a trauma center (5.7% versus 1.2%, pdistribution of trauma centers correlates with injury mortality, with more clustered state trauma centers associated with lower fatality rates. This may be a result of access relative to population density. These results may have implications for trauma system planning and requires further study to investigate underlying mechanisms PMID:26517780

  20. Reporting Military Sexual Trauma: A Mixed-Methods Study of Women Veterans' Experiences Who Served From World War II to the War in Afghanistan.

    Science.gov (United States)

    Wolff, Kristina B; Mills, Peter D

    2016-08-01

    Since 2004, there has been increased effort to reduce military sexual trauma (MST) in the U.S. military. Although MST covers a range of inappropriate behaviors, the majority of research, treatment, and outreach are focused on sexual assault and the experiences of individuals serving in Afghanistan and Iraq. During a study on veterans' involvement in a national peace organization, participants were asked about their military experiences. Veterans served from World War II to current conflicts in Iraq and Afghanistan. Emerging out of the responses were descriptions of women's experiences with MST, barriers to reporting incidents of sexual misconduct and sexual assault, and the challenges they faced when seeking care. Data were gathered using anonymous questionnaires and semi-structured interviews. Out of 52 female veterans, the majority (90%) was subjected to at least one form of MST, and 15% (8) attempted to report the incident(s). Over half of the assailants were of a higher rank than the survivors. The majority of veterans remained silent due to lack of options to report, the status of perpetrators, and fear of retaliation. These data provide a glimpse into the challenges many women veterans faced when seeking assistance reporting incidents or obtaining health care for their MST. Reprint & Copyright © 2016 Association of Military Surgeons of the U.S.

  1. Organizational and provider level factors in implementation of trauma-informed care after a city-wide training: an explanatory mixed methods assessment.

    Science.gov (United States)

    Damian, April Joy; Gallo, Joseph; Leaf, Philip; Mendelson, Tamar

    2017-11-21

    While there is increasing support for training youth-serving providers in trauma-informed care (TIC) as a means of addressing high prevalence of U.S. childhood trauma, we know little about the effects of TIC training on organizational culture and providers' professional quality of life. This mixed-methods study evaluated changes in organizational- and provider-level factors following participation in a citywide TIC training. Government workers and nonprofit professionals (N = 90) who participated in a nine-month citywide TIC training completed a survey before and after the training to assess organizational culture and professional quality of life. Survey data were analyzed using multiple regression analyses. A subset of participants (n = 16) was interviewed using a semi-structured format, and themes related to organizational and provider factors were identified using qualitative methods. Analysis of survey data indicated significant improvements in participants' organizational culture and professional satisfaction at training completion. Participants' perceptions of their own burnout and secondary traumatic stress also increased. Four themes emerged from analysis of the interview data, including "Implementation of more flexible, less-punitive policies towards clients," "Adoption of trauma-informed workplace design," "Heightened awareness of own traumatic stress and need for self-care," and "Greater sense of camaraderie and empathy for colleagues." Use of a mixed-methods approach provided a nuanced understanding of the impact of TIC training and suggested potential benefits of the training on organizational and provider-level factors associated with implementation of trauma-informed policies and practices. Future trainings should explicitly address organizational factors such as safety climate and morale, managerial support, teamwork climate and collaboration, and individual factors including providers' compassion satisfaction, burnout, and secondary

  2. Organizational and provider level factors in implementation of trauma-informed care after a city-wide training: an explanatory mixed methods assessment

    Directory of Open Access Journals (Sweden)

    April Joy Damian

    2017-11-01

    Full Text Available Abstract Background While there is increasing support for training youth-serving providers in trauma-informed care (TIC as a means of addressing high prevalence of U.S. childhood trauma, we know little about the effects of TIC training on organizational culture and providers’ professional quality of life. This mixed-methods study evaluated changes in organizational- and provider-level factors following participation in a citywide TIC training. Methods Government workers and nonprofit professionals (N = 90 who participated in a nine-month citywide TIC training completed a survey before and after the training to assess organizational culture and professional quality of life. Survey data were analyzed using multiple regression analyses. A subset of participants (n = 16 was interviewed using a semi-structured format, and themes related to organizational and provider factors were identified using qualitative methods. Results Analysis of survey data indicated significant improvements in participants’ organizational culture and professional satisfaction at training completion. Participants’ perceptions of their own burnout and secondary traumatic stress also increased. Four themes emerged from analysis of the interview data, including “Implementation of more flexible, less-punitive policies towards clients,” “Adoption of trauma-informed workplace design,” “Heightened awareness of own traumatic stress and need for self-care,” and “Greater sense of camaraderie and empathy for colleagues.” Conclusion Use of a mixed-methods approach provided a nuanced understanding of the impact of TIC training and suggested potential benefits of the training on organizational and provider-level factors associated with implementation of trauma-informed policies and practices. Future trainings should explicitly address organizational factors such as safety climate and morale, managerial support, teamwork climate and collaboration, and

  3. Identification of new fluorescence processes in the UV spectra of cool stars from new energy levels of Fe II and Cr II

    Science.gov (United States)

    Johansson, Sveneric; Carpenter, Kenneth G.

    1988-01-01

    Two fluorescence processes operating in atmospheres of cool stars, symbiotic stars, and the Sun are presented. Two emission lines, at 1347.03 and 1360.17 A, are identified as fluorescence lines of Cr II and Fe II. The lines are due to transitions from highly excited levels, which are populated radiatively by the hydrogen Lyman alpha line due to accidental wavelength coincidences. Three energy levels, one in Cr II and two in Fe II, are reported.

  4. CIVILIAN GUNSHOT WOUNDS TO THE CHEST: A CLINICOPATHOLOGICAL ANALYSIS OF AN ANNUAL CASELOAD AT A LEVEL 1 TRAUMA CENTRE.

    Science.gov (United States)

    Meijering, V M; Hattam, A T; Navsaria, P H; Nicol, A J; Edu, S

    2017-06-01

    Gunshot wounds (GSW) to the chest are common presentations to trauma centres in South Africa. The clinical management and outcome of GSW to the chest are significantly altered by missile trajectory and the associated anatomical structures injured making them challenging injuries to treat. Currently, the management of GSW chest is based on scant evidence and treatment is typically according to algorithms based largely on the anecdotal experience of high volume institutions and experienced clinicians. Ethical approval was obtained for this study. The Electronic Trauma Health Registry (eTHR) Application of the Trauma Centre at Groote Schuur Hospital in Cape Town was interrogated for the year 2015 for all patients with GSW chest. The data was then analysed using descriptive statistics. A total of 141 patients with GSW to the chest were admitted to the Trauma Centre with a median age of 26 years. More than half of the patients, 53. 2% (n = 75) sustained an isolated GSW to the chest. Overall, 29.1% (n = 41) patients sustained a thoracoabdominal injury, which accounts for a significant higher amount of emergency surgeries compared to patients with non thoracoabdominal injuries (54% vs 15%, p = chest surgery of which 5 patients survived. Overall mortality was 7.1% (n = 10) of which 5 patients died from a thoracic cause. Civilian GSW to the chest are common injuries seen in Cape Town, often with concomitant injuries leading to increased morbidity. Significantly more emergency surgeries were done in patients with thoracoabdominal injury. Overall few patients needed chest-related emergency operative intervention (9.2%) with a survival rate of 38.5%. Overall mortality of patients with GSW chest who reached the hospital was 7.1% of whom 50% died from a thoracic cause.

  5. Acute coagulopathy of trauma

    DEFF Research Database (Denmark)

    Johansson, P I; Ostrowski, S R

    2010-01-01

    Acute coagulopathy of trauma predicts a poor clinical outcome. Tissue trauma activates the sympathoadrenal system resulting in high circulating levels of catecholamines that influence hemostasis dose-dependently through immediate effects on the two major compartments of hemostasis, i.......e., the circulating blood and the vascular endothelium. There appears to be a dose-dependency with regards to injury severity and the hemostatic response to trauma evaluated in whole blood by viscoelastic assays like thrombelastography (TEG), changing from normal to hypercoagulable, to hypocoagulable and finally......, is an evolutionary developed response that counterbalances the injury and catecholamine induced endothelial activation and damage. Given this, the rise in circulating catecholamines in trauma patients may favor a switch from hyper- to hypocoagulability in the blood to keep the progressively more procoagulant...

  6. Disseminated intravascular coagulation or acute coagulopathy of trauma shock early after trauma? A prospective observational study

    DEFF Research Database (Denmark)

    Johansson, Per Ingemar; Sorensen, Anne Marie; Perner, Anders

    2011-01-01

    the prevalence of overt DIC and ACoTS in trauma patients and characterized these conditions based on their biomarker profiles. METHODS: Observational study at a single Level I Trauma Centre. Inclusion of 80 adult trauma patients ([greater than or equal to]18 years) who met criteria for full trauma team...

  7. Convergence of Health Level Seven Version 2 Messages to Semantic Web Technologies for Software-Intensive Systems in Telemedicine Trauma Care.

    Science.gov (United States)

    Menezes, Pedro Monteiro; Cook, Timothy Wayne; Cavalini, Luciana Tricai

    2016-01-01

    To present the technical background and the development of a procedure that enriches the semantics of Health Level Seven version 2 (HL7v2) messages for software-intensive systems in telemedicine trauma care. This study followed a multilevel model-driven approach for the development of semantically interoperable health information systems. The Pre-Hospital Trauma Life Support (PHTLS) ABCDE protocol was adopted as the use case. A prototype application embedded the semantics into an HL7v2 message as an eXtensible Markup Language (XML) file, which was validated against an XML schema that defines constraints on a common reference model. This message was exchanged with a second prototype application, developed on the Mirth middleware, which was also used to parse and validate both the original and the hybrid messages. Both versions of the data instance (one pure XML, one embedded in the HL7v2 message) were equally validated and the RDF-based semantics recovered by the receiving side of the prototype from the shared XML schema. This study demonstrated the semantic enrichment of HL7v2 messages for intensive-software telemedicine systems for trauma care, by validating components of extracts generated in various computing environments. The adoption of the method proposed in this study ensures the compliance of the HL7v2 standard in Semantic Web technologies.

  8. Retrospective review of injury severity, interventions and outcomes among helicopter and nonhelicopter transport patients at a Level 1 urban trauma centre.

    Science.gov (United States)

    Hannay, R Scott; Wyrzykowski, Amy D; Ball, Chad G; Laupland, Kevin; Feliciano, David V

    2014-02-01

    Air ambulance transport for injured patients is vitally important given increasing patient volumes, the limited number of trauma centres and inadequate subspecialty coverage in nontrauma hospitals. Air ambulance services have been shown to improve patient outcomes compared with ground transport in select circumstances. Our primary goal was to compare injuries, interventions and outcomes in patients transported by helicopter versus nonhelicopter transport. We performed a retrospective 10-year review of 14 440 patients transported to an urban Level 1 trauma centre by helicopter or by other means. We compared injury severity, interventions and mortality between the groups. Patients transported by helicopter had higher median injury severity scores (ISS), regardless of penetrating or blunt injury, and were more likely to have Glasgow Coma Scale scores less than 8, require airway control, receive blood transfusions and require admission to the intensive care unit or operating room than patients transported by other means. Helicopter transport was associated with reduced overall mortality (odds ratio 0.41, 95% confidence interval 0.33-0.39). Patients transported by other methods were more likely to die in the emergency department. The mean ISS, regardless of transport method, rose from 12.3 to 15.1 (p = 0.011) during our study period. Patients transported by helicopter to an urban trauma centre were more severely injured, required more interventions and had improved survival than those arriving by other means of transport.

  9. Barriers to compliance with evidence-based care in trauma.

    Science.gov (United States)

    Rayan, Nadine; Barnes, Sunni; Fleming, Neil; Kudyakov, Rustam; Ballard, David; Gentilello, Larry M; Shafi, Shahid

    2012-03-01

    We have preciously demonstrated that trauma patients receive less than two-thirds of the care recommended by evidence-based medicine. The purpose of this study was to identify patients least likely to receive optimal care. Records of a random sample of 774 patients admitted to a Level I trauma center (2006-2008) with moderate to severe injuries (Abbreviated Injury Scale score ≥3) were reviewed for compliance with 25 trauma-specific processes of care (T-POC) endorsed by Advanced Trauma Life Support, Eastern Association for the Surgery of Trauma, the Brain Trauma Foundation, Surgical Care Improvement Project, and the Glue Grant Consortium based on evidence or consensus. These encompassed all aspects of trauma care, including initial evaluation, resuscitation, operative care, critical care, rehabilitation, and injury prevention. Multivariate logistic regression was used to identify patients likely to receive recommended care. Study patients were eligible for a total of 2,603 T-POC, of which only 1,515 (58%) were provided to the patient. Compliance was highest for T-POC involving resuscitation (83%) and was lowest for neurosurgical interventions (17%). Increasing severity of head injuries was associated with lower compliance, while intensive care unit stay was associated with higher compliance. There was no relationship between compliance and patient demographics, socioeconomic status, overall injury severity, or daily volume of trauma admissions. Little over half of recommended care was delivered to trauma patients with moderate to severe injuries. Patients with increasing severity of traumatic brain injuries were least likely to receive optimal care. However, differences among patient subgroups are small in relation to the overall gap between observed and recommended care. II.

  10. Readmission after treatment of Grade 3 and 4 renal injuries at a Level I trauma center: Statewide assessment using the Comprehensive Hospital Abstract Reporting System.

    Science.gov (United States)

    Winters, Brian; Wessells, Hunter; Voelzke, Bryan B

    2016-03-01

    One criticism of the existing renal trauma research is the limited outpatient follow-up after index hospitalization. We assessed readmission rates following treatment for American Association for the Surgery of Trauma (AAST) Grade 3 and 4 renal injury using the Comprehensive Hospital Abstract Reporting System (CHARS). We evaluated all patients with AAST Grade 3 and 4 renal injuries admitted to Harborview Medical Center (HMC) between 1998 and 2010, the only Level 1 trauma center in Washington state. Grade 4 renal injuries were stratified by collecting system laceration (CSL) or segmental vascular injury. Data were abstracted from the CHARS database for readmissions to any Washington state hospital within 6 months of renal injury. Clinical variables, diagnoses, and procedures were queried based on DRG International Classification of Diseases-9th Rev. codes. A total of 477 Grade 3 and 159 Grade 4 renal injuries were initially treated at HMC. On admission, 111 patients required intervention: 75 (16%) of 477 Grade 3 and 36 (23%) of 159 Grade 4 injuries. Within 6 months of index hospitalization, 86 (18%) of 477 Grade 3 and 38 (24%) of 159 Grade 4 patients were readmitted to any Washington state hospital. Eighty percent of Grade 3 injuries and 66% of Grade 4 injuries returned to HMC compared with secondary hospitals (p = 0.08). At readmission, 19 (22%) of 86 Grade 3 and 16 (42%) of 38 Grade 4 injuries had a urologic diagnosis. Subsequent procedural intervention was required on readmission in 6 (7%) of 86 Grade 3 and 5 (13%) of 38 Grade 4 renal injuries (all CSL injuries). A subset of patients treated for Grade 3 and 4 renal trauma will be readmitted for further management. While urologic diagnoses and additional procedures may be low overall, readmission to outside hospitals may preclude accurate determination of renal trauma outcomes. Based on these data, patients with Grade 4 CSL injuries seem to be at the highest risk for readmission and to require a subsequent

  11. Early predictors of health-related quality of life outcomes in polytrauma patients with spine injuries: a level 1 trauma center study.

    Science.gov (United States)

    Tee, J W; Chan, C H P; Gruen, R L; Fitzgerald, M C B; Liew, S M; Cameron, P A; Rosenfeld, J V

    2014-02-01

    Study Design Retrospective review on clinical-quality trauma registry prospective data. Objective To identify early predictors of suboptimal health status in polytrauma patients with spine injuries. Methods A retrospective review on a prospective cohort was performed on spine-injured polytrauma patients with successful discharge from May 2009 to January 2011. The Short Form 12-Questionnaire Health Survey (SF-12) was used in the health status assessment of these patients. Univariate and multivariate logistic regression models were applied to investigate the effects of the Injury Severity Score, age, blood sugar level, vital signs, brain trauma severity, comorbidities, coagulation profile, spine trauma-related neurologic status, and spine injury characteristics of the patients. Results The SF-12 had a 52.3% completion rate from 915 patients. The patients who completed the SF-12 were younger, and there were fewer patients with severe spinal cord injuries (American Spinal Injury Association classifications A, B, and C). Other comparison parameters were satisfactorily matched. Multivariate logistic regression revealed five early predictive factors with statistical significance (p ≤ 0.05). They were (1) tachycardia (odds ratio [OR] = 1.88; confidence interval [CI] = 1.11 to 3.19), (2) hyperglycemia (OR = 2.65; CI = 1.51 to 4.65), (3) multiple chronic comorbidities (OR = 2.98; CI = 1.68 to 5.26), and (4) thoracic spine injuries (OR = 1.54; CI = 1.01 to 2.37). There were no independent early predictive factors identified for suboptimal mental health-related qualify of life outcomes. Conclusion Early independent risk factors predictive of suboptimal physical health status identified in a level 1 trauma center in polytrauma patients with spine injuries were tachycardia, hyperglycemia, multiple chronic medical comorbidities, and thoracic spine injuries. Early spine trauma risk factors were shown not to predict suboptimal mental

  12. Trauma and the endocrine system.

    Science.gov (United States)

    Mesquita, Joana; Varela, Ana; Medina, José Luís

    2010-12-01

    The endocrine system may be the target of different types of trauma with varied consequences. The present article discusses trauma of the hypothalamic-pituitary axes, adrenal glands, gonads, and pancreas. In addition to changes in circulating hormone levels due to direct injury to these structures, there may be an endocrine response in the context of the stress caused by the trauma. Copyright © 2010 SEEN. Published by Elsevier Espana. All rights reserved.

  13. Hepatic trauma: a 21-year experience.

    Science.gov (United States)

    Zago, Thiago Messias; Pereira, Bruno Monteiro; Nascimento, Bartolomeu; Alves, Maria Silveira Carvalho; Calderan, Thiago Rodrigues Araujo; Fraga, Gustavo Pereira

    2013-01-01

    To evaluate the epidemiological aspects, behavior, morbidity and treatment outcomes for liver trauma. We conducted a retrospective study of patients over 13 years of age admitted to a university hospital from 1990 to 2010, submitted to surgery or nonoperative management (NOM). 748 patients were admitted with liver trauma. The most common mechanism of injury was penetrating trauma (461 cases, 61.6%), blunt trauma occurring in 287 patients (38.4%). According to the degree of liver injury (AAST-OIS) in blunt trauma we predominantly observed Grades I and II and in penetrating trauma, Grade III. NOM was performed in 25.7% of patients with blunt injury. As for surgical procedures, suturing was performed more frequently (41.2%). The liver-related morbidity was 16.7%. The survival rate for patients with liver trauma was 73.5% for blunt and 84.2% for penetrating trauma. Mortality in complex trauma was 45.9%. trauma remains more common in younger populations and in males. There was a reduction of penetrating liver trauma. NOM proved safe and effective, and often has been used to treat patients with penetrating liver trauma. Morbidity was high and mortality was higher in victims of blunt trauma and complex liver injuries.

  14. Symptoms of post-traumatic stress disorder, severe psychological distress, explosive anger and grief amongst partners of survivors of high levels of trauma in post-conflict Timor-Leste.

    Science.gov (United States)

    Silove, D M; Tay, A K; Steel, Z; Tam, N; Soares, Z; Soares, C; Dos Reis, N; Alves, A; Rees, S

    2017-01-01

    Little is known about the mental health of partners of survivors of high levels of trauma in post-conflict countries. We studied 677 spouse dyads (n = 1354) drawn from a community survey (response 82.4%) in post-conflict Timor-Leste. We used culturally adapted measures of post-traumatic stress disorder (PTSD), psychological distress, explosive anger and grief. Latent class analysis identified three classes of couples: class 1, comprising women with higher trauma events (TEs), men with intermediate TEs (19%); class 2, including men with higher TEs, women with lower TEs (23%); and class 3, comprising couples in which men and women had lower TE exposure (58%) (the reference group). Men and women partners of survivors of higher TE exposure (classes 1 and 2) had increased symptoms of explosive anger and grief compared with the reference class (class 3). Women partners of survivors of higher TE exposure (class 2) had a 20-fold increased rate of PTSD symptoms compared with the reference class, a pattern that was not evident for men living with women exposed to higher levels of trauma (class 1). Men and women living with survivors of higher levels of trauma showed an increase in symptoms of grief and explosive anger. The manifold higher rate of PTSD symptoms amongst women living with men exposed to high levels of trauma requires replication. It is important to assess the mental health of partners when treating survivors of high levels of trauma in post-conflict settings.

  15. Trauma Africa

    Directory of Open Access Journals (Sweden)

    Victor Y. Kong

    2013-11-01

    Full Text Available “Major Trauma. Dr. Kong, please come to the Trauma Unit immediately. Dr. Kong, please come to the Trauma Unit immediately.” Even though I have been working at Edendale Hospital as a trauma registrar for over a year, whenever I hear this announcement over the hospital intercom system, my heart beats just a little faster than normal. When I first arrived at Edendale my colleagues told me that the adrenaline rush I would experience after being called out to attend a new emergency would decrease over time, and indeed they were right. However, it is also true to say that on some occasions more than others, it is still felt more strongly than ever.

  16. Tailbone trauma

    Science.gov (United States)

    For tailbone trauma when no spinal cord injury is suspected: Relieve pressure on the tailbone by sitting on an inflatable rubber ring or cushions. Take acetaminophen for pain. Take a stool softener to avoid constipation. If you suspect injury ...

  17. Paediatric trauma

    African Journals Online (AJOL)

    Trauma Unit, Red Cross War Memorial Children's Hospital, Cape Town ... projects, educational initiatives and advocacy roles on child safety initiatives regarding child injuries as well as child abuse. ... The development of the total body digital.

  18. Perioperative changes of serum cortisol and plasma angiotensin II levels in patients undergoing thoracotomy for malignancy

    International Nuclear Information System (INIS)

    Tian Runhua; Lun Limin; Li Yusheng; Yu Yunyun; Li Xin; Zheng Chunxi

    2006-01-01

    Objective: To investigate the perioperative changes of serum stress hormones cortisol and plasma angiotensin II in patients undergoing thoracotomy for malignancy. Methods: Serum cortisol and plasma angiotensin II levels were measured with RIA repeatedly in 35 thoracotomy patients operated for malignancy before operation, 1 h after starting operation, at the end of operation, and one day later, Heart rate and blood pressure were constantly monitored during operation. Results: The serum levels of cortisol and plasma angiotensin-II rose gradually during operation with significant differences among the measurements (P < 0. 001 -0.05), No age-difference for the measurements was observed except for a higher systolic pressure in patients over 60. Heart rates at 1 h were positively correlated with 1 h angiotensin-II levels. Heart rates at the end of operation were positively correlated with the cortisol and angiotensin-II levels at that time. Conclusion: The serum levels of these stress hormones rose significantly during the operation. Stress responses in older patients were adequate, yet the higher levels of stress hormones might bring more adverse effect in elderly people, especially cognition impairment. Smooth anaesthesia and adequate post-operative analgesia would lessen the stress effect, providing more ideal recovery, especially for the older patients. (authors)

  19. Facial trauma.

    Science.gov (United States)

    Peeters, N; Lemkens, P; Leach, R; Gemels B; Schepers, S; Lemmens, W

    Facial trauma. Patients with facial trauma must be assessed in a systematic way so as to avoid missing any injury. Severe and disfiguring facial injuries can be distracting. However, clinicians must first focus on the basics of trauma care, following the Advanced Trauma Life Support (ATLS) system of care. Maxillofacial trauma occurs in a significant number of severely injured patients. Life- and sight-threatening injuries must be excluded during the primary and secondary surveys. Special attention must be paid to sight-threatening injuries in stabilized patients through early referral to an appropriate specialist or the early initiation of emergency care treatment. The gold standard for the radiographic evaluation of facial injuries is computed tomography (CT) imaging. Nasal fractures are the most frequent isolated facial fractures. Isolated nasal fractures are principally diagnosed through history and clinical examination. Closed reduction is the most frequently performed treatment for isolated nasal fractures, with a fractured nasal septum as a predictor of failure. Ear, nose and throat surgeons, maxillofacial surgeons and ophthalmologists must all develop an adequate treatment plan for patients with complex maxillofacial trauma.

  20. The Role of Cumulative Trauma, Betrayal, and Appraisals in Understanding Trauma Symptomatology

    OpenAIRE

    Martin, Christina Gamache; Cromer, Lisa DeMarni; DePrince, Anne P.; Freyd, Jennifer J.

    2011-01-01

    Poor psychological outcomes are common among trauma survivors, yet not all survivors experience adverse sequelae. The current study examined links between cumulative trauma exposure as a function of the level of betrayal (measured by the relational closeness of the survivor and the perpetrator), trauma appraisals, gender, and trauma symptoms. Participants were 273 college students who reported experiencing at least one traumatic event on a trauma checklist. Three cumulative indices were const...

  1. EAP-based critical incident stress management: utilization of a practice-based assessment of incident severity level in responding to workplace trauma.

    Science.gov (United States)

    DeFraia, Gary S

    2013-01-01

    Central to the field of trauma psychology is assessment of the impact of critical incidents on individuals, as measured by individual symptoms of stress. Accordingly, the trauma literature reflects a proliferation of clinical impact of event scales. Workplace incidents however, affect not only individual employees, but also work organizations, requiring a multi-level response. Critical incident stress management (CISM) is the most prevalent multi-level incident response strategy utilized by organizations, often through specialized CISM units operating within their employee assistance programs (EAPs). While EAP-based CISM units seeks to support both individuals and organizations, studies focused on individual stress dominate the literature, mirroring assessment scales that tend to emphasize clinical as opposed to organizational practice. This research contributes to less-prevalent studies exploring incident characteristics as disruptive to organizations, rather than clinical symptoms as disruptive to individuals. To measure incident disruption, an EAP-based CISM unit developed a critical incident severity scale. By analyzing this unit's extensive practice database, this exploratory study examines how critical incident severity level varies among various types of incidents. Employing the methodology of clinical data mining, this practice-based research generates evidence-informed practice recommendations in the areas of EAP-based CISM intake assessment, organizational consultation and incident response planning.

  2. [Chest trauma].

    Science.gov (United States)

    Freixinet Gilart, Jorge; Ramírez Gil, María Elena; Gallardo Valera, Gregorio; Moreno Casado, Paula

    2011-01-01

    Chest trauma is a frequent problem arising from lesions caused by domestic and occupational activities and especially road traffic accidents. These injuries can be analyzed from distinct points of view, ranging from consideration of the most severe injuries, especially in the context of multiple trauma, to the specific characteristics of blunt and open trauma. In the present article, these injuries are discussed according to the involvement of the various thoracic structures. Rib fractures are the most frequent chest injuries and their diagnosis and treatment is straightforward, although these injuries can be severe if more than three ribs are affected and when there is major associated morbidity. Lung contusion is the most common visceral lesion. These injuries are usually found in severe chest trauma and are often associated with other thoracic and intrathoracic lesions. Treatment is based on general support measures. Pleural complications, such as hemothorax and pneumothorax, are also frequent. Their diagnosis is also straightforward and treatment is based on pleural drainage. This article also analyzes other complex situations, notably airway trauma, which is usually very severe in blunt chest trauma and less severe and even suitable for conservative treatment in iatrogenic injury due to tracheal intubation. Rupture of the diaphragm usually causes a diaphragmatic hernia. Treatment is always surgical. Myocardial contusions should be suspected in anterior chest trauma and in sternal fractures. Treatment is conservative. Other chest injuries, such as those of the great thoracic and esophageal vessels, are less frequent but are especially severe. Copyright © 2011 Sociedad Española de Neumología y Cirugía Torácica. Published by Elsevier Espana. All rights reserved.

  3. Trauma center designation correlates with functional independence after severe but not moderate traumatic brain injury.

    Science.gov (United States)

    Brown, Joshua B; Stassen, Nicole A; Cheng, Julius D; Sangosanya, Ayodele T; Bankey, Paul E; Gestring, Mark L

    2010-08-01

    The mortality of traumatic brain injury (TBI) continues to decline, emphasizing functional outcomes. Trauma center designation has been linked to survival after TBI, but the impact on functional outcomes is unclear. The objective was to determine whether trauma center designation influenced functional outcomes after moderate and severe TBI. Trauma subjects presenting to an American College of Surgeons (ACS) Level I or II trauma center with a Glasgow Coma Score (GCS) independence (FI) defined as a modified functional independence measure (FIM) of 12, and independent expression (IE) defined as a FIM component of 4. These were compared between Level I and Level II centers in subjects with both moderate (GCS 9-12) and severe (GCS Level I designation was associated with FI (odds ratio: 1.16; confidence interval: 1.07-1.24, p < 0.01) and IE (1.10; 1.03-1.17, p < 0.01) after severe TBI. Trauma center designation was not associated with FI or IE after moderate TBI. ACS trauma center designation is significantly associated with FI and IE after severe, but not moderate TBI. Prospective study is warranted to verify and explore factors contributing to this discrepancy.

  4. Changes of serum cortisol and plasma angiotensin-II (AT-II) levels in patients with open chest surgery during peri-operative stage

    International Nuclear Information System (INIS)

    Yu Yunyun; Tian Runhua; Zhao Huiyuan; Li Xiaoqin; Wang Ling

    2005-01-01

    Objective: To assess the systemic stress reaction in patients with open chest surgery through measurement of the changes of serum cortisol and plasma AT-II levels during peri-operative stage. Methods: Serum cortisol and plasma AT-II levels were measured with RIA in 35 patients underwent open chest surgery both before and after the operative procedure. Results: The serum level of cortisol and plasma levels of AT-II were significantly higher after operation than those before operation ( P < 0.05 ). Also, the systolic pressure and heart rate were increased significantly (P<0.05). The post-operative heart rate was significantly positively correlated with both cortisol and AT-II levels (P<0.05). Conclusion: Stress reaction is evident in patients after open chest surgery with increase of serum cortisol and plasma AT-II levels. The stress reaction, if excessive, should be properly dealt with. (authors)

  5. How health service delivery guides the allocation of major trauma patients in the intensive care units of the inclusive (hub and spoke) trauma system of the Emilia Romagna Region (Italy). A cross-sectional study

    Science.gov (United States)

    Volpi, Annalisa; Gordini, Giovanni; Ventura, Chiara; Barozzi, Marco; Caspani, Maria Luisa Rita; Fabbri, Andrea; Ferrari, Anna Maria; Ferri, Enrico; Giugni, Aimone; Marino, Massimiliano; Martino, Costanza; Pizzamiglio, Mario; Ravaldini, Maurizio; Russo, Emanuele; Trabucco, Laura; Trombetti, Susanna; De Palma, Rossana

    2017-01-01

    Objective To evaluate cross-sectional patient distribution and standardised 30-day mortality in the intensive care units (ICU) of an inclusive hub and spoke trauma system. Setting ICUs of the Integrated System for Trauma Patient Care (SIAT) of Emilia-Romagna, an Italian region with a population of approximately 4.5 million. Participants 5300 patients with an Injury Severity Score (ISS) >15 were admitted to the regional ICUs and recorded in the Regional Severe Trauma Registry between 2007 and 2012. Patients were classified by the Abbreviated Injury Score as follows: (1) traumatic brain injury (2) multiple injuriesand (3) extracranial lesions. The SIATs were divided into those with at least one neurosurgical level II trauma centre (TC) and those with a neurosurgical unit in the level I TC only. Results A higher proportion of patients (out of all SIAT patients) were admitted to the level I TC at the head of the SIAT with no additional neurosurgical facilities (1083/1472, 73.6%) compared with the level I TCs heading SIATs with neurosurgical level II TCs (1905/3815; 49.9%). A similar percentage of patients were admitted to level I TCs (1905/3815; 49.9%) and neurosurgical level II TCs (1702/3815, 44.6%) in the SIATs with neurosurgical level II TCs. Observed versus expected mortality (OE) was not statistically different among the three types of centre with a neurosurgical unit; however, the best mean OE values were observed in the level I TC in the SIAT with no neurosurgical unit. Conclusion The Hub and Spoke concept was fully applied in the SIAT in which neurosurgical facilities were available in the level I TC only. The performance of this system suggests that competition among level I and level II TCs in the same Trauma System reduces performance in both. The density of neurosurgical centres must be considered by public health system governors before implementing trauma systems. PMID:28965094

  6. Geriatric trauma.

    Science.gov (United States)

    Adams, Sasha D; Holcomb, John B

    2015-12-01

    The landscape of trauma is changing due to an aging population. Geriatric patients represent an increasing number and proportion of trauma admissions and deaths. This review explores recent literature on geriatric trauma, including triage criteria, assessment of frailty, fall-related injury, treatment of head injury complicated by coagulopathy, goals of care, and the need for ongoing education of all surgeons in the care of the elderly. Early identification of high-risk geriatric patients is imperative to initiate early resuscitative efforts. Geriatric patients are typically undertriaged because of their baseline frailty being underappreciated; however, centers that see more geriatric patients do better. Rapid reversal of anticoagulation is important in preventing progression of brain injury. Anticipation of difficult disposition necessitates early involvement of physical therapy for rehabilitation and case management for appropriate placement. Optimal care of geriatric trauma patients will be based on the well established tenets of trauma resuscitation and injury repair, but with distinct elements that address the physiological and anatomical challenges presented by geriatric patients.

  7. Abdominal trauma

    International Nuclear Information System (INIS)

    Giordany, B.R.

    1985-01-01

    Abdominal injury is an important cause of morbidity and mortality in childhood. Ten percent of trauma-related deaths are due to abdominal injury. Thousands of children are involved in auto accidents annually; many suffer severe internal injury. Child abuse is a second less frequent but equally serious cause of internal abdominal injury. The descriptions of McCort and Eisenstein and their associates in the 1960s first brought to attention the frequency and severity of visceral injury as important manifestations of the child abuse syndrome. Blunt abdominal trauma often causes multiple injuries; in the past, many children have been subjected to exploratory surgery to evaluate the extent of possible hidden injury. Since the advent of noninvasive radiologic imaging techniques including radionuclide scans and ultrasound and, especially, computed tomography (CT), the radiologist has been better able to assess (accurately) the extent of abdominal injury and thus allow conservative therapy in many cases. Penetrating abdominal trauma occurs following gunshot wounds, stabbing, and other similar injury. This is fortunately, a relatively uncommon occurrence in most pediatric centers and will not be discussed specifically here, although many principles of blunt trauma diagnosis are valid for evaluation of penetrating abdominal trauma. If there is any question that a wound has extended intraperitonelly, a sinogram with water-soluble contrast material allows quick, accurate diagnosis. The presence of large amounts of free intraperitoneal gas suggests penetrating injury to the colon or other gas-containing viscus and is generally considered an indication for surgery

  8. The value of trauma registries.

    Science.gov (United States)

    Moore, Lynne; Clark, David E

    2008-06-01

    Trauma registries are databases that document acute care delivered to patients hospitalised with injuries. They are designed to provide information that can be used to improve the efficiency and quality of trauma care. Indeed, the combination of trauma registry data at regional or national levels can produce very large databases that allow unprecedented opportunities for the evaluation of patient outcomes and inter-hospital comparisons. However, the creation and upkeep of trauma registries requires a substantial investment of money, time and effort, data quality is an important challenge and aggregated trauma data sets rarely represent a population-based sample of trauma. In addition, trauma hospitalisations are already routinely documented in administrative hospital discharge databases. The present review aims to provide evidence that trauma registry data can be used to improve the care dispensed to victims of injury in ways that could not be achieved with information from administrative databases alone. In addition, we will define the structure and purpose of contemporary trauma registries, acknowledge their limitations, and discuss possible ways to make them more useful.

  9. Pancreatic trauma.

    Science.gov (United States)

    Lahiri, R; Bhattacharya, S

    2013-05-01

    Pancreatic trauma occurs in approximately 4% of all patients sustaining abdominal injuries. The pancreas has an intimate relationship with the major upper abdominal vessels, and there is significant morbidity and mortality associated with severe pancreatic injury. Immediate resuscitation and investigations are essential to delineate the nature of the injury, and to plan further management. If main pancreatic duct injuries are identified, specialised input from a tertiary hepatopancreaticobiliary (HPB) team is advised. A comprehensive online literature search was performed using PubMed. Relevant articles from international journals were selected. The search terms used were: 'pancreatic trauma', 'pancreatic duct injury', 'radiology AND pancreas injury', 'diagnosis of pancreatic trauma', and 'management AND surgery'. Articles that were not published in English were excluded. All articles used were selected on relevance to this review and read by both authors. Pancreatic trauma is rare and associated with injury to other upper abdominal viscera. Patients present with non-specific abdominal findings and serum amylase is of little use in diagnosis. Computed tomography is effective in diagnosing pancreatic injury but not duct disruption, which is most easily seen on endoscopic retrograde cholangiopancreaticography or operative pancreatography. If pancreatic injury is suspected, inspection of the entire pancreas and duodenum is required to ensure full evaluation at laparotomy. The operative management of pancreatic injury depends on the grade of injury found at laparotomy. The most important prognostic factor is main duct disruption and, if found, reconstructive options should be determined by an experienced HPB surgeon. The diagnosis of pancreatic trauma requires a high index of suspicion and detailed imaging studies. Grading pancreatic injury is important to guide operative management. The most important prognostic factor is pancreatic duct disruption and in these cases

  10. A prospective evaluation of missed injuries in trauma patients, before and after formalising the trauma tertiary survey.

    Science.gov (United States)

    Keijzers, Gerben B; Campbell, Don; Hooper, Jeffrey; Bost, Nerolie; Crilly, Julia; Steele, Michael Craig; Del Mar, Chris; Geeraedts, Leo M G

    2014-01-01

    This study prospectively evaluated in-hospital and postdischarge missed injury rates in admitted trauma patients, before and after the formalisation of a trauma tertiary survey (TTS) procedure. Prospective before-and-after cohort study. TTS were formalised in a single regional level II trauma hospital in November 2009. All multitrauma patients admitted between March-October 2009 (preformalisation of TTS) and December 2009-September 2010 (post-) were assessed for missed injury, classified into three types: Type I, in-hospital, (injury missed at initial assessment, detected within 24 h); Type II, in-hospital (detected in hospital after 24 h, missed at initial assessment and by TTS); Type III, postdischarge (detected after hospital discharge). Secondary outcome measures included TTS performance rates and functional outcomes at 1 and 6 months. A total of 487 trauma patients were included (pre-: n = 235; post-: n = 252). In-hospital missed injury rate (Types I and II combined) was similar for both groups (3.8 vs. 4.8 %, P = 0.61), as were postdischarge missed injury rates (Type III) at 1 month (13.7 vs. 11.5 %, P = 0.43), and 6 months (3.8 vs. 3.3 %, P = 0.84) after discharge. TTS performance was substantially higher in the post-group (27 vs. 42 %, P cumulative missed injury rates >15 %. Some of these injuries were clinically relevant. Although TTS performance was significantly improved by formalising the process (from 27 to 42 %), this did not decrease missed injury rates.

  11. Splenic Trauma

    International Nuclear Information System (INIS)

    Cortes Diaz, Fabio F; Buitrago Mejia, Francisco; Ulloa Guerrero, Luis Heber

    2001-01-01

    The spleen is the organ that is injured during the closed trauma with more frequency and it is the cause more common of foregone death in the patients with wounded abdominal. At the present time the complications of the splenic trauma are related with their severity, associate wounds, diagnostic fail or inadequate treatments. The lesions that are diagnosed in early form are managed quick and satisfactorily, but the forgotten wounds or the diagnoses and late treatments take for themselves high rates of morbid-mortality. The paper includes their phyto pathology, diagnoses, classification and treatment

  12. Ballistic trauma

    Directory of Open Access Journals (Sweden)

    Parvathi Devi Munishwar

    2016-01-01

    Full Text Available Gunshot injuries are rather serious but uncommon type of trauma in India. Radiologists can contribute substantially in the evaluation and treatment of patients with gunshot wounds. Foreign bodies that enter a patient as a result of trauma are contaminated and produce a range of symptoms. Oral and maxillofacial gunshot injuries are usually fatal due to close proximity with vital structures. Here, we report a case in which radiographic evidence of foreign bodies in the right orofacial region exposed a history of a gunshot injury. The patient did not have any major complaints except for reduced mouth opening. These foreign bodies were clinically silent for approximately 12 years.

  13. Thoracic Trauma.

    Science.gov (United States)

    Dennis, Bradley M; Bellister, Seth A; Guillamondegui, Oscar D

    2017-10-01

    Management of chest trauma is integral to patient outcomes owing to the vital structures held within the thoracic cavity. Understanding traumatic chest injuries and appropriate management plays a pivotal role in the overall well-being of both blunt and penetrating trauma patients. Whether the injury includes rib fractures, associated pulmonary injuries, or tracheobronchial tree injuries, every facet of management may impact the short- and long-term outcomes, including mortality. This article elucidates the workup and management of the thoracic cage, pulmonary and tracheobronchial injuries. Copyright © 2017 Elsevier Inc. All rights reserved.

  14. Epidemiology of severe trauma.

    Science.gov (United States)

    Alberdi, F; García, I; Atutxa, L; Zabarte, M

    2014-12-01

    Major injury is the sixth leading cause of death worldwide. Among those under 35 years of age, it is the leading cause of death and disability. Traffic accidents alone are the main cause, fundamentally in low- and middle-income countries. Patients over 65 years of age are an increasingly affected group. For similar levels of injury, these patients have twice the mortality rate of young individuals, due to the existence of important comorbidities and associated treatments, and are more likely to die of medical complications late during hospital admission. No worldwide, standardized definitions exist for documenting, reporting and comparing data on severely injured trauma patients. The most common trauma scores are the Abbreviated Injury Scale (AIS), the Injury Severity Score (ISS) and the Trauma and Injury severity Score (TRISS). Documenting the burden of injury also requires evaluation of the impact of post-trauma impairments, disabilities and handicaps. Trauma epidemiology helps define health service and research priorities, contributes to identify disadvantaged groups, and also facilitates the elaboration of comparable measures for outcome predictions. Copyright © 2014 Elsevier España, S.L.U. y SEMICYUC. All rights reserved.

  15. CT incidence of Morel-Lavallee lesions in patients with pelvic fractures: a 4-year experience at a level 1 trauma center.

    Science.gov (United States)

    Beckmann, Nicholas M; Cai, Chunyan

    2016-12-01

    The aim of this study is to determine the incidence and location of Morel-Lavallee lesions (MLLs) on pelvic CTs performed in evaluation of pelvic fractures and determine if correlation exists between MLLs and mechanism of injury or pelvic ring injury pattern. A retrospective review was performed of pelvic CTs on 1493 consecutive patients presenting with pelvic fractures at our level 1 trauma center. MLLs occurred in 182 of 1493 patients presenting with pelvic fractures. Statistical significance in MLL incidence was found across mechanism of injuries with MLLs being seen most frequently in MCC/ATV accidents and crush injuries. A little over half of MLLs occurred over the lateral thigh with almost all other MLLs occurring over the posterior (flank or lumbar) region. MLLs were much more common in vertical shear and spinopelvic dissociation pelvic ring fracture patterns compared to lateral compression and AP compression patterns. In lateral compression injuries, MLLs most commonly occurred over the thigh. In all other pelvic ring injury patterns, MLLs were predominately posterior. MLL's are not as rare as previously believed. The lateral thigh and lumbar/flank regions should be closely inspected on pelvic trauma patients to identify MLLs, particularly in patients with a spinopelvic dissociation injury pattern.

  16. Interactive Journaling as a Brief Intervention for Level-II DUI and DWI Offenders

    Science.gov (United States)

    Scheck, Amy Mary; Hoffmann, Norman G.; Proctor, Steven L.; Couillou,Ryan J.

    2013-01-01

    This study sought to evaluate the acceptability and effectiveness of a brief alcohol intervention in increasing basic alcohol-related knowledge, and the intention to change high-risk drinking behaviors, among a sample of DUI and DWI offenders. Pre- and post-test data, in addition to program evaluation data, from 872 Level-II DUI and DWI offenders…

  17. Project NOAH: Regulating modern sea-level rise. Phase II: Jerusalem Underground

    Science.gov (United States)

    Newman, Walter S.; Fairbridge, Rhodes W.

    This proposal builds a high-speed inter-urban express between Jerusalem and Tel Aviv, generates 1500 megawatts of hydroelectric energy, curtails littoral erosion, builds a port along the Israeli Mediterranean coast and demands peaceful cooperation on both sides of the Jordan River. Phase II represents a pilot project demonstrating the feasibility of continuing to regulate world sea-level by a new series of water regulation schemes. Phase I previously described all those projects already completed or underway which have inadvertently and/or unintentionally served the purpose of sea-level regulation. These forms of Phase I sea-level regulation include large and small reservoirs, irrigation projects, water infiltration schemes, farm ponds, and swimming and reflecting pools. All these water storage projects have already exercised a very appreciable brake on 20th century sea-level rise. Phase II outlines a high-visibility proposal which will serve to illustrate the viability of “Project NOAH”.

  18. Trauma Theory

    DEFF Research Database (Denmark)

    Pedersen, Bodil Maria

    There are two main trends in psychological approaches to human suffering related to what we term trauma. Although they have their respective limitations both approaches may help us explore and alleviate human suffering. One trend, primarily using concepts like traumatic events and traumatisation ...

  19. Forest Focus Monitoring Database System - Technical Report 2003 Level II Data

    OpenAIRE

    HIEDERER ROLAND; DURRANT TRACY; GRANKE O.; LAMBOTTE Michel; LORENZ M.; MIGNON B.; OEHMICHEN K.

    2007-01-01

    Forest Focus (Regulation (EC) No 2152/2003) is a Community scheme for harmonized, broad-based, comprehensive and long-term monitoring of European forest ecosystems. Under this scheme the monitoring of air pollution effects on forests is carried out by participating countries on the basis of the systematic network of observation points (Level I) and of the network of observation plots for intensive and continuous monitoring (Level II). According to Article 15(1) of the Forest Focus Regulat...

  20. Forest Focus Monitoring Database System - Technical Report 2006 Level II Data

    OpenAIRE

    HIEDERER Roland; DURRANT Tracy; GRANKE Oliver; LAMBOTTE Michel; LORENZ Martin; MIGNON Bertrand

    2008-01-01

    Forest Focus (Regulation (EC) No 2152/2003) is a Community scheme for harmonized, broadbased, comprehensive and long-term monitoring of European forest ecosystems. Under this scheme the monitoring of air pollution effects on forests is carried out by participating countries on the basis of the systematic network of observation points (Level I) and of the network of observation plots for intensive and continuous monitoring (Level II). According to Article 15(1) of the Forest Focus Regulatio...

  1. Quality of trauma care and trauma registries.

    Science.gov (United States)

    Pino Sánchez, F I; Ballesteros Sanz, M A; Cordero Lorenzana, L; Guerrero López, F

    2015-03-01

    Traumatic disease is a major public health concern. Monitoring the quality of services provided is essential for the maintenance and improvement thereof. Assessing and monitoring the quality of care in trauma patient through quality indicators would allow identifying opportunities for improvement whose implementation would improve outcomes in hospital mortality, functional outcomes and quality of life of survivors. Many quality indicators have been used in this condition, although very few ones have a solid level of scientific evidence to recommend their routine use. The information contained in the trauma registries, spread around the world in recent decades, is essential to know the current health care reality, identify opportunities for improvement and contribute to the clinical and epidemiological research. Copyright © 2014 Elsevier España, S.L.U. and SEMICYUC. All rights reserved.

  2. Preliminary Modelling of Radiation Levels at the Fermilab PIP-II Linac

    Energy Technology Data Exchange (ETDEWEB)

    Lari, L. [CERN; Cerutti, F. [CERN; Esposito, L. S. [CERN; Baffes, C. [Fermilab; Dixon, S. J. [Fermilab; Mokhov, N. V. [Fermilab; Rakhno, I. [Fermilab; Tropin, I. S. [Fermilab

    2018-04-01

    PIP-II is the Fermilab's flagship project for providing powerful, high-intensity proton beams to the laboratory's experiments. The heart of PIP-II is an 800-MeV superconducting linac accelerator. It will be located in a new tunnel with new service buildings and connected to the present Booster through a new transfer line. To support the design of civil engineering and mechanical integration, this paper provides preliminary estimation of radiation level in the gallery at an operational beam loss limit of 0.1 W/m, by means of Monte Carlo calculations with FLUKA and MARS15 codes.

  3. Preliminary Modeling Of Radiation Levels At The Fermilab PIP-II Linac arXiv

    CERN Document Server

    Lari, L.; Esposito, L.S.; Baffes, C.; Dixon, S.J.; Mokhov, N.V.; Rakhno, I.; Tropin, I.S.

    PIP-II is the Fermilab's flagship project for providing powerful, high-intensity proton beams to the laboratory's experiments. The heart of PIP-II is an 800-MeV superconducting linac accelerator. It will be located in a new tunnel with new service buildings and connected to the present Booster through a new transfer line. To support the design of civil engineering and mechanical integration, this paper provides preliminary estimation of radiation level in the gallery at an operational beam loss limit of 0.1 W/m, by means of Monte Carlo calculations with FLUKA and MARS15 codes.

  4. Infrastructure and clinical practice for the detection and management of trauma-associated haemorrhage and coagulopathy.

    Science.gov (United States)

    Driessen, A; Schäfer, N; Albrecht, V; Schenk, M; Fröhlich, M; Stürmer, E K; Maegele, M

    2015-08-01

    Early detection and management of post-traumatic haemorrhage and coagulopathy have been associated with improved outcomes, but local infrastructures, logistics and clinical strategies may differ. To assess local differences in infrastructure, logistics and clinical management of trauma-associated haemorrhage and coagulopathy, we have conducted a web-based survey amongst the delegates to the 15th European Congress of Trauma and Emergency Surgery (ECTES) and the 2nd World Trauma (WT) Congress held in Frankfurt, Germany, 25-27 May 2014. 446/1,540 delegates completed the questionnaire yielding a response rate of 29%. The majority specified to work as consultants/senior physicians (47.3%) in general (36.1%) or trauma/orthopaedic surgery (44.5%) of level I (70%) or level II (19%) trauma centres. Clinical assessment (>80%) and standard coagulation assays (74.6%) are the most frequently used strategies for early detection and monitoring of bleeding trauma patients with coagulopathy. Only 30% of the respondents declared to use extended coagulation assays to better characterise the bleeding and coagulopathy prompted by more individualised treatment concepts. Most trauma centres (69%) have implemented local protocols based on international and national guidelines using conventional blood products, e.g. packed red blood cell concentrates (93.3%), fresh frozen plasma concentrates (93.3%) and platelet concentrates (83%), and antifibrinolytics (100%). 89% considered the continuous intake of anticoagulants including "new oral anticoagulants" and platelet inhibitors as an increasing threat to bleeding trauma patients. This study confirms differences in infrastructure, logistics and clinical practice for the detection and management of trauma-haemorrhage and trauma-associated coagulopathy amongst international centres. Ongoing work will focus on geographical differences.

  5. Efeitos do laser de baixa potência sobre a dor e edema no trauma tendíneo de ratos Effects of the low level laser over pain and edema in tendon trauma of rats

    Directory of Open Access Journals (Sweden)

    Gladson Ricardo Flor Bertolini

    2008-08-01

    repair, thus gain body the use of physical resources for the process control. The aim of this study was to evaluate the use of low level laser therapy on the pain and edema of the rats calcaneus tendon, subjected to experimental trauma. We used 28 rats Wistar, divided into four groups: GC - subjected to traumatic injury and the placebo treatment; G2 - subject to injury and irradiated with laser 2 J/cm²; G4 - subject to injury and irradiated with 4 J/cm²; G8 - submitted to injury and irradiated with 8 J/cm². The lesion was performed with the fall of a weight on the side of the right calcaneus tendon of each animal, with energy of about 0.40 J. The pain was evaluated by the paw elevation time (PET for a minute, the animal walking on a metal cylinder with 30 cm in diameter at 3 rpm; the edema evaluation occurred through caliper; moments of the evaluation were: after and before injury, before treatment, 2 hours, 8 hours, 24 hours and 5th injury day. Treatment with laser 670 nm, was so punctual and daily. The results showed increases in PET and formation of edema in all groups after the injury, and for the groups treated there were reducing the pain and edema, being observed in the control group only with the edema reduction in the 5th placebo day. We concluded that the treatment with low level laser therapy decreased the pain and edema of the animals with tendon trauma, in a dose-dependent manner.

  6. Significance of determination of the serum levels of homocysteine (Hcy) and insulin-like growth factor-II (IGF-II) in patients with cerebrovascular diseases

    International Nuclear Information System (INIS)

    Tong Haijiang; Wang Yaling; Wang Lin; Xia Weiren; Shi Min; Lu Yaling

    2006-01-01

    Objective: To investigate the clinical significance of the changes of homocysteine (Hcy) and insulin-like growth factor H (IGF-II) in patients with cerebrovascular diseases (CVD). Methods: The serum Hcy (with CLIA) and IGF-II (with RIA) levels were measured in 123 patients with CVD (cerebral infarction 69 and cerebral hemorrhage 54) and 43 controls. Results: The levels of Hcy and IGF-II in patients with CVD were significantly higher than those in the controls (P 0.05). Conclusion: The serum Hcy and IGF-II levels in patients with CVD are elevated, Hcy and IGF-II may be involved in the development and pathogenesis of CVD. (authors)

  7. Spinal trauma. An imaging approach

    International Nuclear Information System (INIS)

    Cassar-Pullicino, V.N.; Imhof, H.

    2006-01-01

    The diagnosis of trauma to the spine - where the slightest oversight may have catastrophic results - requires a thorough grasp of the spectrum of resultant pathology as well as the imaging modalities used in making an accurate diagnosis. In Spinal Trauma, the internationally renowned team of experts provides a comprehensive, cutting-edge exposition of the current vital role of imaging in the diagnosis and treatment of injuries to the axial skeleton. Beginning with a valuable clinical perspective of spinal trauma, the book offers the reader a unique overview of the biomechanics underlying the pathology of cervical trauma. Acute trauma topics include: - Optimization of imaging modalities - Malalignment - signs and significance - Vertebral fractures - detection and implications - Classification of thoraco-lumbar fractures - rationale and relevance - Neurovascular injury. Distilling decades of clinical and teaching expertise, the contributors further discuss the current role of imaging in special focus topics, which include: - The pediatric spine - Sports injuries - The rigid spine - Trauma in the elderly - Vertebral collapse, benign and malignant - Spinal trauma therapy - Vertebral fractures and osteoporosis - Neuropathic spine. All throughout the book, the focus is on understanding the injury, and its implications and complications, through 'an imaging approach'. Lavishly illustrated with hundreds of superb MR images and CT scans, and clear full-color drawings, the authors conclude with a look into the future, defining clinical trends and research directions. Spinal Trauma - with its broad scope, practical imaging approach, and current focus - is designed to enhance confidence and accuracy, making it essential reading for clinicians and radiologists at all levels. (orig.)

  8. Clinical significance of measurement of serum insulin-like growth factor II and adrenomedulion levels in patients with essential hypertension

    International Nuclear Information System (INIS)

    Fan Bifu; Ji Naijun; Mei Yibin; Wang Chengyao; Chen Donghai; Li Fuyuan; Guan Lihua; Gao Meiying

    2003-01-01

    Objective: To investigate the changes of serum levels of insulin-like growth factor II (IGF II) and adrenomedullin (ADM) in patients with essential hypertension. Methods: Serum IGF II and ADM levels were measured in 62 cases of hypertension and 40 controls with RIA. Results: Serum IGF II and ADM levels were significantly bigger in hypertensive patients than those in the controls (t = 4.454, p < 0.01; t = 3.992, p < 0.01). The serum IGF II level was significantly positively correlated to the serum ADM levels (r = 0.379, p < 0.05) and both were significantly positively correlated to the mean arterial pressure (r = 0.346, r = 0.353, p < 0.05) but not with BMI. Serum ADM levels increased gradually as the disease progressed from stage I to stage III (p < 0.05) with levels in stage III markedly higher than those in stage I (p < 0.01). In EH patients with heart and/or brain and/or renal complications the serum ADM levels were significantly higher than those in EH patients without complications (t = 2.050, p < 0.05). Such differences did not exist in the case of IGF II. Conclusion: Serum IGF II and ADM levels were increased markedly in hypertensive patients. These two factors were mutually positively correlated and both were positively correlated to mean arterial pressure. ADM levels increased gradually as the disease progressing but IGF II levels remained stable

  9. Relationship of blood lead levels and blood pressure in NHANES II: additional calculations

    International Nuclear Information System (INIS)

    Gartside, P.S.

    1988-01-01

    In performing research for associations and relationships among the data thus far published from the NHANES II survey, only the data for the 64 communities involved may be used. The simple omission of a few essential data makes impossible any valid analysis from the data for the 20,325 individual respondents. In this research for associations between blood lead levels and blood pressure in NHANES II, the method of forward stepwise regression was used. This avoids the problem of inflated error rates for blood lead, maximizes the number of data analyzed, and minimizes the number of independent variables entered into the regression model, thus avoiding the pitfalls that previous NHANES II research of blood lead and blood pressure has fallen into when using backward stepwise regression. The results of this research for white male adults, white female adults, and black adults were contradictory and lacked consistency and reliability. In addition, the overall average association between blood lead level and blood pressure was so minute that the only rational conclusion is that there is no evidence for this association to be found in the NHANES II data

  10. Protocol compliance and time management in blunt trauma resuscitation.

    NARCIS (Netherlands)

    Spanjersberg, W.R.; Bergs, E.A.; Mushkudiani, N.; Klimek, M.; Schipper, I.B.

    2009-01-01

    OBJECTIVES: To study advanced trauma life support (ATLS) protocol adherence prospectively in trauma resuscitation and to analyse time management of daily multidisciplinary trauma resuscitation at a level 1 trauma centre, for both moderately and severely injured patients. PATIENTS AND METHODS: All

  11. Spectrum and outcome of pancreatic trauma.

    Science.gov (United States)

    Kantharia, Chetan V; Prabhu, R Y; Dalvi, A N; Raut, Abhijit; Bapat, R D; Supe, Avinash N

    2007-01-01

    Pancreatic trauma is associated with high morbidity and mortality. Diagnosis is often difficult and surgery poses a formidable challenge. Data from 17 patients of pancreatic trauma gathered from a prospectively maintained database were analysed and the following parameters were considered: mode of injury, diagnostic modalities, associated injury, grade of pancreatic trauma and management. Pancreatic trauma was graded from I through IV, as per Modified Lucas Classification. The median age was 39 years (range 19-61). The aetiology of pancreatic trauma was blunt abdominal trauma in 14 patients and penetrating injury in 3. Associated bowel injury was present in 4 cases (3 penetrating injury and 1 blunt trauma) and 1 case had associated vascular injury. 5 patients had grade I, 3 had grade II, 7 had grade III and 2 had grade IV pancreatic trauma. Contrast enhanced computed tomography scan was used to diagnose pancreatic trauma in all patients with blunt abdominal injury. Immediate diagnosis could be reached in only 4 (28.5%) patients. 7 patients responded to conservative treatment. Of the 10 patients who underwent surgery, 6 required it for the pancreas and the duodenum. (distal pancreatectomy with splenectomy-3, pylorus preserving pancreatoduodenectomy-1, debridement with external drainage-1, associated injuries-duodenum-1). Pancreatic fistula, recurrent pancreatitis and pseudocyst formation were seen in 3 (17.05%), 2 (11.7%) and 1 (5.4%) patient respectively. Death occurred in 4 cases (23.5%), 2 each in grades III and IV pancreatic trauma. Contrast enhanced computed tomography scan is a useful modality for diagnosing, grading and following up patients with pancreatic trauma. Although a majority of cases with pancreatic trauma respond to conservative treatment, patients with penetrating trauma, and associated bowel injury and higher grade pancreatic trauma require surgical intervention and are also associated with higher morbidity and mortality.

  12. [Pancreatic trauma].

    Science.gov (United States)

    Arvieux, C; Guillon, F; Létoublon, Ch; Oughriss, M

    2003-10-01

    Early diagnosis of pancreatic trauma has always been challenging because of the lack of correlation between the initial clinical symptomatology, radiologic and laboratory findings, and the severity of the injury. Thanks to the improved performance of spiral CT scanning and magnetic resonance pancreatography, it is now often possible to make an early diagnosis of pancreatic contusion, to localize the site of the injury, and (most importantly) to identify injury to the main pancreatic duct which has major implications for the management of the case. When the trauma victim is unstable, radiologic work-up may be impossible and urgent laparotomy is required. Control of hemorrhage is the primary concern here and a damage control approach with packing may be appropriate; if the pancreatic head has been destroyed, a pancreaticoduodenectomy with delayed reconstruction may be required. If the trauma victim is stable, the treatment strategy will be governed by a variety of parameters--age, clinical condition, associated local anatomic findings (pancreatitis, injury to the duodenum or biliary tract), involvement of the pancreatic duct, and localization of the injury within the gland (to right or left of the mesenteric vessels).

  13. Level II scour analysis for Bridge 37 (TOWNTH00290037) on Town Highway 29, crossing Mill Brook, Townshend, Vermont

    Science.gov (United States)

    Burns, R.L.; Medalie, Laura

    1998-01-01

    This report provides the results of a detailed Level II analysis of scour potential at structure TOWNTH00290037 on Town Highway 29 crossing Mill Brook, Townshend, Vermont (figures 1–8). A Level II study is a basic engineering analysis of the site, including a quantitative analysis of stream stability and scour (FHWA, 1993). Results of a Level I scour investigation also are included in Appendix E of this report. A Level I investigation provides a qualitative geomorphic characterization of the study site. Information on the bridge, gleaned from Vermont Agency of Transportation (VTAOT) files, was compiled prior to conducting Level I and Level II analyses and is found in appendix D.

  14. Depression, anxiety and loss of resilience after multiple traumas: an illustration of a mediated moderation model of sensitization in a group of children who survived the Nazi Holocaust.

    Science.gov (United States)

    Fossion, Pierre; Leys, Christophe; Kempenaers, Chantal; Braun, Stephanie; Verbanck, Paul; Linkowski, Paul

    2013-12-01

    Depressive and anxiety disorders (DAD) have become a major public health problem. Multiple trauma is known to increase the risk of DAD through a sensitization mechanism. We investigate the hypothesis that resilience is a mediator of this mechanism. Former Hidden Children (FHC), the Jewish youths who spent World War II in various hideaway shelters across Nazi-occupied Europe, were compared with a control group. In each group, we measured the presence of multiple traumas, the resilience with the Resilience Scale for Adults, which has a six factors solution, and the DAD with the Hopkins Symptoms Checklist. We test a mediated moderation model with childhood trauma as the predictor; Later trauma as the moderator; Resilience as the mediator; and DAD as the outcome variable. Results are consistent with a sensitization model of DAD mediated by resilience: confrontation with a primary trauma during childhood followed by secondary trauma(s) after childhood damages resilience, which, in turn, results in higher level of DAD. We are unable to differentiate if the sensitization process is a consequence of the nature of the trauma endured by FHC (long-standing exposure to extreme external events) or a consequence of the fact that this first trauma occurred during childhood. Resilience construct is multi-factorial and a limited damaging of some of the factors is sufficient to lead to DAD even if other factors remain unaltered. Resilience can be altered by multiple traumas and, therefore, needs to be bolstered in therapy sessions. Copyright © 2013. Published by Elsevier B.V.

  15. Adaptive behaviors of experts in following standard protocol in trauma management: implications for developing flexible guidelines.

    Science.gov (United States)

    Vankipuram, Mithra; Ghaemmaghami, Vafa; Patel, Vimla L

    2012-01-01

    Critical care environments are complex and dynamic. To adapt to such environments, clinicians may be required to make alterations to their workflows resulting in deviations from standard procedures. In this work, deviations from standards in trauma critical care are studied. Thirty trauma cases were observed in a Level 1 trauma center. Activities tracked were compared to the Advance Trauma Life Support standard to determine (i) if deviations had occurred, (ii) type of deviations and (iii) whether deviations were initiated by individuals or collaboratively by the team. Results show that expert clinicians deviated to innovate, while deviations of novices result mostly in error. Experts' well developed knowledge allows for flexibility and adaptiveness in dealing with standards, resulting in innovative deviations while minimizing errors made. Providing informatics solution, in such a setting, would mean that standard protocols would have be flexible enough to "learn" from new knowledge, yet provide strong support for the trainees.

  16. The Role of Cumulative Trauma, Betrayal, and Appraisals in Understanding Trauma Symptomatology.

    Science.gov (United States)

    Martin, Christina Gamache; Cromer, Lisa Demarni; Deprince, Anne P; Freyd, Jennifer J

    2013-03-01

    Poor psychological outcomes are common among trauma survivors, yet not all survivors experience adverse sequelae. The current study examined links between cumulative trauma exposure as a function of the level of betrayal (measured by the relational closeness of the survivor and the perpetrator), trauma appraisals, gender, and trauma symptoms. Participants were 273 college students who reported experiencing at least one traumatic event on a trauma checklist. Three cumulative indices were constructed to assess the number of different types of traumas experienced that were low (LBTs), moderate (MBTs), or high in betrayal (HBTs). Greater trauma exposure was related to more symptoms of depression, dissociation, and PTSD, with exposure to HBTs contributing the most. Women were more likely to experience HBTs than men, but there were no gender differences in trauma-related symptoms. Appraisals of trauma were predictive of trauma-related symptoms over and above the effects explained by cumulative trauma at each level of betrayal. The survivor's relationship with the perpetrator, the effect of cumulative trauma, and their combined impact on trauma symptomatology are discussed.

  17. Isolated hip fracture care in an inclusive trauma system : A trauma system wide evaluation

    NARCIS (Netherlands)

    van Laarhoven, J. J E M; van Lammeren, G. W.; Houwert, R. M.; van Laarhoven, Constance; Hietbrink, F.; Leenen, L. P H; Verleisdonk, E. J M M

    2015-01-01

    Introduction: Elderly patients with a hip fracture represent a large proportion of the trauma population; however, little is known about outcome differences between different levels of trauma care for these patients. The aim of this study is to analyse the outcome of trauma care in patients with a

  18. Electrons and photons at High Level Trigger in CMS for Run II

    CERN Document Server

    Bin Anuar, Afiq Aizuddin

    2015-01-01

    The CMS experiment has been designed with a 2-level trigger system. The first level is implemented using custom-designed electronics. The second level is the so-called High Level Trigger (HLT), a streamlined version of the CMS offline reconstruction software running on a computer farm. For Run II of the Large Hadron Collider, the increase in center-of-mass energy and luminosity will raise the event rate to a level challenging for the HLT algorithms. New approaches have been studied to keep the HLT output rate manageable while maintaining thresholds low enough to cover physics analyses. The strategy mainly relies on porting online the ingredients that have been successfully applied in the offline reconstruction, thus allowing to move HLT selection closer to offline cuts. Improvements in HLT electron and photon definitions will be presented, focusing in particular on updated clustering algorithm and the energy calibration procedure, new Particle-Flow-based isolation approach and pileup mitigation techniques, a...

  19. Obesity in pediatric trauma.

    Science.gov (United States)

    Witt, Cordelie E; Arbabi, Saman; Nathens, Avery B; Vavilala, Monica S; Rivara, Frederick P

    2017-04-01

    The implications of childhood obesity on pediatric trauma outcomes are not clearly established. Anthropomorphic data were recently added to the National Trauma Data Bank (NTDB) Research Datasets, enabling a large, multicenter evaluation of the effect of obesity on pediatric trauma patients. Children ages 2 to 19years who required hospitalization for traumatic injury were identified in the 2013-2014 NTDB Research Datasets. Age and gender-specific body mass indices (BMI) were calculated. Outcomes included injury patterns, operative procedures, complications, and hospital utilization parameters. Data from 149,817 pediatric patients were analyzed; higher BMI percentiles were associated with significantly more extremity injuries, and fewer injuries to the head, abdomen, thorax and spine (p values Obese children also had significantly longer lengths of stay and more frequent ventilator requirement. Among children admitted after trauma, increased BMI percentile is associated with increased risk of death and potentially preventable complications. These findings suggest that obese children may require different management than nonobese counterparts to prevent complications. Level III; prognosis study. Copyright © 2017 Elsevier Inc. All rights reserved.

  20. Urethral trauma

    International Nuclear Information System (INIS)

    Carrington, B.M.; Hricak, H.; Dixon, C.; McAninch, J.W.

    1990-01-01

    This paper evaluates the role of MR imaging in posterior urethral trauma. Fifteen patients with posttraumatic membranous urethral strictures underwent prospective MR imaging with a 1.5-T unit before open urethroplasty. All patients had transaxial T1-weighted (500/20) and T2-weighted (2,500/70) spin-echo images and T2-weighted sagittal and coronal images (matrix, 192 x 256; section thickness, 4 mm with 20% gap). Conventional retrograde and cystourethrography were performed preoperatively. Compared with conventional studies, MR imaging defined the length and location of the urethral injury and provided additional information regarding the direction and degree of prostatic and urethral dislocation

  1. Images in kidney trauma

    International Nuclear Information System (INIS)

    Rodriguez, Jose Luis; Rodriguez, Sonia Pilar; Manzano, Ana Cristina

    2007-01-01

    A case of a 3 years old female patient, who suffered blunt lumbar trauma (horse kick) with secondary kidney trauma, is reported. Imaging findings are described. Renal trauma classification and imaging findings are reviewed

  2. The CMS Level-1 tau lepton and Vector Boson Fusion triggers for the LHC Run II

    CERN Document Server

    Amendola, Chiara

    2017-01-01

    The CMS experiment implements a sophisticated two-level triggering system composed of Level-1, instrumented by custom-design hardware boards, and a software High-Level-Trigger. A new Level-1 trigger architecture with improved performance is now being used to maintain the thresholds that were used in LHC Run I for the more challenging luminosity conditions experienced during Run II. The upgrades to the calorimetry trigger will be described along with performance data. The algorithms for the selection of final states with tau leptons, both for precision measurements and for searches of new physics beyond the Standard Model, will be described in detail. The implementation of the first dedicated Vector Boson Fusion trigger algorithm will be presented as well, along with its performance on benchmark physics signals.

  3. Diagnoses of gastric cancer and other gastric diseases by serum pepsinogen I and II levels

    International Nuclear Information System (INIS)

    Xiao Zhijian; Jiang Mengjun

    1998-01-01

    Serum pepsinogens I and II (PGI, PGII) levels were determined by PGI and PGII-RIA kits in 84 healthy controls and 128 patients of gastric diseases including 42 patients with gastric cancer. The results showed peptic ulcer cases had elevated PGI and PGII levels. The atrophic gastritis cases had low PGI levels and the gastric cancer cases had low PGI and low PGI/PGII ratio. Using the cut-off values of PGI<35 μg/L and PGI/PGII<1.5 for clinical purpose, the sensitivity and specificity of the test for gastric cancer was 73% and 78%, respectively. Combined with endoscope examination, the serum PGI and PGII levels are valuable for the early diagnosis of gastric cancer

  4. SAGE II Measurements of Stratospheric Aerosol Properties at Non-Volcanic Levels

    Science.gov (United States)

    Thomason, Larry W.; Burton, Sharon P.; Luo, Bei-Ping; Peter, Thomas

    2008-01-01

    Since 2000, stratospheric aerosol levels have been relatively stable and at the lowest levels observed in the historical record. Given the challenges of making satellite measurements of aerosol properties at these levels, we have performed a study of the sensitivity of the product to the major components of the processing algorithm used in the production of SAGE II aerosol extinction measurements and the retrieval process that produces the operational surface area density (SAD) product. We find that the aerosol extinction measurements, particularly at 1020 nm, remain robust and reliable at the observed aerosol levels. On the other hand, during background periods, the SAD operational product has an uncertainty of at least a factor of 2 during due to the lack of sensitivity to particles with radii less than 100 nm.

  5. Operator interface for the PEP-II low level RF control system

    International Nuclear Information System (INIS)

    Allison, S.; Claus, R.

    1997-05-01

    This paper focuses on the operational aspects of the low level RF control system being built for the PEP-II storage rings at SLAC. Subsystems requiring major operational considerations include displays for monitor and control from UNIX workstations, slow feedback loops and control sequences residing on microprocessors, and various client applications in the existing SLAC Linear Collider (SLC) control system. Since commissioning of PEP-II RF is currently in-progress, only those parts of the control system used during this phase are discussed in detail. Based on past experience with the SLC control system, it is expected that effort expended during commissioning on a solid user interface will result in smoother transition to full reliable 24-hour-a-day operation

  6. Traumatismos oculares Ocular traumas

    Directory of Open Access Journals (Sweden)

    Gelen Welch Ruiz

    2007-12-01

    Full Text Available Se realizó un estudio descriptivo de tipo retrospectivo longitudinal cuyo universo estuvo constituido por 72 ojos de 72 pacientes con traumatismos oculares mecánicos que fueron hospitalizados en el Hospital Militar Central “Dr. Carlos J. Finlay” desde enero de 1999 hasta enero de 2005. Para el análisis estadístico de la información se utilizó el programa automatizado SPSS versión 11.5 en el cual también se conformó la base de datos y se realizaron los cálculos de acuerdo con el tipo de variable analizada. Se utilizaron medidas de resumen, tendencia central y asociación estadística con un nivel de significación de p A retrospective longitudinal and descriptive study was carried out in 72 eyes from 72 patients with mechanical occular traumas, who had been hospitalized in “Dr. Carlos J. Finlay” Military Hospital from December 1999 to January 2005. For the statistical data analysis, an automated program (SPSS 11.5 version was used to create the database and estimations were made according to the variable types. Summary measures, central tendency measures and statistical association with significance level equal to p < 0.05 were employed. Males prevailed (95.8%, the average age was 30.26 years with a minimum rate of 17 years and maximum rate of 82 years. The most frequent mechanisms of trauma were aggressions (23. 6% and injures from secondary projectiles (13.9%. The anterior segment traumas were more frequent (61, 1% than posterior segment traumas (6.94%. Both segments of the eyeball were affected in 39, 1% of eyes which evinced the worst visual acuity. The most common associated injures were hyphema (54, 2% and vitreous hemorrhage (16.6%. Closed trauma (contusions were more common and most of the eyes had better final visual acuity (45, 2% with vision range of 0.6-1.0 and 26.2% with vision range of 0.59-0.1. On the other hand, eyes affected by open trauma (simple wound, contusion-wound, wound with intraocular foreign body and

  7. Skeleton scintigraphy in trauma

    International Nuclear Information System (INIS)

    Ansari, M.

    2002-01-01

    Skeletal trauma is common and presents both an opportunity and a problem in skeletal scintigraphy. The opportunity arises in the ability of skeletal scintigraphy to demonstrate abnormalities early after direct trauma. It is well recognized that the early detection of fractures in some sites cannot be reliably achieved by standard radiography, especially in the femoral neck and scaphoid bone. The problem comes in recognizing the effects of skeletal trauma when using skeletal scintigraphy for another purpose, such as the detection of metastatic disease. iatrogenic trauma to either the skeleton or soft tissues may be manifest scintigraphic ally. For example Craniotomy typically leaves a rim pattern at the surgical margin. Rib Retraction during thoracotomy can elicit periosteal reaction. Areas of the skeletal receiving curative levels of ionizing radiation (typically 4000 rads or greater) characteristically demonstrate decreased uptake within 6 months to 1 year after therapy. The generally high sensitivity of the skeletal scintigraphy seems to make it an ideal survey test in cases of suspected child abuse especially in which radiographs are unrevealing. Because of difficulties in obtaining a history of trauma from a preschool child or even eliciting a satisfactory description of the location and nature of the pain, skeletal scintigraphy provides a simple and reliable investigation in these children. Subtle trauma, such as that from stress fractures is often difficult to visualize on a plain radiograph. Skeletal scintigraphy is frequently positive at the time of clinical presentation. Skeletal scintigraphy is exquisitely sensitive to the remodeling process and typically shows abnormalities 1 to 2 weeks or more before the appearance of radiographic changes in stress fractures. The periosteal reaction can be visualized within hours of the injury. Insufficiency and fatigue fractures such as vertebral compression fracture, which is probably the most common consequence of

  8. The elusive 2s3s1S level in B II

    International Nuclear Information System (INIS)

    Martinson, I; Awaya, Y; Ekberg, J O; Kink, I; Mannervik, S; Ryabtsev, A N

    2003-01-01

    It has been known for nearly 30 years that the theoretical and experimental values for the energy of the 2s3s 1 S level in singly ionized boron, B II, differ strongly. Since there is much better agreement for other B II levels, it has been concluded that the experimental value for 2s3s 1 S must be revised. Despite a number of recordings over the years of sliding-spark, hollow cathode and beam-foil spectra, this level has not been located. We have now performed another beam-foil experiment, using higher resolution and sensitivity than in most previous studies. By combining these new data with previous results, we have identified transitions from the 2s4p, 2s5p and 2p3s 1 P levels to 2s3s 1 S, the excitation energy (137 622 ± 3 cm -1 ) of which is now well established and in excellent agreement with theoretical predictions

  9. The Cortisol Paradox of Trauma-Related Disorders: Lower Phasic Responses but Higher Tonic Levels of Cortisol Are Associated with Sexual Abuse in Childhood.

    Directory of Open Access Journals (Sweden)

    Inga Schalinski

    Full Text Available Inconsistent findings exist for the activity of the hypothalamic-pituitary-adrenal (HPA axis in patients with stress related disorders. Recent studies point towards early life stress as a potential modulator.We investigated the impact of childhood sexual abuse on phasic (saliva cortisol reactivity and tonic (hair cortisol regulation. Furthermore, we assessed predictors on cortisol accumulation in hair. Women (N = 43 with stress-related disorders underwent a standardized assessment of idiographic adverse and traumatic experiences and psychopathology, while measuring salivary cortisol and, heart rate and blood pressure.Comparing women with and without childhood sexual abuse revealed lower rates of responders and distinct levels of salivary cortisol to the interview in conjunction with a lower heart rate for the abused group. Childhood adversities, traumatic experiences, and depression contributed to higher hair cortisol levels.Our finding of lower response rate and distinct salivary cortisol pattern in individuals with childhood sexual abuse compared to individuals without early sexual abuse supports the role of environmental programming for the HPA axis. Both, childhood adversities and traumatic stress emerge as crucial factors for long-term cortisol secretion. Lower or suppressed phasic cortisol responses to trauma-related stimuli may therefore be associated with higher tonic values. Thus, early exposure to adversities may result in a biological distinct phenotype in adult patients with stress-related disorders.

  10. The Cortisol Paradox of Trauma-Related Disorders: Lower Phasic Responses but Higher Tonic Levels of Cortisol Are Associated with Sexual Abuse in Childhood.

    Science.gov (United States)

    Schalinski, Inga; Elbert, Thomas; Steudte-Schmiedgen, Susann; Kirschbaum, Clemens

    2015-01-01

    Inconsistent findings exist for the activity of the hypothalamic-pituitary-adrenal (HPA) axis in patients with stress related disorders. Recent studies point towards early life stress as a potential modulator. We investigated the impact of childhood sexual abuse on phasic (saliva cortisol reactivity) and tonic (hair cortisol) regulation. Furthermore, we assessed predictors on cortisol accumulation in hair. Women (N = 43) with stress-related disorders underwent a standardized assessment of idiographic adverse and traumatic experiences and psychopathology, while measuring salivary cortisol and, heart rate and blood pressure. Comparing women with and without childhood sexual abuse revealed lower rates of responders and distinct levels of salivary cortisol to the interview in conjunction with a lower heart rate for the abused group. Childhood adversities, traumatic experiences, and depression contributed to higher hair cortisol levels. Our finding of lower response rate and distinct salivary cortisol pattern in individuals with childhood sexual abuse compared to individuals without early sexual abuse supports the role of environmental programming for the HPA axis. Both, childhood adversities and traumatic stress emerge as crucial factors for long-term cortisol secretion. Lower or suppressed phasic cortisol responses to trauma-related stimuli may therefore be associated with higher tonic values. Thus, early exposure to adversities may result in a biological distinct phenotype in adult patients with stress-related disorders.

  11. Symptoms, Quality of Life and level of functioning of traumatized refugees at Psychiatric Trauma Clinic in Copenhagen

    DEFF Research Database (Denmark)

    Buhman, Cæcilie; Mortensen, Erik Lykke; Lundstrøm, Stine

    2014-01-01

    with mental health were explored using linear and logistic regression and Pearson's correlation coefficients. RESULTS: Among the patients, the prevalence of depression, somatic disease, pain, psychotic symptoms co-existing with PTSD and very low level of functioning was high. Persecution, being an ex...

  12. Accuracy of Perceived Estimated Travel Time by EMS to a Trauma Center in San Bernardino County, California

    Directory of Open Access Journals (Sweden)

    Michael M. Neeki

    2016-06-01

    Full Text Available Introduction: Mobilization of trauma resources has the potential to cause ripple effects throughout hospital operations. One major factor affecting efficient utilization of trauma resources is a discrepancy between the prehospital estimated time of arrival (ETA as communicated by emergency medical services (EMS personnel and their actual time of arrival (TOA. The current study aimed to assess the accuracy of the perceived prehospital estimated arrival time by EMS personnel in comparison to their actual arrival time at a Level II trauma center in San Bernardino County, California. Methods: This retrospective study included traumas classified as alerts or activations that were transported to Arrowhead Regional Medical Center in 2013. We obtained estimated arrival time and actual arrival time for each transport from the Surgery Department Trauma Registry. The difference between the median of ETA and actual TOA by EMS crews to the trauma center was calculated for these transports. Additional variables assessed included time of day and month during which the transport took place. Results: A total of 2,454 patients classified as traumas were identified in the Surgery Department Trauma Registry. After exclusion of trauma consults, walk-ins, handoffs between agencies, downgraded traumas, traumas missing information, and traumas transported by agencies other than American Medical Response, Ontario Fire, Rialto Fire or San Bernardino County Fire, we included a final sample size of 555 alert and activation classified traumas in the final analysis. When combining all transports by the included EMS agencies, the median of the ETA was 10 minutes and the median of the actual TOA was 22 minutes (median of difference=9 minutes, p<0.0001. Furthermore, when comparing the difference between trauma alerts and activations, trauma activations demonstrated an equal or larger difference in the median of the estimated and actual time of arrival (p<0.0001. We also found

  13. The detection of serum homocysteine (Hcy) level in II diabetes mellitus with hyperinsulinism

    International Nuclear Information System (INIS)

    He Meiqiong; Zhang Ling; Quan Xinsheng; Zhou Youjun; Wang Ying

    2003-01-01

    To explore the relationship between serum total homocysteine (Hcy) level and II diabetes mellitus (DM) with hyperinsulinism and insulin resistance, serum total Hcy level in 30 normal subjects and 78 type II DM (38 with hyperinsulinism) are detected. The results show: the mean serum Hcy level is 11.90 ± 3.90 μmo/L, 9.21 ± 2.83 μmol/L at oral glucose tolerance test (OGTT) 1 h and 10.43 ± 3.82 μmol/L at OGTT 2h in normal subjects (n=30); 21.80 ± 7.98 μmol/L, 17.98 ± 6.83 μmol/L at OGTT 1 h and 12.58 ± 6.73 μmol/L at OGTT 2 h in DM without hyperinsulinism and angiopathy (n=40); and 19.80 ± 7.98 μmol/L, 14.50 ± 7.69 μmol/L at OGTT 1 h and 11.07 ± 6.52 μmol/L at OGTT 2 h in DM with hyperinsulinism (n=38). The Hcy level is a significant difference among three groups (P<0.001, P<0.01). Hcy level of DM with hyperinsulinism is lower than that of DM with hyperinsulinism (P<0.01). The serum Hcy level in DM is higher than that in control group, the elevated level of serum Hcy may be related to the diabetic hyperinsulinism and insulin resistance

  14. The TETRA-II Experiment to Observe Terrestrial Gamma Flashes at Ground Level - Preliminary Results

    Science.gov (United States)

    Cherry, M. L.; Adams, C.; Al-Nussirat, S.; Bai, S.; Banadaki, Y.; Bitzer, P. M.; Hoffmann, J.; Khosravi, E.; Legault, M.; Orang, M.; Pleshinger, D. J.; Rodriguez, R.; Smith, D.; Trepanier, J. C.; Sunda-Meya, A.; Zimmer, N.

    2017-12-01

    An upgraded version of the TGF and Energetic Thunderstorm Rooftop Array (TETRA-II) consists of an array of BGO scintillators to detect bursts of gamma rays from thunderstorms at ground level in four separate locations: the campus of Louisiana State University in Baton Rouge, Louisiana; the campus of the University of Puerto Rico at Utuado, Puerto Rico; the Centro Nacional de Metrologia de Panama (CENAMEP) in Panama City, Panama; and the Severe Weather Institute and Radar & Lightning Laboratories in Huntsville, Alabama. The original TETRA-I array of NaI scintillators at Louisiana State University detected 37 millisecond-scale bursts of gamma rays at energies 50 keV-2 MeV associated with nearby (brief description of the TETRA-I observations, a description of TETRA-II, and preliminary results of the first events observed by TETRA-II will be presented including frequency and time history of events, spectral information, and correlation with local radar and radio data.

  15. Study of Blood Leptin Levels before and After Treatment with Metformin in Diabetes Type Ii Patients

    Directory of Open Access Journals (Sweden)

    R Didehdar

    2005-04-01

    Full Text Available Introduction: Leptin is a fat tissue hormone that has 176 amino acids with a molecular weight of 16 KD . Leptin has effects on the hypothalamus and peripheral tissues resulting in decreased food absorption and increased energy consumption that finally reduces the body weight and BMI. The aim of this research was to investigate the blood levels of leptin before and after treatment with Metformin in type II diabetic patients. Methods: 25 type II diabetic patients without any previous drug treatment history were investigated. This study was a clinical trail before and after treatment with Metformin. Results: There was no particular difference in BMI, average body weight, fat mass and free fat mass before and after treatment. Similarly, the difference in concentration levels of blood glucose, cholesterol, tri-glycerides and LDL-cholesterol before and after treatment was not statistically significant. Also, there was no difference in the average concentration of leptin and insulin before and after treatment Conclusion: This result showed that although metformin decreased glucose and lipid levels during the treatment period, (1 month it did not have an effect on leptin, Insulin and other related factors during treatment.;

  16. Leiomyosarcoma of the inferior vena cava level II involvement: curative resection and reconstruction of renal veins

    Directory of Open Access Journals (Sweden)

    Wang Quan

    2012-06-01

    Full Text Available Abstract Leiomyosarcoma of the inferior vena cava (IVCL is a rare retroperitoneal tumor. We report two cases of level II (middle level, renal veins to hepatic veins IVCL, who underwent en bloc resection with reconstruction of bilateral or left renal venous return using prosthetic grafts. In our cases, IVCL is documented to be occluded preoperatively, therefore, radical resection of tumor and/or right kidney was performed and the distal end of inferior vena cava was resected and without caval reconstruction. None of the patients developed edema or acute renal failure postoperatively. After surgical resection, adjuvant radiation therapy was administrated. The patients have been free of recurrence 2 years and 3 months, 9 months after surgery, respectively, indicating the complete surgical resection and radiotherapy contribute to the better survival. The reconstruction of inferior vena cava was not considered mandatory in level II IVCL, if the retroperitoneal venous collateral pathways have been established. In addition to the curative resection of IVCL, the renal vascular reconstruction minimized the risks of procedure-related acute renal failure, and was more physiologically preferable. This concept was reflected in the treatment of the two patients reported on.

  17. Changes of serum TNF-α and sTNFR II levels in hyperthyroid patients treated with 131I

    International Nuclear Information System (INIS)

    Li Fangdu

    2004-01-01

    Objective: To study the influence of 131 I therapy on the auto-immune status of hyperthyroid patients through measurement of the changes of serum TNF-α and sTNFR II levels. Methods: Serum levels of TNF-α and sTNFR II were measured with IRA and ELISA respectively in 36 hyperthyroid patients and 31 controls. Six to twelve months after 131 I therapy, the serum levels were again measured in the patients. Results: The 36 patients fell into two groups after treatment: 27 with thyroid function normalized (cured) and 9 remained hyper- thyroid (treatment failure). Before treatment, the serum TNF-α and sTNFR II levels in both groups of patients were significantly higher than those in the controls (p 0.05). In the treatment failure group, serum levels of TNF-α and sTNFR II were not much decreased after therapy (vs before treatment, p>0.05). Serum TNF-α levels were positively correlated to the serum sTNFR II levels in the patients (r=0.264, p 3 , FT 4 levels (r=0.354, p 131 I therapy would effectively suppress the auto-immune status in hyperthyroid patients; changes of serum TNF-α and sTNFR II levels would reflect the result

  18. Rib fracture fixation in the 65 years and older population: A paradigm shift in management strategy at a Level I trauma center.

    Science.gov (United States)

    Fitzgerald, Michael T; Ashley, Dennis W; Abukhdeir, Hesham; Christie, D Benjamin

    2017-03-01

    , respectively. RP in the 65-year and older trauma population demonstrates a measurable decrease in mortality and respiratory complications, improves respiratory mechanics, and permits an accelerated return to functioning state. Therapeutic/care management study, level IV.

  19. Severity-Adjusted Mortality in Trauma Patients Transported by Police

    Science.gov (United States)

    Band, Roger A.; Salhi, Rama A.; Holena, Daniel N.; Powell, Elizabeth; Branas, Charles C.; Carr, Brendan G.

    2018-01-01

    Study objective Two decades ago, Philadelphia began allowing police transport of patients with penetrating trauma. We conduct a large, multiyear, citywide analysis of this policy. We examine the association between mode of out-of-hospital transport (police department versus emergency medical services [EMS]) and mortality among patients with penetrating trauma in Philadelphia. Methods This is a retrospective cohort study of trauma registry data. Patients who sustained any proximal penetrating trauma and presented to any Level I or II trauma center in Philadelphia between January 1, 2003, and December 31, 2007, were included. Analyses were conducted with logistic regression models and were adjusted for injury severity with the Trauma and Injury Severity Score and for case mix with a modified Charlson index. Results Four thousand one hundred twenty-two subjects were identified. Overall mortality was 27.4%. In unadjusted analyses, patients transported by police were more likely to die than patients transported by ambulance (29.8% versus 26.5%; OR 1.18; 95% confidence interval [CI] 1.00 to 1.39). In adjusted models, no significant difference was observed in overall mortality between the police department and EMS groups (odds ratio [OR] 0.78; 95% CI 0.61 to 1.01). In subgroup analysis, patients with severe injury (Injury Severity Score >15) (OR 0.73; 95% CI 0.59 to 0.90), patients with gunshot wounds (OR 0.70; 95% CI 0.53 to 0.94), and patients with stab wounds (OR 0.19; 95% CI 0.08 to 0.45) were more likely to survive if transported by police. Conclusion We found no significant overall difference in adjusted mortality between patients transported by the police department compared with EMS but found increased adjusted survival among 3 key subgroups of patients transported by police. This practice may augment traditional care. PMID:24387925

  20. Insuring the uninsured: potential impact of Health Care Reform Act of 2010 on trauma centers.

    Science.gov (United States)

    Shafi, Shahid; Ogola, Gerald; Fleming, Neil; Rayan, Nadine; Kudyakov, Rustam; Barnes, Sunni A; Ballard, David J

    2012-11-01

    Viability of trauma centers is threatened by cost of care provided to patients without health insurance. The health care reform of 2010 is likely to benefit trauma centers by mandating universal health insurance by 2014. However, the financial benefit of this mandate will depend on the reimbursement provided. The study hypothesis was that compensation for the care of uninsured trauma patients at Medicare or Medicaid rates will lead to continuing losses for trauma centers. Financial data for first hospitalization were obtained from an urban Level I trauma center for 3 years (n = 6,630; 2006-2008) and linked with clinical information. Patients were grouped into five payments categories: commercial (29%), Medicaid (8%), Medicare (20%), workers' compensation (6%), and uninsured (37%). Prediction models for costs and payments were developed for each category using multiple regression models, adjusting for patient demographics, injury characteristics, complications, and survival. These models were used to predict payments that could be expected if uninsured patients were covered by different insurance types. Results are reported as net margin per patient (payments minus total costs) for each insurance type, with 95% confidence intervals, discounted to 2008 dollar values. Patients were typical for an urban trauma center (median age of 43 years, 66% men, 82% blunt, 5% mortality, and median length of stay 4 days). Overall, the trauma center lost $5,655 per patient, totaling $37.5 million over 3 years. These losses were encountered for patients without insurance ($14,343), Medicare ($4,838), and Medicaid ($15,740). Patients with commercial insurance were profitable ($5,295) as were those with workers' compensation ($6,860). Payments for the care of the uninsured at Medicare/Medicaid levels would lead to continued losses at $2,267 to $4,143 per patient. The health care reforms of 2010 would lead to continued losses for trauma centers if uninsured are covered with Medicare

  1. The use of laparoscopy in the diagnosis and treatment of blunt and penetrating abdominal injuries: 10-year experience at a level 1 trauma center.

    Science.gov (United States)

    Johnson, Jeremy J; Garwe, Tabitha; Raines, Alexander R; Thurman, Joseph B; Carter, Sandra; Bender, Jeffrey S; Albrecht, Roxie M

    2013-03-01

    Diagnostic laparoscopy (DL) has decreased the rate of nontherapeutic laparotomy for patients suffering from penetrating injuries. We evaluated whether DL similarly lowers the rate of nontherapeutic laparotomy for patients with blunt injuries. All patients undergoing DL over a 10-year period (ie, 2001-2010) in a single level 1 trauma center were classified by the mechanism of injury. Demographic and perioperative data were compared using the Student t and Fisher exact tests. There were 131 patients included, 22 of whom sustained blunt injuries. Patients suffering from blunt injuries were more severely injured (Injury Severity Score 18.0 vs 7.3, P = .0001). The most common indication for DL after blunt injury was a computed tomographic scan concerning for bowel injury (59.1%). The rate of nontherapeutic laparotomy for patients sustaining penetrating vs blunt injury was 1.8% and nil, respectively. DL, when coupled with computed tomographic findings, is an effective tool for the initial management of patients with blunt injuries. Copyright © 2013 Elsevier Inc. All rights reserved.

  2. The relationship between workplace violence, perceptions of safety, and Professional Quality of Life among emergency department staff members in a Level 1 Trauma Centre.

    Science.gov (United States)

    Copeland, Darcy; Henry, Melissa

    2018-02-02

    Emergency department staff members are frequently exposed to workplace violence which may have physical, psychological, and workforce related consequences. The purpose of this study was to examine the relationships between exposure to workplace violence, tolerance to violence, expectations of violence, perceptions of workplace safety, and Professional Quality of Life (compassion satisfaction - CS, burnout - BO, secondary traumatic stress - STS) among emergency department staff members. A cross-sectional design was used to survey all emergency department staff members from a suburban Level 1 Trauma Centre in the western United States. All three dimensions of Professional Quality of Life were associated with exposure to non-physical patient violence including: general threats (CS p = .012, BO p = .001, STS p = .035), name calling (CS p = .041, BO p = .021, STS p = .018), and threats of lawsuit (CS p = .001, BO p = .001, STS p = .02). Tolerance to violence was associated with BO (p = .004) and CS (p = .001); perception of safety was associated with BO (p = .018). Exposure to non-physical workplace violence can significantly impact staff members' compassion satisfaction, burnout and secondary traumatic stress. Greater attention should be paid to the effect of non-physical workplace violence. Additionally, addressing tolerance to violence and perceptions of safety in the workplace may impact Professional Quality of Life. Copyright © 2018 Elsevier Ltd. All rights reserved.

  3. Critically Evaluated Energy Levels, Spectral Lines, Transition Probabilities, and Intensities of Singly Ionized Vanadium (V ii)

    Energy Technology Data Exchange (ETDEWEB)

    Saloman, Edward B. [Dakota Consulting, Inc., 1110 Bonifant Street, Suite 310, Silver Spring, MD 20910 (United States); Kramida, Alexander [National Institute of Standards and Technology, Gaithersburg, MD 20899 (United States)

    2017-08-01

    The energy levels, observed spectral lines, and transition probabilities of singly ionized vanadium, V ii, have been compiled. The experimentally derived energy levels belong to the configurations 3 d {sup 4}, 3 d {sup 3} ns ( n  = 4, 5, 6), 3 d {sup 3} np , and 3 d {sup 3} nd ( n  = 4, 5), 3 d {sup 3}4 f , 3 d {sup 2}4 s {sup 2}, and 3 d {sup 2}4 s 4 p . Also included are values for some forbidden lines that may be of interest to the astrophysical community. Experimental Landé g -factors and leading percentages for the levels are included when available, as well as Ritz wavelengths calculated from the energy levels. Wavelengths and transition probabilities are reported for 3568 and 1896 transitions, respectively. From the list of observed wavelengths, 407 energy levels are determined. The observed intensities, normalized to a common scale, are provided. From the newly optimized energy levels, a revised value for the ionization energy is derived, 118,030(60) cm{sup −1}, corresponding to 14.634(7) eV. This is 130 cm{sup −1} higher than the previously recommended value from Iglesias et al.

  4. Head Trauma: First Aid

    Science.gov (United States)

    First aid Head trauma: First aid Head trauma: First aid By Mayo Clinic Staff Most head trauma involves injuries that are minor and don't require ... 21, 2015 Original article: http://www.mayoclinic.org/first-aid/first-aid-head-trauma/basics/ART-20056626 . Mayo ...

  5. The transgenerational transmission of refugee trauma

    DEFF Research Database (Denmark)

    Dalgård, Nina Thorup; Montgomery, Edith

    2017-01-01

    Purpose The purpose of this paper is to explore the role of family functioning in the transgenerational transmission of trauma in a sample of 30 refugee families with traumatized parents and children without a history of direct trauma exposure from the Middle East. Design/methodology/approach Based...... and lower scores on the SDQ. Originality/value These findings suggest that the transgenerational transmission of trauma may be associated with family functioning and have implications for interventions at several levels....

  6. [Differences of blood plasma renin activity, angiotensin II and aldosterone levels in essential or secondary hypertension].

    Science.gov (United States)

    Song, Ai-ling; Zeng, Zheng-pei; Tong, An-li; Lu, Lin; Chen, Shi; Li, Ming; Fu, Chun-li; Wang, Yong-hui; Sun, Mei-li

    2012-04-01

    To study on the difference of plasma renin activity (PRA), angiotensin II (Ang II), and aldosterone levels in patients with essential hypertension (EH) or primary aldosteronism (PA) or pheochromocytoma (PHEO), and to analyze the sensitivity and specificity on the diagnosis of PA among patients with hypertension with aldosterone/PRA ratio (ARR). The plasma aldosterone, Ang II and PRA concentrations in supine and upright positions were measured by radioimmunoassay from 413 patients including idiopathic hyperaldosteronism (IHA, n = 111), aldosterone-producing adenoma (APA, n = 118), PHEO (n = 98) and EH (n = 86). ARR was calculated. Plasma aldosterone concentrations in both of supine and upright positions in PHEO group [374 (294, 465) pmol/L and 629 (449, 997) pmol/L] and PA group [471 (346, 632) pmol/L and 673 (499, 825) pmol/L] were higher than those in EH group [277 (224, 332) pmol/L and 427 (341, 501) pmol/L] (P 0.05). The PRA level in both positions of each group were PHEO group [0.3 (0.2, 1.0) µg · L(-1) · h(-1) and 1.4 (0.6, 3.4) µg · L(-1) · h(-1)] > EH group [0.2 (0.1, 0.4) µg · L(-1) · h(-1) and 0.6 (0.4, 1.0) µg · L(-1) · h(-1)] (P PA group [0.1 (0.1, 0.1) µg · L(-1) · h(-1) and 0.2 (0.1, 0.3) µg · L(-1) · h(-1)] (P < 0.01), and APA group [0.1 (0.1, 0.1) µg · L(-1) · h(-1) and 0.1 (0.1, 0.3) µg · L(-1) · h(-1)] < IHA group [0.1 (0.1, 0.2) µg · L(-1) · h(-1) and 0.2 (0.1, 0.3) µg · L(-1) · h(-1)] (supine P < 0.01; upright P < 0.05). APA was divided into 2 types with renin-Ang II-responsive APA (n = 26) and unresponsive APA (n = 92). The plasma aldosterone concentration was lower in supine position but higher in upright position in renin-Ang II-responsive APA than in unresponsive APA patients. ARR in upright was higher in PA group (P < 0.01) but lower in PHEO group (P < 0.05) compared with EH. ARR was higher in APA than in IHA (P < 0.01). The sensitivity and specificity of ARR as 40 (aldosterone unit: ng/dl; PRA unit: µg · L(-1

  7. Development of High Level Trigger Software for Belle II at SuperKEKB

    International Nuclear Information System (INIS)

    Lee, S; Itoh, R; Katayama, N; Mineo, S

    2011-01-01

    The Belle collaboration has been trying for 10 years to reveal the mystery of the current matter-dominated universe. However, much more statistics is required to search for New Physics through quantum loops in decays of B mesons. In order to increase the experimental sensitivity, the next generation B-factory, SuperKEKB, is planned. The design luminosity of SuperKEKB is 8 x 10 35 cm −2 s −1 a factor 40 above KEKB's peak luminosity. At this high luminosity, the level 1 trigger of the Belle II experiment will stream events of 300 kB size at a 30 kHz rate. To reduce the data flow to a manageable level, a high-level trigger (HLT) is needed, which will be implemented using the full offline reconstruction on a large scale PC farm. There, physics level event selection is performed, reducing the event rate by ∼ 10 to a few kHz. To execute the reconstruction the HLT uses the offline event processing framework basf2, which has parallel processing capabilities used for multi-core processing and PC clusters. The event data handling in the HLT is totally object oriented utilizing ROOT I/O with a new method of object passing over the UNIX socket connection. Also under consideration is the use of the HLT output as well to reduce the pixel detector event size by only saving hits associated with a track, resulting in an additional data reduction of ∼ 100 for the pixel detector. In this contribution, the design and implementation of the Belle II HLT are presented together with a report of preliminary testing results.

  8. [Clinical study of the influence of daily sedation interruption on fluctuation of blood glucose level and mortality of critical patients with multiple trauma].

    Science.gov (United States)

    Li, Yong; Jin, Zhaochen; Cai, Yan; Ji, Musen; Kong, Xianru; Liu, Jing; Yang, Hongfeng; Wang, Chenglong

    2014-04-01

    To assess the influence of a protocol of routine daily interruption of sedation on fluctuation of blood glucose level and mortality of critical patients with multiple trauma. A prospective study involving 68 critical patients with multiple trauma admitted to intensive care unit (ICU) was performed. Finger blood glucose level was measured after the implementation of daily interruption of sedation, and the results were recorded every 2 hours during the first 24 hours. Mean (MEAN), standard deviation (SD) and coefficient of variability (CV) of blood glucose level, glycemic liability index (GLI), mean amplitude of glycemic excursion (MAGE) and largest amplitude of glycemic excursions (LAGE) were calculated respectively, and 30-day mortality was recorded. The patients under study were divided into four groups according to the median values of MEAN and GLI, group A with patients of low MEAN+low GLI (n=34), group B with patients of low MEAN+high GLI (n=14), group C with patients of high MEAN+low GLI (n=12), and group D with patients of high MEAN+high GLI (n=8). Glucose levels, their range of fluctuation, and the prognosis were compared among groups. Five of the 68 patients died, with a gross mortality rate of 7.4%. Group analysis demonstrated that the patients in group A had the best prognosis with the 30-day mortality rate of 0 (0/34), while that of the group D was worst with the 30-day mortality rate of 37.5% (3/8). The MEAN levels of glucose were relatively lower in groups A and B (6.7±1.3 mmol/L, 7.6±0.8 mmol/L) and higher in groups C and D (9.3±1.4 mmol/L, 10.7±1.3 mmol/L). Indicators of glucose level fluctuation, including SD, CV, GLI, LAGE, and MAGE, were lower in groups A and C (SD: 1.6±0.4 mmol/L, 1.7±0.6 mmol/L; CV: 0.2±0.1, 0.2±0.1; GLI: 26.5±19.5, 40.1±17.6; LAGE: 4.6±2.3 mmol/L, 6.5±1.9 mmol/L; MAGE: 2.7±0.8 mmol/L, 3.1±0.80 mmol/L), and higher in groups B and D (SD: 2.9±0.7 mmol/L, 3.9±0.8 mmol/L; CV: 0.4±0.1, 0.4±0.1; GLI: 120.5±33.2, 184

  9. Clinical analysis of the changes of plasma PRA, AT-II and Aid levels in patients with acute renal failure

    International Nuclear Information System (INIS)

    Zhang Qiuyue; Yang Yongqing

    2002-01-01

    Objective: To investigate the role of changes of plasma PRA, AT-II and Ald levels in the pathogenesis of acute renal failure. Methods: Plasma PRA, AT-II and Ald levels were determined with RIA in 40 normal subjects and 72 cases of acute renal failure. Results: Plasma PRA, AT-II and Ald levels in the patients were markedly increased as compared with those in normal subjects (p < 0.05, p < 0.01, p < 0.001 respectively). There were no linearity and exponential relationship between plasma PRA, AT-II, Ald levels and the 24 h urinary sodium excretion amount (within the range of 89.1 - 365.2 mEq). Conclusion: Acute renal failure could activate the RAAS function

  10. Levels and clinical significance of serum IGF-II in patients with five kinds of malignant tumors

    International Nuclear Information System (INIS)

    Qi Falian; Xu Jun; Du Xiumin; Ke Bingkun; Yang Daoli

    2002-01-01

    Objective: To study the levels and clinical significance of serum IGF-II in patients with malignant tumor. Methods: Levels of serum IGF-II were detected in patients with gastric cancer, lung cancer, liver cancer, ovarian carcinoma and endometrial carcinoma by radioimmunoassay, levels in patients with hepatic cirrhosis, uterine myoma and normal controls were also determined for comparison. Results: The levels of serum IGF-II in patients with gastric cancer, lung cancer and liver cancer were significantly higher than those in normal controls (p 0.05). Conclusion: The determination of serum IGF-II has no clinical significance in patients with endometrial carcinoma, ovarian carcinoma and uterine myoma but it could be useful to judge the severity and evaluate the prognosis in patients with gastric cancer, lung cancer, liver cancer and cirrhosis

  11. Spinal trauma. An imaging approach

    Energy Technology Data Exchange (ETDEWEB)

    Cassar-Pullicino, V.N. [The Robert Jones and Agnes Hunt Orthopaedic Hospital, Oswestry, Shropshire (United Kingdom). Dept. of Radiology; Imhof, H. [University and General Hospital Vienna (Austria). Dept. of Radiodiagnostics

    2006-07-01

    The diagnosis of trauma to the spine - where the slightest oversight may have catastrophic results - requires a thorough grasp of the spectrum of resultant pathology as well as the imaging modalities used in making an accurate diagnosis. In Spinal Trauma, the internationally renowned team of experts provides a comprehensive, cutting-edge exposition of the current vital role of imaging in the diagnosis and treatment of injuries to the axial skeleton. Beginning with a valuable clinical perspective of spinal trauma, the book offers the reader a unique overview of the biomechanics underlying the pathology of cervical trauma. Acute trauma topics include: - Optimization of imaging modalities - Malalignment - signs and significance - Vertebral fractures - detection and implications - Classification of thoraco-lumbar fractures - rationale and relevance - Neurovascular injury. Distilling decades of clinical and teaching expertise, the contributors further discuss the current role of imaging in special focus topics, which include: - The pediatric spine - Sports injuries - The rigid spine - Trauma in the elderly - Vertebral collapse, benign and malignant - Spinal trauma therapy - Vertebral fractures and osteoporosis - Neuropathic spine. All throughout the book, the focus is on understanding the injury, and its implications and complications, through 'an imaging approach'. Lavishly illustrated with hundreds of superb MR images and CT scans, and clear full-color drawings, the authors conclude with a look into the future, defining clinical trends and research directions. Spinal Trauma - with its broad scope, practical imaging approach, and current focus - is designed to enhance confidence and accuracy, making it essential reading for clinicians and radiologists at all levels. (orig.)

  12. Level II scour analysis for Bridge 8, (MANCTH00060008) on Town Highway 6, crossing Bourn Brook, Manchester, Vermont

    Science.gov (United States)

    Burns, Ronda L.; Hammond, Robert E.

    1997-01-01

    This report provides the results of a detailed Level II analysis of scour potential at structure MANCTH00060008 on Town Highway 6 crossing Bourn Brook, Manchester, Vermont (figures 1–8). A Level II study is a basic engineering analysis of the site, including a quantitative analysis of stream stability and scour (U.S. Department of Transportation, 1993). Results of a Level I scour investigation also are included in Appendix E of this report. A Level I investigation provides a qualitative geomorphic characterization of the study site. Information on the bridge, gleaned from Vermont Agency of Transportation (VTAOT) files, was compiled prior to conducting Level I and Level II analyses and is found in Appendix D.

  13. Level II scour analysis for Bridge 30, (HUNTTH00220030), on Town Highway 22, crossing Brush Brook, Huntington, Vermont

    Science.gov (United States)

    Burns, Ronda L.

    1997-01-01

    This report provides the results of a detailed Level II analysis of scour potential at structure HUNTTH00220030 on Town Highway 22 crossing Brush Brook, Huntington, Vermont (figures 1–8). A Level II study is a basic engineering analysis of the site, including a quantitative analysis of stream stability and scour (U.S. Department of Transportation, 1993). Results of a Level I scour investigation also are included in Appendix E of this report. A Level I investigation provides a qualitative geomorphic characterization of the study site. Information on the bridge, gleaned from Vermont Agency of Transportation (VTAOT) files, was compiled prior to conducting Level I and Level II analyses and is found in Appendix D.

  14. Level II scour analysis for Bridge 16 (GROTTH00170016) on Town Highway 17, crossing the Wells River, Groton, Vermont

    Science.gov (United States)

    Striker, L.K.; Ivanoff, M.A.

    1997-01-01

    This report provides the results of a detailed Level II analysis of scour potential at structure GROTTH00170016 on Town Highway 17 crossing the Wells River, Groton, Vermont (figures 1–8). A Level II study is a basic engineering analysis of the site, including a quantitative analysis of stream stability and scour (U.S. Department of Transportation, 1993). Results of a Level I scour investigation also are included in Appendix E of this report. A Level I investigation provides a qualitative geomorphic characterization of the study site. Information on the bridge, gleaned from Vermont Agency of Transportation (VTAOT) files, was compiled prior to conducting Level I and Level II analyses and is found in Appendix D.

  15. Level II scour analysis for brigde 5 (STOCTH00360005) on Town Highway 36, crossing Stony Brook, Stockridge, Vermont

    Science.gov (United States)

    Striker, Lora K.; Weber, Matthew A.

    1998-01-01

    This report provides the results of a detailed Level II analysis of scour potential at structure STOCTH00360005 on Town Highway 36 crossing Stony Brook, Stockbridge, Vermont (figures 1–8). A Level II study is a basic engineering analysis of the site, including a quantitative analysis of stream stability and scour (U.S. Department of Transportation, 1993). Results of a Level I scour investigation also are included in appendix E of this report. A Level I investigation provides a qualitative geomorphic characterization of the study site. Information on the bridge, gleaned from Vermont Agency of Transportation (VTAOT) files, was compiled prior to conducting Level I and Level II analyses and is found in appendix D.

  16. Level II scour analysis for Bridge 8 (ATHETH00090008) on Town Highway 9, crossing Bull Creek, Athens, Vermont

    Science.gov (United States)

    Boehmler, Erick M.; Burns, Ronda L.

    1997-01-01

    This report provides the results of a detailed Level II analysis of scour potential at structure ATHETH00090008 on Town Highway 9 crossing Bull Creek in Athens, Vermont (figures 1–8). A Level II study is a basic engineering analysis of the site, including a quantitative analysis of stream stability and scour (U.S. Department of Transportation, 1993). Results of a Level I scour investigation also are included in Appendix E of this report. A Level I investigation provides a qualitative geomorphic characterization of the study site. Information on the bridge, gleaned from Vermont Agency of Transportation (VTAOT) files, was compiled prior to conducting Level I and Level II analyses and is found in Appendix D.

  17. Level II scour analysis for Bridge 16, (NEWBTH00500016) on Town Highway 50, crossing Halls Brook, Newbury, Vermont

    Science.gov (United States)

    Burns, Ronda L.; Degnan, James R.

    1997-01-01

    This report provides the results of a detailed Level II analysis of scour potential at structure NEWBTH00500016 on Town Highway 50 crossing Halls Brook, Newbury, Vermont (figures 1–8). A Level II study is a basic engineering analysis of the site, including a quantitative analysis of stream stability and scour (U.S. Department of Transportation, 1993). Results of a Level I scour investigation also are included in Appendix E of this report. A Level I investigation provides a qualitative geomorphic characterization of the study site. Information on the bridge, gleaned from Vermont Agency of Transportation (VTAOT) files, was compiled prior to conducting Level I and Level II analyses and is found in Appendix D.

  18. Level II scour analysis for Bridge 37, (BRNETH00740037) on Town Highway 74, crossing South Peacham Brook, Barnet, Vermont

    Science.gov (United States)

    Burns, Ronda L.; Severance, Timothy

    1997-01-01

    This report provides the results of a detailed Level II analysis of scour potential at structure BRNETH00740037 on Town Highway 74 crossing South Peacham Brook, Barnet, Vermont (figures 1–8). A Level II study is a basic engineering analysis of the site, including a quantitative analysis of stream stability and scour (U.S. Department of Transportation, 1993). Results of a Level I scour investigation also are included in Appendix E of this report. A Level I investigation provides a qualitative geomorphic characterization of the study site. Information on the bridge, gleaned from Vermont Agency of Transportation (VTAOT) files, was compiled prior to conducting Level I and Level II analyses and is found in Appendix D.

  19. Level II scour analysis for Bridge 37 (BARTTH00080037) on Town Highway 8, crossing Willoughby River, Barton, Vermont

    Science.gov (United States)

    Ayotte, Joseph D.; Boehmler, Erick M.

    1996-01-01

    This report provides the results of a detailed Level II analysis of scour potential at structure BARTTH00080037 on town highway 8 crossing the Willoughby River, Barton, Vermont (figures 1–8). A Level II study is a basic engineering analysis of the site, including a quantitative analysis of stream stability and scour (U.S. Department of Transportation, 1993). Results of a Level I scour investigation also are included in Appendix E of this report. A Level I investigation provides a qualitative geomorphic characterization of the study site. Information on the bridge, gleaned from Vermont Agency of Transportation (VTAOT) files, was compiled prior to conducting Level I and Level II analyses and is found in Appendix D. The site is in the New England Upland section of the New England physiographic province

  20. Trauma exposure, resilience, social support, and PTSD construct validity among former prisoners of war.

    Science.gov (United States)

    Gold, P B; Engdahl, B E; Eberly, R E; Blake, R J; Page, W F; Frueh, B C

    2000-01-01

    The aim of this study was to investigate predictors of persistent symptoms of posttraumatic stress disorder (PTSD) and to examine the construct validity of PTSD in a national sample of 270 World War II and Korean Conflict prisoners of war (POWs). POWs were interviewed at two points in time (1965 and 1990). Predictors included PTSD symptomatology measured in 1965 by items from the Cornell Medical Index (CMI), severity of captivity trauma, resilience factors, and post-trauma social support. The criterion, symptomatology in the early 1990s, was evaluated with the PTSD module of the Structured Clinical Interview for DSM (SCID). The CMI provided only partial coverage of PTSD criteria and appeared to provide only a general index of distress. Clustering of SCID items in two-dimensional space via multidimensional scaling analysis offers some construct validation for the DSM's differentiation of PTSD symptoms into criterion groups, although there was not a perfect match. Trauma severity is best related to PTSD symptomatology experienced in 1990, mitigated in part by greater education level and age at the time of trauma exposure. Surprisingly, 1965 distress added only a modest amount to the prediction of current distress, while post-trauma social support added none. These findings support previous work showing the severe psychological sequelae of POW status 40-50 years after captivity, and indicate that trauma severity during captivity is the best predictor of current PTSD symptomatology. Results also add to our understanding of the conceptual differentiation of PTSD symptoms into separate and distinct symptom clusters.

  1. Is paediatric trauma severity overestimated at triage?

    DEFF Research Database (Denmark)

    DO, H Q; Hesselfeldt, R; Steinmetz, J

    2014-01-01

    BACKGROUND: Severe paediatric trauma is rare, and pre-hospital and local hospital personnel experience with injured children is often limited. We hypothesised that a higher proportion of paediatric trauma victims were taken to the regional trauma centre (TC). METHODS: This is an observational...... follow-up study that involves one level I TC and seven local hospitals. We included paediatric (trauma patients with a driving distance to the TC > 30 minutes. The primary end-point was the proportion of trauma patients arriving in the TC. RESULTS: We included 1934...... trauma patients, 238 children and 1696 adults. A total of 33/238 children (13.9%) vs. 304/1696 adults (17.9%) were transported to the TC post-injury (P = 0.14). Among these, children were significantly less injured than adults [median Injury Severity Score (ISS) 9 vs. 14, P 

  2. Evaluation of nutrition deficits in adult and elderly trauma patients.

    Science.gov (United States)

    Wade, Charles E; Kozar, Rosemary A; Dyer, Carmel B; Bulger, Eileen M; Mourtzakis, Marina; Heyland, Daren K

    2015-05-01

    As metabolism is often escalated following injury, severely injured trauma patients are at risk for underfeeding and adverse outcomes. From an international database of 12,573 critically ill, adult mechanically ventilated patients, who received a minimum of 3 days of nutrition therapy, trauma patients were identified and nutrition practices and outcomes compared with nontrauma patients. Within the trauma population, we compared nutrition practices and outcomes of younger vs older patients. There were 1279 (10.2%) trauma patients. They were younger, were predominantly male, had lower Acute Physiology and Chronic Health Evaluation II (APACHE II) scores, and had an overall lower body mass index compared with nontrauma patients. Eighty percent of trauma patients received enteral feeding compared with 78% of nontrauma patients. Trauma patients were prescribed more calories and protein yet received similar amounts as nontrauma patients. Nutrition adequacy was reduced in both trauma and nontrauma patients. Survival was higher in trauma patients (86.6%) compared with nontrauma patients (71.8%). When patients who died were included as never discharged, trauma patients were more rapidly discharged from the intensive care unit (ICU) and hospital. Within the trauma population, 17.5% were elderly (≥65 years). The elderly had increased days of ventilation, ICU stay, and mortality compared with younger trauma patients. In a multivariable model, age and APACHE II score, but not nutrition adequacy, were associated with time to discharge alive from the hospital. Significant nutrition deficits were noted in all patients. Elderly trauma patients have worse outcomes compared with younger patients. Further studies are necessary to evaluate whether increased nutrition intake can improve the outcomes of trauma patients, especially geriatric trauma patients. © 2014 American Society for Parenteral and Enteral Nutrition.

  3. Fibrinogen depletion in trauma: early, easy to estimate and central to trauma-induced coagulopathy.

    Science.gov (United States)

    Davenport, Ross; Brohi, Karim

    2013-09-24

    Fibrinogen is fundamental to hemostasis and falls rapidly in trauma hemorrhage, although levels are not routinely measured in the acute bleeding episode. Prompt identification of critically low levels of fibrinogen and early supplementation has the potential to correct trauma-induced coagulation and improve outcomes. Early estimation of hypofibrinogenemia is possible using surrogate markers of shock and hemorrhage; for example, hemoglobin and base excess. Rapid replacement with fibrinogen concentrate or cryoprecipitate should be considered a clinical priority in major trauma hemorrhage.

  4. The relationship between processes and outcomes for injured older adults: a study of a statewide trauma system.

    Science.gov (United States)

    Saillant, N N; Earl-Royal, E; Pascual, J L; Allen, S R; Kim, P K; Delgado, M K; Carr, B G; Wiebe, D; Holena, D N

    2017-02-01

    Age is a risk factor for death, adverse outcomes, and health care use following trauma. The American College of Surgeons' Trauma Quality Improvement Program (TQIP) has published "best practices" of geriatric trauma care; adoption of these guidelines is unknown. We sought to determine which evidence-based geriatric protocols, including TQIP guidelines, were correlated with decreased mortality in Pennsylvania's trauma centers. PA's level I and II trauma centers self-reported adoption of geriatric protocols. Survey data were merged with risk-adjusted mortality data for patients ≥65 from a statewide database, the Pennsylvania Trauma Systems Foundation (PTSF), to compare mortality outlier status and processes of care. Exposures of interest were center-specific processes of care; outcome of interest was PTSF mortality outlier status. 26 of 27 eligible trauma centers participated. There was wide variation in care processes. Four trauma centers were low outliers; three centers were high outliers for risk-adjusted mortality rates in adults ≥65. Results remained consistent when accounting for center volume. The only process associated with mortality outlier status was age-specific solid organ injury protocols (p = 0.04). There was no cumulative effect of multiple evidence-based processes on mortality rate (p = 0.50). We did not see a link between adoption of geriatric best-practices trauma guidelines and reduced mortality at PA trauma centers. The increased susceptibility of elderly to adverse consequences of injury, combined with the rapid growth rate of this demographic, emphasizes the importance of identifying interventions tailored to this population. III. Descriptive.

  5. 11.361 sports injuries in a 15-year survey of a Level I emergency trauma department reveal different severe injury types in the 6 most common team sports.

    Science.gov (United States)

    Krutsch, Werner; Krutsch, Volker; Hilber, Franz; Pfeifer, Christian; Baumann, Florian; Weber, Johannes; Schmitz, Paul; Kerschbaum, Maximilian; Nerlich, Michael; Angele, Peter

    2018-06-01

     Severe sports-related injuries are a common affliction treated in Level I trauma departments. Detailed knowledge on injury characteristics from different medical settings is essential to improve the development of injury prevention strategies in different team sports.  Team sport injuries were retrospectively analysed in a Level I trauma department registry over 15 years. Injury and treatment data were compared with regard to competition and training exposure. Injury data such as "time of visitation", "type of injury", "multiple injured body regions" and "immediate hospitalisation" helped to define the severity level of each team sports injury.  At the Level I trauma department, 11.361 sports-related injuries were seen over 15 years, of which 34.0 % were sustained during team sports. Soccer injuries were the most common injuries of all team sports (71.4 %). The lower extremity was the most affected body region overall, followed by the upper extremity. Head injuries were mainly seen in Ice hockey and American football and concussion additionally frequently in team handball. Slight injuries like sprains or contusions occurred most frequently in all team sports. In soccer and team handball, injuries sustained in competition were significantly more severe (p team sports, injury prevention strategies should address competitive as well as training situations, whichmay need different strategies. © Georg Thieme Verlag KG Stuttgart · New York.

  6. Early changes of serum insulin-like growth factor-II (IGF-II) levels in patients with acute brain injury

    International Nuclear Information System (INIS)

    Liu Cegang; Zhang Xinlu; Tao Jin; Xu Anding; Xu Shanshui; Huang Zhenpeng

    2003-01-01

    Objective: To investigate the early changes and clinical significance of serum Insulin-like growth factor-II (IGF-II) levels in patients with acute brain injury. Methods: Radioimmunoassay was used for measurement of the serum IGF-II concentration in 30 controls and 29 acute brain injury patients before and after treatment (within 1 day, at 3 and 7 days). Results: The serum IGF-II levels in brain injury patients at 1 day, 3 day 7 days after injury were 0.131 ± 0.047 ng/ml, 0.117 ± 0.046 ng/ml and 0.123 ±0.050 ng/ml respectively and were significantly lower than those in controls 0.44 ± 0.014 ng/ml, p<0.01. Differences among the values of the three days were not significant. Conclusion: IGF-II might play important role in the pathophysiological process of early acute brain injury

  7. Decreased plasma levels of factor II + VII + X correlate with increased levels of soluble cytokine receptors in patients with malaria and meningococcal infections

    DEFF Research Database (Denmark)

    Bygbjerg, I C; Hansen, M B; Rønn, A M

    1997-01-01

    The levels of coagulation factors II + VII + X and of blood platelets (thrombocytes) as well as of cytokines and soluble cytokine receptors were studied in the patients with malaria or meningococcal infections. The coagulation factors were decreased particularly in the meningococcal patients, while...... thrombocytes were lowest in the Plasmodium falciparum malaria patients. There was no correlation between factors II + VII + X and thrombocytes, but plasma levels of coagulation factors II + VII + X were found to correlate inversely with levels of soluble interleukin-2 receptor (sIL-2R) and soluble tumour...... necrosis factor-I (sTNF-RI) in patients with malaria and meningococcal infections. Elevated sIL-2R and sTNF-RI levels and decreased coagulation factors reverted to normal within 3-5 days after initiation of therapy in P. falciparum patients followed consecutively. Estimation of coagulation factors may...

  8. Application of determination of PRA, Ang II and IGF-1 levels in the study of typing of essential hypertension

    International Nuclear Information System (INIS)

    Lu Yongyi; Chen Qun; Yang Yongqing

    2010-01-01

    Objective: To study the clinical application of determination of plasma renin activity (PRA), Angiotensin II (Ang II ) and insulin-like growth factor-1 (IGF-1) levels in typing of essential hypertension (EH). Methods: Determined the levels of PRA and Aug II in 256 patients with EH and 70 healthy volunteers (as control group) by radioimmunoassay, and measured IGF-1 level by enzyme immunoassay. Research on the typing of EH and the difference between the groups. Results: The PRA and Ang II in control group was (0.432±0.236) μg·L -1 ·h -1 and (31.7±7.4) μg/L respectively. In 256 patients with EH, PRA was increased, normal and decreased in 18.0%, 71.8% and 10.2% respectively, while the level of Ang II was increased, normal and decreased in 12.9%, 76.2% and 10.9% respectively. The IGF-1 levels in 256 patients with EH were increased following the increase of blood pressure. Conclusion: Typing of EH patients with PRA and Ang II as well as the determination of IGF-1 were useful in treating and following up the patients with EH. (authors)

  9. Commissioning experience with the PEP-II low-level RF system

    International Nuclear Information System (INIS)

    Corredoura, P.; Allison, S.; Claus, R.; Ross, W.; Sapozhnikov, L.; Schwarz, H.D.; Tighe, R.; Yee, C.; Ziomek, C.

    1997-05-01

    The low-level RF system for PEP-II is a modular design housed in a VXI environment and supported by EPICS. All signal processing and control is done at baseband using in-phase and quadrature (IQ) techniques. Remotely configurable RF feedback loops are used to control coupled-bunch instabilities driven by the accelerating mode of the RF cavities. A programmable DSP based feedback loop is implemented to control phase variations across the klystron due to the required adjustment of the cathode voltage to limit cathode power dissipation. The DSP loop also adaptively cancels modulations caused by klystron power supply ripple at selected power line harmonics between 60 Hz and 10 kHz. The system contains a built-in baseband network analyzer which allows remote measurement of the RF feedback loop transfer functions and automated configuration of these loops. This paper presents observations and measured data from the system

  10. Hospital-level Variation in Utilization of Surgery for Clinical Stage I-II Pancreatic Adenocarcinoma.

    Science.gov (United States)

    Swords, Douglas S; Mulvihill, Sean J; Skarda, David E; Finlayson, Samuel R G; Stoddard, Gregory J; Ott, Mark J; Firpo, Matthew A; Scaife, Courtney L

    2017-07-11

    To (1) evaluate rates of surgery for clinical stage I-II pancreatic ductal adenocarcinoma (PDAC), (2) identify predictors of not undergoing surgery, (3) quantify the degree to which patient- and hospital-level factors explain differences in hospital surgery rates, and (4) evaluate the association between adjusted hospital-specific surgery rates and overall survival (OS) of patients treated at different hospitals. Curative-intent surgery for potentially resectable PDAC is underutilized in the United States. Retrospective cohort study of patients ≤85 years with clinical stage I-II PDAC in the 2004 to 2014 National Cancer Database. Mixed effects multivariable models were used to characterize hospital-level variation across quintiles of hospital surgery rates. Multivariable Cox proportional hazards models were used to estimate the effect of adjusted hospital surgery rates on OS. Of 58,553 patients without contraindications or refusal of surgery, 63.8% underwent surgery, and the rate decreased from 2299/3528 (65.2%) in 2004 to 4412/7092 (62.2%) in 2014 (P < 0.001). Adjusted hospital rates of surgery varied 6-fold (11.4%-70.9%). Patients treated at hospitals with higher rates of surgery had better unadjusted OS (median OS 10.2, 13.3, 14.2, 16.5, and 18.4 months in quintiles 1-5, respectively, P < 0.001, log-rank). Treatment at hospitals in lower surgery rate quintiles 1-3 was independently associated with mortality [Hazard ratio (HR) 1.10 (1.01, 1.21), HR 1.08 (1.02, 1.15), and HR 1.09 (1.04, 1.14) for quintiles 1-3, respectively, compared with quintile 5] after adjusting for patient factors, hospital type, and hospital volume. Quality improvement efforts are needed to help hospitals with low rates of surgery ensure that their patients have access to appropriate surgery.

  11. Level-1 trigger selection of electrons and photons with CMS for LHC Run-II.

    CERN Document Server

    AUTHOR|(CDS)2088114

    2016-01-01

    The CMS experiment has a sophisticated two-level online selection system that achieves a rejection factor of nearly $10^5$. The first, hardware-level trigger (L1) is based on coarse information coming from the calorimeters and the muon detectors while the High-Level Trigger combines fine-grain information from all subdetectors. During Run II, the LHC will increase its center of mass energy to 13 or 14 TeV, and progressively reach an instantaneous luminosity of $2\\times10^{34} \\mathrm{cm}^{-2}\\mathrm{s}^{-1}$. In order to guarantee a successful and ambitious physics programme in this intense environment, the CMS trigger and data acquisition system must be upgraded. The L1 calorimeter trigger hardware and architecture in particular has been redesigned to maintain the current thresholds even in presence of more demanding conditions (e.g., for electrons and photons) and improve the performance for the selection of $\\tau$ leptons. This design benefits from recent $\\mu$TCA technology, allowing sophisticated algorit...

  12. NSLS-II High Level Application Infrastructure And Client API Design

    International Nuclear Information System (INIS)

    Shen, G.; Yang, L.; Shroff, K.

    2011-01-01

    The beam commissioning software framework of NSLS-II project adopts a client/server based architecture to replace the more traditional monolithic high level application approach. It is an open structure platform, and we try to provide a narrow API set for client application. With this narrow API, existing applications developed in different language under different architecture could be ported to our platform with small modification. This paper describes system infrastructure design, client API and system integration, and latest progress. As a new 3rd generation synchrotron light source with ultra low emittance, there are new requirements and challenges to control and manipulate the beam. A use case study and a theoretical analysis have been performed to clarify requirements and challenges to the high level applications (HLA) software environment. To satisfy those requirements and challenges, adequate system architecture of the software framework is critical for beam commissioning, study and operation. The existing traditional approaches are self-consistent, and monolithic. Some of them have adopted a concept of middle layer to separate low level hardware processing from numerical algorithm computing, physics modelling, data manipulating, plotting, and error handling. However, none of the existing approaches can satisfy the requirement. A new design has been proposed by introducing service oriented architecture technology. The HLA is combination of tools for accelerator physicists and operators, which is same as traditional approach. In NSLS-II, they include monitoring applications and control routines. Scripting environment is very important for the later part of HLA and both parts are designed based on a common set of APIs. Physicists and operators are users of these APIs, while control system engineers and a few accelerator physicists are the developers of these APIs. With our Client/Server mode based approach, we leave how to retrieve information to the

  13. Comparison of quality control for trauma management between Western and Eastern European trauma center

    Directory of Open Access Journals (Sweden)

    Gambale Giorgio

    2008-11-01

    Full Text Available Abstract Background Quality control of trauma care is essential to define the effectiveness of trauma center and trauma system. To identify the troublesome issues of the system is the first step for validation of the focused customized solutions. This is a comparative study of two level I trauma centers in Italy and Romania and it has been designed to give an overview of the entire trauma care program adopted in these two countries. This study was aimed to use the results as the basis for recommending and planning changes in the two trauma systems for a better trauma care. Methods We retrospectively reviewed a total of 182 major trauma patients treated in the two hospitals included in the study, between January and June 2002. Every case was analyzed according to the recommended minimal audit filters for trauma quality assurance by The American College of Surgeons Committee on Trauma (ACSCOT. Results Satisfactory yields have been reached in both centers for the management of head and abdominal trauma, airway management, Emergency Department length of stay and early diagnosis and treatment. The main significant differences between the two centers were in the patients' transfers, the leadership of trauma team and the patients' outcome. The main concerns have been in the surgical treatment of fractures, the outcome and the lacking of documentation. Conclusion The analyzed hospitals are classified as Level I trauma center and are within the group of the highest quality level centers in their own countries. Nevertheless, both of them experience major lacks and for few audit filters do not reach the mmum standard requirements of ACS Audit Filters. The differences between the western and the eastern European center were slight. The parameters not reaching the minimum requirements are probably occurring even more often in suburban settings.

  14. Elderly trauma patients have high circulating noradrenaline levels but attenuated release of adrenaline, platelets, and leukocytes in response to increasing injury severity

    DEFF Research Database (Denmark)

    Johansson, Pär I; Sørensen, Anne Marie; Perner, Anders

    2012-01-01

    : High patient age is a strong predictor of poor outcome in trauma patients. The present study investigated the effect of age on mortality and biomarkers of sympathoadrenal activation, tissue, endothelial, and glycocalyx damage, coagulation activation/inhibition, fibrinolysis, and inflammation in...

  15. Visualization on supercomputing platform level II ASC milestone (3537-1B) results from Sandia.

    Energy Technology Data Exchange (ETDEWEB)

    Geveci, Berk (Kitware, Inc., Clifton Park, NY); Fabian, Nathan; Marion, Patrick (Kitware, Inc., Clifton Park, NY); Moreland, Kenneth D.

    2010-09-01

    This report provides documentation for the completion of the Sandia portion of the ASC Level II Visualization on the platform milestone. This ASC Level II milestone is a joint milestone between Sandia National Laboratories and Los Alamos National Laboratories. This milestone contains functionality required for performing visualization directly on a supercomputing platform, which is necessary for peta-scale visualization. Sandia's contribution concerns in-situ visualization, running a visualization in tandem with a solver. Visualization and analysis of petascale data is limited by several factors which must be addressed as ACES delivers the Cielo platform. Two primary difficulties are: (1) Performance of interactive rendering, which is most computationally intensive portion of the visualization process. For terascale platforms, commodity clusters with graphics processors(GPUs) have been used for interactive rendering. For petascale platforms, visualization and rendering may be able to run efficiently on the supercomputer platform itself. (2) I/O bandwidth, which limits how much information can be written to disk. If we simply analyze the sparse information that is saved to disk we miss the opportunity to analyze the rich information produced every timestep by the simulation. For the first issue, we are pursuing in-situ analysis, in which simulations are coupled directly with analysis libraries at runtime. This milestone will evaluate the visualization and rendering performance of current and next generation supercomputers in contrast to GPU-based visualization clusters, and evaluate the performance of common analysis libraries coupled with the simulation that analyze and write data to disk during a running simulation. This milestone will explore, evaluate and advance the maturity level of these technologies and their applicability to problems of interest to the ASC program. Scientific simulation on parallel supercomputers is traditionally performed in four

  16. Contribution to growth and increment analysis on the Italian CONECOFOR Level II Network

    Directory of Open Access Journals (Sweden)

    Emilio AMORINI

    2002-09-01

    Full Text Available The paper deals with the "Estimation of growth and yield" included in the National Programme on Intensive Monitoring of Forest Ecosystems CONECOFOR Aims of the paper are: i to outline the composition and design of Level II PMPs network, also examining the structural characteristics of forest stands; ii to describe the contents of mensurational surveys carried out in winter 1996/97 and 1999/00; iii to analyse the growth rates in progress at each PMP using selected descriptors. Stand origin (11 high forests and 13 stored coppices and transitory crops and the number of forest types tested are focused as the main discriminants of the PMPs network. This composition, together with irregular forestry practice, results in a number of consequences (prevailing age classes, tree densities and related stand structures, growth patterns which cause a high in-and-between variability of all growth parameters. For the purposes of this analysis, the network of the plots was divided into three main sets: broadleaved high forest (i.e. beech stands, 6 PMPs; coniferous forest (i.e. Norway spruce stands, 5 PMPs; coppice forest (i.e. deciduous and evergreen oaks, beech and hardbeam stands, 13 PMPs. The measurement of basic growth variables (dbh and tree height was used to describe the tree populations in each PMP; the calculation of basal area, mean and top dbh, mean and top height, provided the reference dataset at each inventory. The assessment of social class according to Kraft gave information on vertical stand structure and made it possible to analyse growth according to tree layers. Data comparison provided increments in the interval 1997-2000. The occurrence of natural mortality and ingrowth was also assessed to take into account their combined effect on tree population dynamics. No trend was found, due to limited data availability, but it was possible to have a detailed overview of the stand situation and growth rates in PMPs.

  17. Performances of the ATLAS Level-1 Muon barrel trigger during the Run-II data taking

    CERN Document Server

    Sessa, Marco; The ATLAS collaboration

    2017-01-01

    The Level-1 Muon Barrel Trigger is one of the main elements of the event selection of the ATLAS experiment at the Large Hadron Collider. It exploits the Resistive Plate Chambers (RPC) detectors to generate the trigger signal. The RPCs are placed in the barrel region of the ATLAS experiment: they are arranged in three concentric double layers and operate in a strong magnetic toroidal field. RPC detectors cover the pseudo-rapidity range $|\\eta|<1.05$ for a total surface of more than $4000\\ m^2$ and about 3600 gas volumes. The Level-1 Muon Trigger in the barrel region allows to select muon candidates with respect to their transverse momentum and associates them with the correct bunch-crossing number. The trigger system is able to take a decision within a latency of about 2 $\\mu s$. The detailed measurement of the RPC detector efficiencies and of the trigger performance during the ATLAS Run-II data taking is here presented.

  18. Optimisation of the level-1 calorimeter trigger at ATLAS for Run II

    Energy Technology Data Exchange (ETDEWEB)

    Suchek, Stanislav [Kirchhoff-Institute for Physics, Im Neuenheimer Feld 227, 69120 Heidelberg (Germany); Collaboration: ATLAS-Collaboration

    2015-07-01

    The Level-1 Calorimeter Trigger (L1Calo) is a central part of the ATLAS Level-1 Trigger system, designed to identify jet, electron, photon, and hadronic tau candidates, and to measure their transverse energies, as well total transverse energy and missing transverse energy. The optimisation of the jet energy resolution is an important part of the L1Calo upgrade for Run II. A Look-Up Table (LUT) is used to translate the electronic signal from each trigger tower to its transverse energy. By optimising the LUT calibration we can achieve better jet energy resolution and better performance of the jet transverse energy triggers, which are vital for many physics analyses. In addition, the improved energy calibration leads to significant improvements of the missing transverse energy resolution. A new Multi-Chip Module (MCM), as a part of the L1Calo upgrade, provides two separate LUTs for jets and electrons/photons/taus, allowing to optimise jet transverse energy and missing transverse energy separately from the electromagnetic objects. The optimisation is validated using jet transverse energy and missing transverse energy triggers turn-on curves and rates.

  19. Clinical significance of determination of changes of serum IGF-II, CRP levels after treatment in pediatric patients with broncho-pneumonia

    International Nuclear Information System (INIS)

    Chen Chuanbin

    2006-01-01

    Objective: To investigate the changes of serum insulin-like growth factor-II (IGF-II), CRP levels after treatment in pediatric patients with bronchopneumonia. Methods: Serum IGF-II levels were measured with RIA and serum CRP levels with immune method both before and after treatment in 33 pediatric patients with bronchopneumonia and 35 controls. Results: Before treatment the serum levels of IGF-II, CRP were significantly higher in the patients than those in controls (P 0.05). Conclusion: Determination of serum IGF-II, CRP levels is clinically useful in the management of pediatric patients with bronchopneumonia. (authors)

  20. Trauma facilities in Denmark

    DEFF Research Database (Denmark)

    Weile, Jesper; Nielsen, Klaus; Primdahl, Stine C

    2018-01-01

    Background: Trauma is a leading cause of death among adults aged challenge. Evidence supports the centralization of trauma facilities and the use multidisciplinary trauma teams. Because knowledge is sparse on the existing distribution of trauma facilities...... and the organisation of trauma care in Denmark, the aim of this study was to identify all Danish facilities that care for traumatized patients and to investigate the diversity in organization of trauma management. Methods: We conducted a systematic observational cross-sectional study. First, all hospitals in Denmark...... were identified via online services and clarifying phone calls to each facility. Second, all trauma care manuals on all facilities that receive traumatized patients were gathered. Third, anesthesiologists and orthopedic surgeons on call at all trauma facilities were contacted via telephone...

  1. High-Fidelity Simulation in Occupational Therapy Curriculum: Impact on Level II Fieldwork Performance

    Directory of Open Access Journals (Sweden)

    Rebecca Ozelie

    2016-10-01

    Full Text Available Simulation experiences provide experiential learning opportunities during artificially produced real-life medical situations in a safe environment. Evidence supports using simulation in health care education yet limited quantitative evidence exists in occupational therapy. This study aimed to evaluate the differences in scores on the AOTA Fieldwork Performance Evaluation for the Occupational Therapy Student of Level II occupational therapy students who received high-fidelity simulation training and students who did not. A retrospective analysis of 180 students from a private university was used. Independent samples nonparametric t tests examined mean differences between Fieldwork Performance Evaluation scores of those who did and did not receive simulation experiences in the curriculum. Mean ranks were also analyzed for subsection scores and practice settings. Results of this study found no significant difference in overall Fieldwork Performance Evaluation scores between the two groups. The students who completed simulation and had fieldwork in inpatient rehabilitation had the greatest increase in mean rank scores and increases in several subsections. The outcome measure used in this study was found to have limited discriminatory capability and may have affected the results; however, this study finds that using simulation may be a beneficial supplement to didactic coursework in occupational therapy curriculums.

  2. Precise Wavelengths and Energy Levels for the Spectra of Cr I, Mn I, and Mn III, and Branching Fractions for the Spectra of Fe II and Cr II

    Science.gov (United States)

    Nave, Gillian

    I propose to measure wavelengths and energy levels for the spectra of Cr I, Mn I, and Mn III covering the wavelength range 80 nm to 5500 nm, and oscillator strengths for Fe II and Cr II in the region 120 nm to 2500 nm. I shall also produce intensity calibrated atlases and linelists of the iron-neon and chromium-neon hollow cathode lamps that can be compared with astrophysical spectra. The spectra will be obtained from archival data from spectrometers at NIST and Kitt Peak National Observatory and additional experimental observations as necessary from Fourier transform (FT) and grating spectrometers at NIST. The wavelength uncertainty of the strong lines will be better than 1 part in 10^7. The radiometric calibration of the spectra will be improved in order to reduce the uncertainty of measured oscillator strengths in the near UV region and extend the wavelength range of these measurements down to 120 nm. These will complement and support the measurements of lifetimes and branching fractions by J. E. Lawler in the near UV region. An intensive effort by NIST and Imperial College London that was partly funded by previous NASA awards has resulted in comprehensive analyses of the spectra of Fe II, Cr II and Cu II, with similar analyses of Mn II, Ni II, and Sc II underway. The species included in this proposal will complete the analysis of the first two ionization stages of the elements titanium through nickel using the same techniques, and add the spectrum of Mn III - one of the most important doubly-ionized elements. The elements Cr I and Mn I give large numbers of spectral lines in spectra of cool stars and important absorption lines in the interstellar medium. The spectrum of Mn III is important in chemically peculiar stars and can often only be studied in the UV region. Analyses of many stellar spectra depend on comprehensive analyses of iron-group elements and are hampered by incomplete spectroscopic data. As a result of many decades of work by the group at the

  3. Trial storage of high-level waste in the Asse II salt mine

    International Nuclear Information System (INIS)

    1984-01-01

    This report covers a second phase of the work performed by GSF and KfK in the Asse II salt mine, with a view to disposal of radioactive waste in salt formations. New items of the research were geophysical investigations of the behaviour of heated salt and preparation of a trial storage in the Asse II salt mine

  4. Early versus delayed decompression in acute subaxial cervical spinal cord injury: A prospective outcome study at a Level I trauma center from India

    OpenAIRE

    Gupta, Deepak Kumar; Vaghani, Gaurang; Siddiqui, Saquib; Sawhney, Chhavi; Singh, Pankaj Kumar; Kumar, Atin; Kale, S. S.; Sharma, B. S.

    2015-01-01

    Aims: This study was done with the aim to compare the clinical outcome and patients’ quality of life between early versus delayed surgically treated patients of acute subaxial cervical spinal cord injury. The current study was based on the hypothesis that early surgical decompression and fixations in acute subaxial cervical spinal cord trauma is safe and is associated with improved outcome as compared to delayed surgical decompression. Materials and Methods: A total of 69 patients were recrui...

  5. Reconstructing Northern Hemisphere upper-level fields during World War II

    Energy Technology Data Exchange (ETDEWEB)

    Broennimann, S. [Lunar and Planetary Laboratory, University of Arizona, PO Box 210092, Tucson, AZ 85721-0092 (United States); Luterbacher, J. [Institute of Geography, University of Bern, Bern (Switzerland); NCCR Climate, University of Bern, Bern (Switzerland)

    2004-05-01

    Monthly mean fields of temperature and geopotential height (GPH) from 700 to 100 hPa were statistically reconstructed for the extratropical Northern Hemisphere for the World War II period. The reconstruction was based on several hundred predictor variables, comprising temperature series from meteorological stations and gridded sea level pressure data (1939-1947) as well as a large amount of historical upper-air data (1939-1944). Statistical models were fitted in a calibration period (1948-1994) using the NCEP/NCAR Reanalysis data set as predictand. The procedure consists of a weighting scheme, principal component analyses on both the predictor variables and the predictand fields and multiple regression models relating the two sets of principal component time series to each other. According to validation experiments, the reconstruction skill in the 1939-1944 period is excellent for GPH at all levels and good for temperature up to 500 hPa, but somewhat worse for 300 hPa temperature and clearly worse for 100 hPa temperature. Regionally, high predictive skill is found over the midlatitudes of Europe and North America, but a lower quality over Asia, the subtropics, and the Arctic. Moreover, the quality is considerably better in winter than in summer. In the 1945-1947 period, reconstructions are useful up to 300 hPa for GPH and, in winter, up to 500 hPa for temperature. The reconstructed fields are presented for selected months and analysed from a dynamical perspective. It is demonstrated that the reconstructions provide a useful tool for the analysis of large-scale circulation features as well as stratosphere-troposphere coupling in the late 1930s and early 1940s. (orig.)

  6. Management of pancreatic trauma.

    Science.gov (United States)

    Girard, E; Abba, J; Arvieux, C; Trilling, B; Sage, P Y; Mougin, N; Perou, S; Lavagne, P; Létoublon, C

    2016-08-01

    Pancreatic trauma (PT) is associated with high morbidity and mortality; the therapeutic options remain debated. Retrospective study of PT treated in the University Hospital of Grenoble over a 22-year span. The decision for initial laparotomy depended on hemodynamic status as well as on associated lesions. Main pancreatic duct lesions were always searched for. PT lesions were graded according to the AAST classification. Of a total of 46 PT, 34 were grades II or I. Hemodynamic instability led to immediate laparotomy in 18 patients, for whom treatment was always drainage of the pancreatic bed; morbidity was 30%. Eight patients had grade III injuries, six of whom underwent immediate operation: three underwent splenopancreatectomy without any major complications while the other three who had simple drainage required re-operation for peritonitis, with one death related to pancreatic complications. Four patients had grades IV or V PT: two pancreatoduodenectomies were performed, with no major complication, while one patient underwent duodenal reconstruction with pancreatic drainage, complicated by pancreatic and duodenal fistula requiring a hospital stay of two months. The post-trauma course was complicated for all patients with main pancreatic duct involvement. Our outcomes were similar to those found in the literature. In patients with distal PT and main pancreatic duct involvement, simple drainage is associated with high morbidity and mortality. For proximal PT, the therapeutic options of drainage versus pancreatoduodenectomy must be weighed; pancreatoduodenectomy may be unavoidable when the duodenum is injured as well. Two-stage (resection first, reconstruction later) could be an effective alternative in the emergency setting when there are other associated traumatic lesions. Copyright © 2016. Published by Elsevier Masson SAS.

  7. Clinical significance of determination of serum insulin-like growth factor II levels in patients with chronic obstructive pulmonary diseases (COPD)

    International Nuclear Information System (INIS)

    Wu Changming

    2006-01-01

    Objective: To explore the clinical significance of the changes of serum insulinlike growth factor II (IGF-II) levels in patients with chronic obstruive pulmonary diseases (COPD). Methods: The serum IGF-II levels was determined with radioimmunoassay in 60 patients with COPD and 30 controls. Results: The serum IGF-II levels in patients with COPD were significantly higher than those in controls (0.65 ± 0.22μg/L vs 0.51±0.18μg/L, P<0.01). There were no significant differences among the levels in patients of different stages (stages I, II, III). Levels of IGF-II were significantly higher in patients succumbed to the dis- ease than those in patients recoverd (P<0.05). Conclusion: Serum IGF-II levels were significantly increased in patients with COPD, especially in those succumbed. (authors)

  8. Computed tomography in trauma

    International Nuclear Information System (INIS)

    Toombs, B.D.; Sandler, C.M.

    1987-01-01

    This book begins with a chapter dealing with the epidemiology and mechanisms of trauma. Trauma accounts for more lives lost in the United States than cancer and heart disease. The fact that 30%-40% of trauma-related deaths are caused by improper or delayed diagnoses or treatment emphasizes the importance of rapid and accurate methods to establish a diagnosis. Acute thoracic, abdominal, and pelvic trauma and their complications are discussed. A chapter on high-resolution CT of spinal and facial trauma and the role of three-dimensional reconstruction images is presented

  9. Computed tomography in trauma

    Energy Technology Data Exchange (ETDEWEB)

    Toombs, B.D.; Sandler, C.M.

    1987-01-01

    This book begins with a chapter dealing with the epidemiology and mechanisms of trauma. Trauma accounts for more lives lost in the United States than cancer and heart disease. The fact that 30%-40% of trauma-related deaths are caused by improper or delayed diagnoses or treatment emphasizes the importance of rapid and accurate methods to establish a diagnosis. Acute thoracic, abdominal, and pelvic trauma and their complications are discussed. A chapter on high-resolution CT of spinal and facial trauma and the role of three-dimensional reconstruction images is presented.

  10. [Relationship between blood glucose levels and salivary pH and buffering capacity in type II diabetes patients].

    Science.gov (United States)

    Elkafri, I H; Mashlah, A; Shaqifa, A

    2014-03-13

    This study was evaluated the relationship between blood glucose levels and salivary pH and buffering capacity in type II diabetic patients. The sample comprised 210 participants (age ranged 40-60 years). Based on fasting blood glucose levels the participants were divided into 3 groups: controls with normal blood glucose levels; diabetic patients with levels ≤ 200 mg/dL; and diabetic patients with levels > 200 mg/dL. Salivary pH and buffering capacity were determined in a sample of resting (non-stimulated) saliva taken from each participant. Salivary pH levels in diabetic patients with blood glucose levels > 200 mg/dL were lower than in the controls and diabetic patients with levels ≤ 200 mg/dL. Salivary pH levels were comparable in controls and diabetic patients with blood glucose levels ≤ 200 mg/dL. Salivary buffering capacity in the 3 groups was comparable.

  11. Ultrasonography in trauma

    DEFF Research Database (Denmark)

    Weile, Jesper; Nielsen, Klaus; Primdahl, Stine C

    2017-01-01

    BACKGROUND: The Focused Assessment with Sonography in Trauma (FAST) protocol is considered beneficial in emergent evaluation of trauma patients with blunt or penetrating injury and has become integrated into the Advanced Trauma Life Support (ATLS) protocol. No guidelines exist as to the use...... of ultrasonography in trauma in Denmark. We aimed to determine the current use of ultrasonography for assessing trauma patients in Denmark. METHODS: We conducted a nation-wide cross-sectional investigation of ultrasonography usage in trauma care. The first phase consisted of an Internet-based investigation....... Twenty-one (95.5%) of the guidelines included and recommended FAST as part of trauma assessment. The recommended person to perform the examination was the radiologist in n = 11 (50.0%), the surgeon in n = 6 (27.3%), the anesthesiologist in n = 1 (4.5%), and unspecified in n = 3 (13.6%) facilities. FAST...

  12. Management of colorectal trauma: a review.

    Science.gov (United States)

    Cheong, Ju Yong; Keshava, Anil

    2017-07-01

    Traumatic colorectal injuries are common during times of military conflict, and major improvements in their care have arisen in such periods. Since World War II, many classification systems for colorectal trauma have been proposed, including (i) Flint Grading System; (ii) Penetrating Abdominal Trauma Index; (iii) Colonic/Rectal Injury Scale; and (iv) destructive/non-destructive colonic injuries. The primary goal of these classifications was to aid surgical management and, more particularly, to determine whether a primary repair or faecal diversion should be performed. Primary repair is now the preferred surgical option. Patients who have been identified as having destructive injuries have been found to have higher anastomotic leak rates after a primary repair. Damage control principles need to be adhered to in surgical decision-making. In this review, we discuss the mechanisms of injury, classifications, clinical presentation and current recommendations for the management of colorectal trauma. © 2017 Royal Australasian College of Surgeons.

  13. What is the best treatment to decrease pro-inflammatory cytokine release in acute skeletal muscle injury induced by trauma in rats: low-level laser therapy, diclofenac, or cryotherapy?

    Science.gov (United States)

    de Almeida, Patrícia; Tomazoni, Shaiane Silva; Frigo, Lucio; de Carvalho, Paulo de Tarso Camillo; Vanin, Adriane Aver; Santos, Larissa Aline; Albuquerque-Pontes, Gianna Móes; De Marchi, Thiago; Tairova, Olga; Marcos, Rodrigo Labat; Lopes-Martins, Rodrigo Álvaro Brandão; Leal-Junior, Ernesto Cesar Pinto

    2014-03-01

    Currently, treatment of muscle injuries represents a challenge in clinical practice. In acute phase, the most employed therapies are cryotherapy and nonsteroidal anti-inflammatory drugs. In the last years, low-level laser therapy (LLLT) has becoming a promising therapeutic agent; however, its effects are not fully known. The aim of this study was to analyze the effects of sodium diclofenac (topical application), cryotherapy, and LLLT on pro-inflammatory cytokine levels after a controlled model of muscle injury. For such, we performed a single trauma in tibialis anterior muscle of rats. After 1 h, animals were treated with sodium diclofenac (11.6 mg/g of solution), cryotherapy (20 min), or LLLT (904 nm; superpulsed; 700 Hz; 60 mW mean output power; 1.67 W/cm(2); 1, 3, 6 or 9 J; 17, 50, 100 or 150 s). Assessment of interleukin-1β and interleukin-6 (IL-1β and IL-6) and tumor necrosis factor-alpha (TNF-α) levels was performed at 6 h after trauma employing enzyme-linked immunosorbent assay method. LLLT with 1 J dose significantly decreased (p cryotherapy groups. On the other hand, treatment with diclofenac and cryotherapy does not decrease pro-inflammatory cytokine levels compared to the non-treated injured group. Therefore, we can conclude that 904 nm LLLT with 1 J dose has better effects than topical application of diclofenac or cryotherapy in acute inflammatory phase after muscle trauma.

  14. Plasma gelsolin is reduced in trauma patients

    DEFF Research Database (Denmark)

    Dahl, B; Schiødt, F V; Ott, P

    1999-01-01

    in the circulation can lead to a condition resembling multiple organ dysfunction syndrome (MODS), and we have previously demonstrated that the level of Gc-globulin is decreased after severe trauma. The purpose of the present study was to determine whether the plasma levels of gelsolin were altered in the early phase...... after trauma. Twenty-three consecutive trauma patients were studied. Plasma samples were assayed for gelsolin by immunonephelometry with polyclonal rabbit antihuman gelsolin prepared in our own laboratory. The median time from injury until the time the first blood sample was taken was 52 min (range 20......-110) and the median Injury Severity Score (ISS) was 20 (range 4-50). The gelsolin level on admission was reduced significantly in the trauma patients compared with normal controls. The median level was 51 mg/L (7-967) vs. 207 mg/L (151-621), P

  15. Trauma care in Africa: a status report from Botswana, guided by the World Health Organization's "Guidelines for Essential Trauma Care".

    Science.gov (United States)

    Hanche-Olsen, Terje Peder; Alemu, Lulseged; Viste, Asgaut; Wisborg, Torben; Hansen, Kari S

    2012-10-01

    Trauma represents a significant and increasing challenge to health care systems all over the world. This study aimed to evaluate the trauma care capabilities of Botswana, a middle-income African country, by applying the World Health Organization's Guidelines for Essential Trauma Care. All 27 government (16 primary, 9 district, 2 referral) hospitals were surveyed. A questionnaire and checklist, based on "Guidelines for Essential Trauma Care" and locally adapted, were developed as situation analysis tools. The questionnaire assessed local trauma organization, capacity, and the presence of quality improvement activity. The checklist assessed physical availability of equipment and timely availability of trauma-related skills. Information was collected by interviews with hospital administrators, key personnel within trauma care, and through on-site physical inspection. Hospitals in Botswana are reasonably well supplied with human and physical resources for trauma care, although deficiencies were noted. At the primary and district levels, both capacity and equipment for airway/breathing management and vascular access was limited. Trauma administrative functions were largely absent at all levels. No hospital in Botswana had any plans for trauma education, separate from or incorporated into other improvement activities. Team organization was nonexistent, and training activities in the emergency room were limited. This study draws a picture of trauma care capabilities of an entire African country. Despite good organizational structures, Botswana has room for substantial improvement. Administrative functions, training, and human and physical resources could be improved. By applying the guidelines, this study creates an objective foundation for improved trauma care in Botswana.

  16. Hotspots in trauma memories and their relationship to successful trauma-focused psychotherapy: a pilot study

    NARCIS (Netherlands)

    Nijdam, Mirjam J.; Baas, Melanie A. M.; Olff, Miranda; Gersons, Berthold P. R.

    2013-01-01

    Imaginal exposure is an essential element of trauma-focused psychotherapies for posttraumatic stress disorder (PTSD). Exposure should in particular focus on the "hotspots," the parts of trauma memories that cause high levels of emotional distress which are often reexperienced. Our aim was to

  17. Liquid Metallic Hydrogen II. A Critical Assessment of Current and Primordial Helium Levels in the Sun

    Directory of Open Access Journals (Sweden)

    Robitaille P.-M.

    2013-04-01

    lar winds which, though highly variable, provide a wealth of data. Evaluations of pr imordial helium levels based on 1 the spectroscopic study of H-II regions and 2 microwav e anisotropy data, re- main highly questionable. Current helium levels, both with in the stars (Robitaille J. C. and Robitaille P.-M. Liquid Metallic Hydrogen III. Interca lation and Lattice Exclusion versus Gravitational Settling, and Their Consequences Rel ative to Internal Structure, Surface Activity, and Solar Winds in the Sun. Progr. Phys. , 2013, v. 2, in press and the universe at large, appear to be overstated. A careful con sideration of available ob- servational data suggests that helium abundances are consi derably lower than currently believed.

  18. Self-evaluated competence in trauma reception

    DEFF Research Database (Denmark)

    Steinthorsdottir, Kristin Julia; Svenningsen, Peter; Fabricius, Rasmus

    2017-01-01

    Introduction: No formal training requirements exist for trauma teams in Denmark. The aim of this study was to investigate the point prevalence level of training and the selfevaluated competence of doctors involved in trauma care. Methods: On two nights, all doctors on call at departments involved...... in trauma care were interviewed and answered a structured questionnaire pertaining to their level of training and self-evaluated level of competence in relevant skills. These skills included the ability to perform diagnostics and interventions as mandated by the Advanced Trauma Life Support and Definitive...... surgeons (GS) were specialists. In terms of self-evaluated competence, 95% of AN felt competent performing damage control resuscitation, 82% of OS felt competent performing damage control surgery on extremities, whereas 55% of GS felt competent performing damage control surgery in the abdomen. A total...

  19. Self-evaluated competence in trauma reception

    DEFF Research Database (Denmark)

    Steinthorsdottir, Kristin Julia; Svenningsen, Peter; Fabricius, Rasmus

    2017-01-01

    INTRODUCTION: No formal training requirements exist for trauma teams in Denmark. The aim of this study was to investigate the point prevalence level of training and the self-evaluated competence of doctors involved in trauma care. METHODS: On two nights, all doctors on call at departments involved...... in trauma care were interviewed and answered a structured questionnaire pertaining to their level of training and self-evaluated level of competence in relevant skills. These skills included the ability to perform diagnostics and interventions as mandated by the Advanced Trauma Life Support and Definitive...... surgeons (GS) were specialists. In terms of self-evaluated competence, 95% of AN felt competent performing damage control resuscitation, 82% of OS felt competent performing damage control surgery on extremities, whereas 55% of GS felt competent performing damage control surgery in the abdomen. A total...

  20. Changes in thyroid hormones in surgical trauma.

    Directory of Open Access Journals (Sweden)

    Arunabh

    1992-07-01

    Full Text Available A prospective study of 20 patients who underwent elective surgery, is presented reporting the effect of surgical trauma on circulating thyroid hormone levels. Although no increase in the serum T4 levels was observed following surgery, serum T3 values were found to decrease and serum rT3 values were found to increase in the post-operative period, representing activation of an alternate pathway in the peripheral conversion of T4 to T3. Since trauma induces a hypermetabolic state due to hypersecretion of cortisol, alterations in thyroid hormone levels were concluded to represent an appropriate response in trauma to counter the effects of trauma-induced cortisol hypersecretion.

  1. Relationship between Disease Activity and Circulating Level of Collagen II C-Telopeptide Fragments in Papain Induced Osteoarthritis Rat Model

    Directory of Open Access Journals (Sweden)

    Humaira Majeed Khan

    2014-01-01

    Full Text Available Osteoarthritis (OA is a progressive degeneration of articular cartilage leading to failure in functional mobility of joints. It is characterized by morphological, biochemical and molecular changes in histology of cartilage. Different biological markers are used as indicators to precisely predict the stage of cartilage destruction of joints in OA patients and to evaluate the therapeutic efficacy of drugs used for OA. The present research was chalked out to establish relationship between disease activity and serum level of C-terminal telopeptide of type II collagen (CTX-II in experimentally induced OA rat model. Out of 30 male Wistar rats, 25 were used to induce OA by injecting papain (10mg/0.5mL of 0.05M sodium acetate in right knee joints whereas five (control were injected with sterile normal saline solution on day 0. Blood samples (5mL each were collected on weekly basis up to 28th days of post papain injection. Sera were separated and subjected to perform ELISA for estimating CTX-II fragments as cartilage biomarker (CartiLaps ® ELISA kit in experimental groups. Maximum level of CTX–II (pg/mL (40.44±3.07 was observed in sera samples of day 14 post papain injection followed by days 21 (40.22±2.01, 28 (36.82±3.81, 7 (34.48±4.17, 1 (15.08±4.22 and day 0 (2.55±0.10. The early changes in serum CTX-II from day 0 to 14 showed significant association with cartilage damage. Later on, no significant difference was observed in CTX-II level on day 14, 21 and 28 post papain injection. It is concluded that elevation in serum CTX-II level was concomitant with the onset of disease and degradation of cartilage. Moreover, CTX-II is a sensitive diagnostic biomarker to monitor joint disorder severity in papain induced OA rat experimental model on different days. These findings may be used as base line for early diagnosis of disease and initiation of therapy for successful outcome.

  2. TraumaTutor: Perceptions of a Smartphone Application as a Learning Resource for Trauma Management

    Directory of Open Access Journals (Sweden)

    James Wigley

    2013-01-01

    Full Text Available Aim. We investigated perceptions of a new smartphone application (app as a learning resource. Methods. We developed TraumaTutor, an iPhone app consisting of 150 questions and explanatory answers on trauma management. This was used by 20 hospital staff that either had a special interest in managing trauma or who were studying for relevant exams, such as ATLS. A subsequent questionnaire assessed users’ experience of smartphone applications and their perceptions of TraumaTutor. Results. Of those surveyed, 85% had a device capable of running app software, and 94% of them had used apps for medical education. Specific to TraumaTutor, 85% agreed that it was pitched at the right level, 95% felt that the explanations improved understanding of trauma management, and 100% found the app easy to use. In fact, on open questioning, the clear user interface and the quality of the educational material were seen as the major advantages of TraumaTutor, and 85% agreed that the app would be a useful learning resource. Conclusions. Smartphone applications are considered a valuable educational adjunct and are commonly used by our target audience. TraumaTutor shows overwhelming promise as a learning supplement due to its immediacy, accessibility, and relevance to those preparing for courses and managing trauma.

  3. Protocol compliance and time management in blunt trauma resuscitation.

    Science.gov (United States)

    Spanjersberg, W R; Bergs, E A; Mushkudiani, N; Klimek, M; Schipper, I B

    2009-01-01

    To study advanced trauma life support (ATLS) protocol adherence prospectively in trauma resuscitation and to analyse time management of daily multidisciplinary trauma resuscitation at a level 1 trauma centre, for both moderately and severely injured patients. All victims of severe blunt trauma were consecutively included. Patients with a revised trauma score (RTS) of 12 were resuscitated by a "minor trauma" team and patients with an RTS of less than 12 were resuscitated by a "severe trauma" team. Digital video recordings were used to analyse protocol compliance and time management during initial assessment. From 1 May to 1 September 2003, 193 resuscitations were included. The "minor trauma" team assessed 119 patients, with a mean injury severity score (ISS) of 7 (range 1-45). Overall protocol compliance was 42%, ranging from 0% for thoracic percussion to 93% for thoracic auscultation. The median resuscitation time was 45.9 minutes (range 39.7-55.9). The "severe team" assessed 74 patients, with a mean ISS of 22 (range 1-59). Overall protocol compliance was 53%, ranging from 4% for thoracic percussion to 95% for thoracic auscultation. Resuscitation took 34.8 minutes median (range 21.6-44.1). Results showed the current trauma resuscitation to be ATLS-like, with sometimes very low protocol compliance rates. Timing of secondary survey and radiology and thus time efficiency remains a challenge in all trauma patients. To assess the effect of trauma resuscitation protocols on outcome, protocol adherence needs to be improved.

  4. Management of duodenal trauma

    Directory of Open Access Journals (Sweden)

    CHEN Guo-qing

    2011-02-01

    Full Text Available 【Abstract】Duodenal trauma is uncommon but nowadays seen more and more frequently due to the increased automobile accidents and violent events. The management of duodenal trauma can be complicated, especially when massive injury to the pancreatic-duodenal-biliary complex occurs simultaneously. Even the patients receive surgeries in time, multiple postoperative complications and high mortality are common. To know and manage duodenal trauma better, we searched the recent related literature in PubMed by the keywords of duodenal trauma, therapy, diagnosis and abdomen. It shows that because the diagnosis and management are complicated and the mortality is high, duodenal trauma should be treated in time and tactfully. And application of new technology can help improve the management. In this review, we discussed the incidence, diagnosis, management, and complications as well as mortality of duodenal trauma. Key words: Duodenum; Wounds and injuries; Diagnosis; Therapeutics

  5. Trauma-affected refugees

    DEFF Research Database (Denmark)

    Sonne, Charlotte Kærgaard

    2016-01-01

    received the same manual-based Cognitive Behavioural Therapy (CBT) as well as social counselling. The mean length of the treatment course was 6.3 months. The primary outcome measure was self-reported PTSD symptoms assessed on the Harvard Trauma Questionnaire (HTQ). Other outcome measures were self......-reported depression and anxiety symptoms measured on Hopkins Symptom Check List-25 (HSCL-25), self-reported social functioning measured on the Social Adjustment Scale Self Report, short version (SAS-SR), and observer-rated depression and anxiety symptoms assessed on the Hamilton Depression and Anxiety Ratings Scales...... (HAM D+A ). Social support was assessed on the Crisis Support Scale (CSS), level of functioning assessed on the Sheehan Disability Scale (SDS), quality of life was assessed on the WHO-5, the somatisation items of the Symptom Checklist-90 (SCL-90), pain in four different body areas measured on Visual...

  6. Comparing two methods of electronic and teacher-based education on nursing students’ level of knowledge in taking care of trauma patients

    Directory of Open Access Journals (Sweden)

    samaneh alizadeh

    2015-06-01

    Full Text Available Objective: Trauma is a major health problem worldwide regardless of regional socioeconomic and healthcare status. As a leading cause of death, trauma results in severe socioeconomic damages, which could be highly prevented by optimal care. As nurses are the major professional groups involved in patient care, improvement of their knowledge and practical skill leads to more qualified healthcare staff. Nowadays, traditional methods of education cannot meet students’ needs and modern methods of training are recommended to be applied. This study, therefore, aimed to compare the effects of two methods of teaching (electronic education and teacher-based education on students’ learning and the efficacy rate of each method on the knowledge of fourth year students of nursing and midwifery faculty in Tabriz University of Medical Sciences. Methods: In this study, the participants were randomly assigned into 2 educational groups of electronic (experimental group and teacher-based (control group method. All participants took a pre-test. Then each group attended the same course in a different method. Finally, post-test was taken by the participants and data were analyzed. Results: A comparison of the mean knowledge score of both groups showed that electronic education was more effective than teacher-based education. Conclusion: The electronic training will result in more effective learning in comparison to teacher-based method and can be applied as an appropriate and efficient method of education

  7. Management of duodenal trauma

    OpenAIRE

    CHEN Guo-qing; YANG Hua

    2011-01-01

    【Abstract】Duodenal trauma is uncommon but nowadays seen more and more frequently due to the increased automobile accidents and violent events. The management of duodenal trauma can be complicated, especially when massive injury to the pancreatic-duodenal-biliary complex occurs simultaneously. Even the patients receive surgeries in time, multiple postoperative complications and high mortality are common. To know and manage duodenal trauma better, we searched the recent related literature...

  8. EPIDEMOLOGY OF TRAUMA GLOBALY

    Directory of Open Access Journals (Sweden)

    Nur Yuniarti

    2013-10-01

    Full Text Available Normal 0 false false false EN-US X-NONE X-NONE MicrosoftInternetExplorer4 This study describes the epidemiology of trauma globaly. Trauma can cause death, burden of disease and economic losses. Traffic accidents are the most common cause of injury in the whole world. Riskesdes 2007, the proportion of the highest injury of Yogyakarta, experienced by adult age group, higher in male, the high levels of injury increasing the proportion of respondents. Found in the work as an employee, in the upper midle economic level. Lower limb (leg is part most affected by injuries. Based on the types of injuries classified as serious in a row that a head injury. Traffic accidents are often caused by four factors: road user, drivers, pedestrian, and vehicle. Because the victim of traffic accident is quite high and high health costs incurred. By him that there are three phases of stage traffic accident prevention, the prevention of the pre-crash phase, the phase of the accident, when the accident occur, to minimize the injuries. /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-priority:99; mso-style-qformat:yes; mso-style-parent:""; mso-padding-alt:0in 5.4pt 0in 5.4pt; mso-para-margin:0in; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:11.0pt; font-family:"Calibri","sans-serif"; mso-ascii-font-family:Calibri; mso-ascii-theme-font:minor-latin; mso-fareast-font-family:"Times New Roman"; mso-fareast-theme-font:minor-fareast; mso-hansi-font-family:Calibri; mso-hansi-theme-font:minor-latin; mso-bidi-font-family:"Times New Roman"; mso-bidi-theme-font:minor-bidi;}

  9. Clinical significance of measurement of changes of serum IGF-II, NO levels after treatment in pediatric patients with bronchial pneumonia

    International Nuclear Information System (INIS)

    Zhao Huajiang

    2005-01-01

    Objective: To study the clinical significance of changes of serum IGF-II and NO levels after treatment in pediatric patients with bronchial pneumonia. Methods: Serum IGF-II (with RIA) and NO (with Biochemical method) levels were measured in 38 pediatric patients with bronchial pneumonia both before and after treatment as well as in 35 controls. Results: Before treatment, in the patients the serum IGF-II, and NO levels were significantly higher than those in controls (P 0.05). Conclusion: Serum IGF-II and NO levels changes could reflect the disease status of the patients as well as the progress of diseases. (authors)

  10. Current approach to liver traumas.

    Science.gov (United States)

    Kaptanoglu, Levent; Kurt, Necmi; Sikar, Hasan Ediz

    2017-03-01

    Liver injuries remain major obstacle for successful treatment, due to size and location of the liver. Requirement for surgery should be determined by clinical factors, most notably hemodynamical state. In this present study we tried to declare our approach to liver traumas. We also tried to emphasize the importance of conservative treatment, since surgeries for liver traumas carry high mortality rates. Patients admitted to the Department of Emergency Surgery at Kartal Research and Education Hospital, due to liver trauma were retrospectively analyzed between 2003 and 2013. Patient demographics, hepatic panel, APTT (activated partial thromboplastin time), PT (prothrombin time), INR (international normalized ratio), fibrinogen, biochemistry panel were recorded. Hemodynamic instability was the most prominent factor for surgery decision, in the lead of current Advanced Trauma Life Support (ATLS) protocols. Operation records and imaging modalities revealed liver injuries according to the Organ Injury Scale of the American Association for the Surgery of Trauma. 300 patients admitted to emergency department were included in our study (187 males and 113 females). Mean age was 47 years (range, 12-87). The overall mortality rate was 13% (40 out of 300). Major factor responsible for mortality rates and outcome was stability of cases on admission. 188 (% 63) patients were counted as stable, whereas 112 (% 37) cases were found unstable (blood pressure ≤ 90, after massive resuscitation). 192 patients were observed conservatively, whereas 108 cases received abdominal surgery. High levels of AST, ALT, LDH, INR, creatinine and low levels of fibrinogen and low platelet counts on admission were found to be associated with mortality and these cases also had Grade 4 and 5 injuries. Hemodynamic instability on admission and the type and grade of injury played major role in mortality rates). Packing was performed in 35 patients, with Grade 4 and 5 injuries. Mortality rate was %13 (40

  11. The Epidemiology of Emergency Department Trauma Discharges in the United States.

    Science.gov (United States)

    DiMaggio, Charles J; Avraham, Jacob B; Lee, David C; Frangos, Spiros G; Wall, Stephen P

    2017-10-01

    Injury-related morbidity and mortality is an important emergency medicine and public health challenge in the United States. Here we describe the epidemiology of traumatic injury presenting to U.S. emergency departments (EDs), define changes in types and causes of injury among the elderly and the young, characterize the role of trauma centers and teaching hospitals in providing emergency trauma care, and estimate the overall economic burden of treating such injuries. We conducted a secondary retrospective, repeated cross-sectional study of the Nationwide Emergency Department Data Sample (NEDS), the largest all-payer ED survey database in the United States. Main outcomes and measures were survey-adjusted counts, proportions, means, and rates with associated standard errors (SEs) and 95% confidence intervals. We plotted annual age-stratified ED discharge rates for traumatic injury and present tables of proportions of common injuries and external causes. We modeled the association of Level I or II trauma center care with injury fatality using a multivariable survey-adjusted logistic regression analysis that controlled for age, sex, injury severity, comorbid diagnoses, and teaching hospital status. There were 181,194,431 (SE = 4,234) traumatic injury discharges from U.S. EDs between 2006 and 2012. There was a mean year-to-year decrease of 143 (95% CI = -184.3 to -68.5) visits per 100,000 U.S. population during the study period. The all-age, all-cause case-fatality rate for traumatic injuries across U.S. EDs during the study period was 0.17% (SE = 0.001%). The case-fatality rate for the most severely injured averaged 4.8% (SE = 0.001%), and severely injured patients were nearly four times as likely to be seen in Level I or II trauma centers (relative risk = 3.9 [95% CI = 3.7 to 4.1]). The unadjusted risk ratio, based on group counts, for the association of Level I or II trauma centers with mortality was risk ratio = 4.9 (95% CI = 4.5 to 5.3); however, after sex, age

  12. About Military Sexual Trauma

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  13. About Military Sexual Trauma

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  15. [Trauma registry and injury].

    Science.gov (United States)

    Shapira, S C

    2001-10-01

    The trauma registry network constitutes an essential database in every injury prevention system. In order to rationally estimate the extent of injury in general, and injuries from traffic accidents in particular, the trauma registry systems should contain the most comprehensive and broad database possible, in line with the operational definitions. Ideally, the base of the injury pyramid should also include mild injuries and even "near-misses". The Israeli National Trauma Registry has come a long way in the last few years. The eventual inclusion of all trauma centers in Israel will enable the establishment of a firm base for the allocation of resources by decision-makers.

  16. About Military Sexual Trauma

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  17. [Morbimortality in patients with hepatic trauma].

    Science.gov (United States)

    Fonseca-Neto, Olival Cirilo Lucena da; Ehrhardt, Rogério; Miranda, Antonio Lopes de

    2013-06-01

    The liver is the intra-abdominal organ more injured in patient victims of trauma. The injury occurs more frequently in the penetrating trauma. The incidence of mortality for injuries of the liver is 10%. To evaluate the mortality of the patients with hepatic trauma, the treatment applied and its evolution. Were analyzed, retrospectively, the charts of all patients with hepatic trauma and surgical indication. Were analyzed: gender, age, ISS (injury severity score), classification of the abdominal trauma type (open or closed), causing instrument of the open traumas, degree of the injury, hepatic segments involved, presence of associated injuries, type of surgical treatment: not-therapeutic laparotomy and therapeutic laparotomy, reoperations, complications, time of hospitalization in days and mortality. One hundred and thirty-seven patients participated. Of these, 124 were men (90.5%). The majority (56.2%) had 20-29 years old. Closed abdominal trauma was most prevalent (67.9%). Of the penetrating traumas, the originated with firearms were in 24.8%. One hundred and three patients had only one injured hepatic segment (75.2%) and 34 (24.8%) two. Grade II injuries were in 66.4%. Of the 137 patients with laparotomy, 89 had been not-therapeutic, while in 48 it was necessary to repair associated injuries. Spleen and diaphragm had been the more frequently injured structures, 30% and 26%, respectively. The ISS varied of eight to 72, being the ISS > 50 (eight patients) associate with fatal evolution (five patients). Biliary fistula and hepatic abscess had been the main complications. Seven deaths had occurred. Concomitant injuries, hepatic and other organs, associated with ISS > 50 presented higher possibility of complications and death.

  18. Increased Resistin Levels in Intra-abdominal Sepsis: Correlation with proinflammatory cytokines & Acute Physiology & Chronic Health Evaluation II scores

    Directory of Open Access Journals (Sweden)

    Tonguç U. Yilmaz

    2014-10-01

    Full Text Available Objectives: Resistin, a hormone secreted from adipocytes and considered to be a likely cause of insulin resistance, has recently been accepted as a proinflammatory cytokine. This study aimed to determine the correlation between resistin levels in patients with intra-abdominal sepsis and mortality. Methods: Of 45 patients with intraabdominal sepsis, a total of 35 adult patients were included in the study. This study was undertaken from December 2011 to December 2012 and included patients who had no history of diabetes mellitus and who were admitted to the general surgery intensive care units of Gazi University and Bülent Ecevit University School of Medicine, Turkey. Evaluations were performed on 12 patients with sepsis, 10 patients with severe sepsis, 13 patients with septic shock and 15 healthy controls. The patients’ plasma resistin, interleukin-6 (IL-6, tumour necrosis factor alpha (TNF-α, interleukin-1 beta (IL-1β, procalcitonin, lactate and glucose levels and Acute Physiology and Chronic Health Evaluation (APACHE II scores were studied daily for the first five days after admission. A correlation analysis of serum resistin levels with cytokine levels and APACHE II scores was performed. Results: Serum resistin levels in patients with sepsis were significantly higher than in the healthy controls (P <0.001. A significant correlation was found between serum resistin levels and APACHE II scores, serum IL-6, IL-1β, TNF-α, procalcitonin, lactate and glucose levels. Furthermore, a significant correlation was found between serum resistin levels and all-cause mortality (P = 0.02. Conclusion: The levels of resistin were significantly positively correlated with the severity of disease and were a possible mediator of a prolonged inflammatory state in patients with intra-abdominal sepsis.

  19. Primary closure in colon trauma.

    Science.gov (United States)

    Salinas-Aragón, Luis Enrique; Guevara-Torres, Lorenzo; Vaca-Pérez, Enrique; Belmares-Taboada, Jaime Arístides; Ortiz-Castillo, Fátima de Guadalupe; Sánchez-Aguilar, Martín

    2009-01-01

    Primary repair of colon injuries is an accepted therapeutic option; however, controversy persists regarding its safety. Our objective was to report the evolution and presence of complications in patients with colon injury who underwent primary closure and to determine if the time interval (>6 h), degree of injury, contamination, anatomic site injured, PATI (Penetrating Abdominal Trauma Index) >25, and the presence of other injuries in colon trauma are associated with increased morbidity and mortality. This was a prospective, observational, longitudinal and descriptive study conducted at the Central Hospital "Dr. Ignacio Morones Prieto," San Luis Potosí, Mexico, from January 1, 2003 to December 31, 2007. We included patients with abdominal trauma with colon injury subjected to surgical treatment. chi(2) was used for basic statistical analysis. There were 481 patients with abdominal trauma who underwent surgery; 77(16.1%) had colon injury. Ninety percent (n = 69) were treated in the first 6 h; 91% (n = 70) were due to penetrating injuries, and gunshot wound accounted for 48% (n = 37). Transverse colon was the most frequently injured (38%) (n = 29). Grade I and II injuries accounted for 75.3% (n = 58). Procedures included primary repair (76.66 %) (n = 46); resection with anastomosis (8.3%) (n = 5); and colostomy (15%) (n = 9). Associated injuries were present in 76.6% (n = 59). There was some degree of contamination in 85.7% (n = 66); 82.8% (58) had PATI colon injury. Primary repair is a safe procedure for treatment of colon injuries. Patients with primary repair had lower morbidity (p <0.009). Surgery during the first 6 h (p <0.006) and in hemodynamically stable patients (p <0.014) had a lower risk of complications.

  20. Comparison of serum pepsinogen i and ii and gastrin 17 level in ...

    African Journals Online (AJOL)

    Introduction: Serum screening systems are useful in monitoring gastric cancer. The present research studied and compared serum ... Patients with precancerous lesions were considered the case group (40 individuals) and patients with chronic gastritis the control group (88 individuals). Serum pepsinogen I, pepsinogen II, ...

  1. Artificial Intelligence Can Predict Daily Trauma Volume and Average Acuity.

    Science.gov (United States)

    Stonko, David P; Dennis, Bradley M; Betzold, Richard D; Peetz, Allan B; Gunter, Oliver L; Guillamondegui, Oscar D

    2018-04-19

    The goal of this study was to integrate temporal and weather data in order to create an artificial neural network (ANN) to predict trauma volume, the number of emergent operative cases, and average daily acuity at a level 1 trauma center. Trauma admission data from TRACS and weather data from the National Oceanic and Atmospheric Administration (NOAA) was collected for all adult trauma patients from July 2013-June 2016. The ANN was constructed using temporal (time, day of week), and weather factors (daily high, active precipitation) to predict four points of daily trauma activity: number of traumas, number of penetrating traumas, average ISS, and number of immediate OR cases per day. We trained a two-layer feed-forward network with 10 sigmoid hidden neurons via the Levenberg-Marquardt backpropagation algorithm, and performed k-fold cross validation and accuracy calculations on 100 randomly generated partitions. 10,612 patients over 1,096 days were identified. The ANN accurately predicted the daily trauma distribution in terms of number of traumas, number of penetrating traumas, number of OR cases, and average daily ISS (combined training correlation coefficient r = 0.9018+/-0.002; validation r = 0.8899+/- 0.005; testing r = 0.8940+/-0.006). We were able to successfully predict trauma and emergent operative volume, and acuity using an ANN by integrating local weather and trauma admission data from a level 1 center. As an example, for June 30, 2016, it predicted 9.93 traumas (actual: 10), and a mean ISS score of 15.99 (actual: 13.12); see figure 3. This may prove useful for predicting trauma needs across the system and hospital administration when allocating limited resources. Level III STUDY TYPE: Prognostic/Epidemiological.

  2. Penetrating abdominal trauma.

    Science.gov (United States)

    Henneman, P L

    1989-08-01

    The management of patients with penetrating abdominal trauma is outlined in Figure 1. Patients with hemodynamic instability, evisceration, significant gastrointestinal bleeding, peritoneal signs, gunshot wounds with peritoneal violation, and type 2 and 3 shotgun wounds should undergo emergency laparotomy. The initial ED management of these patients includes airway management, monitoring of cardiac rhythm and vital signs, history, physical examination, and placement of intravenous lines. Blood should be obtained for initial hematocrit, type and cross-matching, electrolytes, and an alcohol level or drug screen as needed. Initial resuscitation should utilize crystalloid fluid replacement. If more than 2 liters of crystalloid are needed to stabilize an adult (less in a child), blood should be given. Group O Rh-negative packed red blood cells should be immediately available for a patient in impending arrest or massive hemorrhage. Type-specific blood should be available within 15 minutes. A patient with penetrating thoracic and high abdominal trauma should receive a portable chest x-ray, and a hemo- or pneumothorax should be treated with tube thoracostomy. An unstable patient with clinical signs consistent with a pneumothorax, however, should receive a tube thoracostomy prior to obtaining roentgenographic confirmation. If time permits, a nasogastric tube and Foley catheter should be placed, and the urine evaluated for blood (these procedures can be performed in the operating room). If kidney involvement is suspected because of hematuria or penetrating trauma in the area of a kidney or ureter in a patient requiring surgery, a single-shot IVP should be performed either in the ED or the operating room. An ECG is important in patients with possible cardiac involvement and in patients over the age of 40 going to the operating room. Tetanus status should be updated, and appropriate antibiotics covering bowel flora should be given. Operative management should rarely be delayed

  3. Direct to Operating Room Trauma Resuscitation Decreases Mortality Among Severely Injured Children.

    Science.gov (United States)

    Wieck, Minna M; Cunningham, Aaron J; Behrens, Brandon; Ohm, Erika T; Maxwell, Bryan G; Hamilton, Nicholas A; Adams, M Christopher; Cole, Frederick J; Jafri, Mubeen A

    2018-03-16

    Expediting evaluation and intervention for severely injured patients has remained a mainstay of advanced trauma care. One technique, direct to operating room (DOR) resuscitation, for selective adult patients has demonstrated decreased mortality. We sought to investigate the application of this protocol in children. All DOR pediatric patients from 2009-2016 at a pediatric Level I Trauma Center were identified. DOR criteria included penetrating injury, chest injuries, amputations, significant blood loss, cardiopulmonary resuscitation, and surgeon discretion. Demographics, injury patterns, interventions, and outcomes were analyzed. Observed mortality was compared to expected mortality, calculated using Trauma Injury Severity Score (TRISS) methodology, with two-tailed t-tests and a p-value 15, 33% had GCS≤8, and 9% were hypotensive. The most commonly injured body regions were external (66%), head (34%), chest (30%), and abdomen (27%). Sixty-seven patients (82%) required emergent procedural intervention, most commonly wound exploration/repair (35%), central venous access (22%), tube thoracostomy (19%) and laparotomy (18%). Predictors of intervention were ISS>15 (odds ratio=14, p=0.013) and GCS<9 (odds ratio=8.5, p=0.044). The survival rate to discharge for DOR patients was 84% compared with an expected survival of 79% (TRISS) (p=0.4). The greatest improvement relative to expected mortality was seen in the subgroup with penetrating trauma (84.5% vs. 74.4%, p=0.002). A selective policy of resuscitating the most severely injured children in the operating room can decrease mortality. Patients suffering penetrating trauma with the highest ISS and diminished GCS have the greatest benefit. Trauma centers with appropriate resources should evaluate implementing similar policies. Level II. Diagnostic tests or criteria.

  4. PRESTO-II, Low Level Radioactive Waste Transport and Risk Assessment

    International Nuclear Information System (INIS)

    1990-01-01

    1 - Description of program or function: PRESTO-II evaluates possible health effects from shallow-land and waste-disposal trenches. The model is intended to serve as a non- site-specific screening model for assessing radionuclide transport, ensuing exposure, and health impacts to a static local population fora 1000-year period following the end of disposal operations. Human exposure scenarios considered include normal releases (including leaching and operational spillage), human intrusion, and limited site farming or reclamation. Pathways and processes of transit from the trench to an individual or population include ground-water transport, overland flow, erosion, surface water dilution, suspension, atmospheric transport, deposition, inhalation, external exposure, and ingestion of contaminated beef, milk, crops, and water. Both population doses and individual doses, as well as doses to the intruder and farmer, may be calculated. Cumulative health effects in terms of cancer deaths are calculated for the population over the 1000-year period using a life-table approach developed by EPA (CCC-422/RADRISK). The DARTAB model is used in modified form to generate human health risk estimates from radionuclide concentrations and intake values. 2 - Method of solution: PRESTO-II tracks radionuclide transport through surface and subsurface pathways and human exposures through external exposure, inhalation, and ingestion with a resolution of 1 y. The methodology is mechanistic, and physical transport processes are modeled separately and in detail. PRESTO-II computes infiltration through the trench cap from experimentally determined permeability and hourly precipitation values. Watershed infiltration is determined using a parametric evapotranspiration equation requiring input values for several site variables. A finite element approach is used to compute trench water balance. 3 - Restrictions on the complexity of the problem: The PRESTO-II model is most appropriately used as a

  5. Childhood trauma, combat trauma, and substance use in National Guard and reserve soldiers.

    Science.gov (United States)

    Vest, Bonnie M; Hoopsick, Rachel A; Homish, D Lynn; Daws, Rachel C; Homish, Gregory G

    2018-02-27

    The goal of this work was to examine associations among childhood trauma, combat trauma, and substance use (alcohol problems, frequent heavy drinking [FHD], current cigarette smoking, and current/lifetime drug use) and the interaction effects of childhood trauma and combat exposure on those associations among National Guard/reserve soldiers. Participants (N = 248) completed an electronic survey asking questions about their military experiences, physical and mental health, and substance use. Childhood trauma and combat exposure were examined jointly in regression models, controlling for age, marital satisfaction, and number of deployments. Childhood trauma was associated with current drug use (trend level, odds ratio [OR] = 1.44, 95% confidence interval [CI]: 0.97, 2.14; P = .072) in the main effect model; however, there was not a significant interaction with combat. Combat exposure had a significant interaction with childhood trauma on alcohol problems (b = -0.56, 95% CI: -1.12, -0.01; P = .048), FHD (b = -0.27, 95% CI: -0.47, -0.08; P = .007), and lifetime drug use (OR = 1.78, 95% CI: 1.04, 3.04; P = .035). There were no associations with either of the trauma measures and current cigarette smoking. These results demonstrate that childhood and combat trauma have differential effects on alcohol use, such that combat trauma may not add to the effect on alcohol use in those with greater child maltreatment but may contribute to greater alcohol use among those with low child maltreatment. As expected, childhood and combat trauma had synergistic effects on lifetime drug use. Screening for multiple types of trauma prior to enlistment and/or deployment may help to identify at-risk individuals and allow time for early intervention to prevent future adverse outcomes.

  6. Non-operative management of isolated liver trauma.

    Science.gov (United States)

    Li, Min; Yu, Wen-Kui; Wang, Xin-Bo; Ji, Wu; Li, Jie-Shou; Li, Ning

    2014-10-01

    Liver trauma is the most common abdominal emergency with high morbidity and mortality. Now, non-operative management (NOM) is a selective method for liver trauma. The aim of this study was to determine the success rate, mortality and morbidity of NOM for isolated liver trauma. Medical records of 81 patients with isolated liver trauma in our unit were analyzed retrospectively. The success rate, mortality and morbidity of NOM were evaluated. In this series, 9 patients with grade IV-V liver injuries underwent emergent operation due to hemodynamic instability; 72 patients, 6 with grade V, 18 grade IV, 29 grade III, 15 grade II and 4 grade I, with hemodynamic stability received NOM. The overall success rate of NOM was 97.2% (70/72). The success rates of NOM in the patients with grade I-III, IV and V liver trauma were 100%, 94.4% and 83.3%. The complication rates were 10.0% and 45.5% in the patients who underwent NOM and surgical treatment, respectively. No patient with grade I-II liver trauma had complications. All patients who underwent NOM survived. NOM is the first option for the treatment of liver trauma if the patient is hemodynamically stable. The grade of liver injury and the volume of hemoperitoneum are not suitable criteria for selecting NOM. Hepatic angioembolization associated with the correction of hypothermia, coagulopathy and acidosis is important in the conservative treatment for liver trauma.

  7. Prospects after Major Trauma

    NARCIS (Netherlands)

    Holtslag, H.R.

    2007-01-01

    Introduction. After patients survived major trauma, their prospects, in terms of the consequences for functioning, are uncertain, which may impact severely on patient, family and society. The studies in this thesis describes the long-term outcomes of severe injured patients after major trauma. In

  8. Trauma and the truth

    NARCIS (Netherlands)

    Meeter, Martijn

    2016-01-01

    Witnessing horrible things may leave a person scarred for life — an effect usually referred to as psychological trauma. We do not know exactly what it does or how it worms its way into our psyche, but psychological trauma has been linked to a wide range of fear- and depression-related symptoms

  9. An in-situ simulation-based educational outreach project for pediatric trauma care in a rural trauma system.

    Science.gov (United States)

    Bayouth, Lilly; Ashley, Sarah; Brady, Jackie; Lake, Bryan; Keeter, Morgan; Schiller, David; Robey, Walter C; Charles, Stephen; Beasley, Kari M; Toschlog, Eric A; Longshore, Shannon W

    2018-02-01

    Outcome disparities between urban and rural pediatric trauma patients persist, despite regionalization of trauma systems. Rural patients are initially transported to the nearest emergency department (ED), where pediatric care is infrequent. We aim to identify educational intervention targets and increase provider experience via pediatric trauma simulation. Prospective study of simulation-based pediatric trauma resuscitation was performed at three community EDs. Level one trauma center providers facilitated simulations, providing educational feedback. Provider performance comfort and skill with tasks essential to initial trauma care were assessed, comparing pre-/postsimulations. Primary outcomes were: 1) improved comfort performing skills, and 2) team performance during resuscitation. Provider comfort with the following improved (p-values education improves provider comfort and performance. Comparison of patient outcomes to evaluate improvement in pediatric trauma care is warranted. IV. Copyright © 2017 Elsevier Inc. All rights reserved.

  10. Radiology in chest trauma

    International Nuclear Information System (INIS)

    Wenz, W.; Kloehn, I.; Wolfart, W.; Freiburg Univ.

    1979-01-01

    In chest trauma, a routine chest film, preferably in the lateral as well as the frontal projection, is the basic part of the work-up. Occasionally valuable additional methods are fluoroscopy, tomography, bronchography, contrast studies of the GI Tract and angiography and angiocardiography. In 679 chest trauma patients, traffic accidents and falls were the main reason for the trauma. There were 248 fractures; then - in order of frequency - hemopneumothorax (76), lung contusion (58), subcutaneous emphysema (33) cardiac (16) and vascular trauma (12) and damage to other organs. While 20-30% mistakes are made in diagnosing rib fractures in acute trauma, there is high accuracy in the diagnosis of the other injuries. Many cases are shown to demonstrate the value of diagnostic radiology. (orig.) [de

  11. Experimental determination of the energy levels of the antimony atom (Sb II), ions of the antimony (Sb II, Sb III), mercury (Hg IV) and cesium (Cs X)

    International Nuclear Information System (INIS)

    Arcimowicz, B.

    1993-01-01

    The thesis concerns establishing the energy scheme of the electronic levels, obtained from the analysis of the investigated spectra of antimony atom and ions (Sb I, Sb II, Sb III) and higher ionized mercury (Hg IV) and cesium (Cs X) atoms. The experimental studies were performed with optical spectroscopy methods. The spectra of the elements under study obtained in the spectral range from visible (680 nm) to vacuum UV (40 nm) were analysed. The classification and spectroscopic designation of the experimentally established 169 energy levels were obtained on the basis of the performed calculations and the fine structure analysis. The following configurations were considered: 5s 2 5p 2 ns, 5s 2 5p 2 n'd, 5s5p 4 of the antimony atom, 5s 2 5pns, 5s 2 5pn'd, 5s5p 3 of the ion Sb II, 5s 2 ns, 5s 2 n'd, 5s5p 2 of the on Sb III, 5d 8 6p of the ion Hg IV 4d 9 5s and 4d 9 5p Cs X. A reclassification was performed and some changes were introduced to the existing energy level scheme of the antimony atom, with the use of the information obtained from the absorption spectrum taken in the VUV region by the ''flash pyrolysis'' technique. The measurements of the hyperfine splittings in 19 spectral lines belonging to the antimony atom and ions additionally confirmed the assumed classification of the levels involved in these lines. The energy level scheme, obtained for Sb III, was compared to the other ones in the isoelectronic sequence starting with In I. On the basis of the analysis of the Hg IV spectrum it was proved that ground configuration of the three times ionized mercury atom is 5d 9 not 5d 8 6s as assumed until now. The fine structure, established from the analysis of the spectra of the elements under study was examined in multiconfiguration approximation. As a result of the performed calculations the fine structure parameters and wavefunctions were determined for the levels whose energy values were experimentally established in the thesis. (author). 140 refs, 22 figs, 17

  12. Predictors of abdominal injuries in blunt trauma.

    Science.gov (United States)

    Farrath, Samiris; Parreira, José Gustavo; Perlingeiro, Jacqueline A G; Solda, Silvia C; Assef, José Cesar

    2012-01-01

    To identify predictors of abdominal injuries in victims of blunt trauma. retrospective analysis of trauma protocols (collected prospectively) of adult victims of blunt trauma in a period of 15 months. Variables were compared between patients with abdominal injuries (AIS>0) detected by computed tomography or/and laparotomy (group I) and others (AIS=0, group II). Student's t, Fisher and qui-square tests were used for statistical analysis, considering p3) in head (18.5% vs. 7.9%), thorax (29.2% vs. 2.4%) and extremities (40.0% vs. 13.7%). The highest odds ratios for the diagnosis of abdominal injuries were associated flail chest (21.8) and pelvic fractures (21.0). Abdominal injuries were more frequently observed in patients with hemodynamic instability, changes in Glasgow coma scale and severe lesions to the head, chest and extremities.

  13. Existence of limit cycles in a three level trophic chain with Lotka–Volterra and Holling type II functional responses

    International Nuclear Information System (INIS)

    Castellanos, Víctor; Chan-López, Ramón E.

    2017-01-01

    In this paper we analyze a three level trophic chain model, considering a logistic growth for the lowest trophic level, a Lotka–Volterra and Holling type II functional responses for predators in the middle and in the cusp in the chain, respectively. The differential system is based on the Leslie–Gower scheme. We establish conditions on the parameters that guarantee the coexistence of populations in the habitat. We find that an Andronov–Hopf bifurcation takes place. The first Lyapunov coefficient is computed explicitly and we show the existence of a stable limit cycle. Numerically, we observe a strange attractor and there exist evidence of the model to exhibit chaotic dynamics.

  14. Clinical significance of measurement of changes of serum IGF-II, EGF and CYFRA21-1 levels after chemotherapy in patients with lung cancer

    International Nuclear Information System (INIS)

    Chen Jianlin

    2010-01-01

    Objective: To study the clinical significance of changes of serum IGF-II, EGF and CYFRA21-1 levels after chemotherapy in patients with lung cancer. Methods: Serum IGF-II, EGF (with RIA), and CYFRA21-1 (with ECLIA) levels were determined both before and after chemotherapy in 39 patients with lung cancer as well as once in 35 controls. Results: Before chemotherapy, serum IGF-II, EGF and CYFRA21-1 levels were significantly higher in the patients than those in controls(P<0.01). Six months after chemotherapy, serum IGF-II, EGF and CYFRA21-1 levels dropped markedly, but remained significantly higher than those in controls(P<0.05). Conclusion: The development of lung cancer in patients was closely related to the serum IGF-II, EGF and CYFRA21-1 levels. (authors)

  15. Fibrinogen depletion in trauma: early, easy to estimate and central to trauma-induced coagulopathy

    OpenAIRE

    Davenport, Ross; Brohi, Karim

    2013-01-01

    Fibrinogen is fundamental to hemostasis and falls rapidly in trauma hemorrhage, although levels are not routinely measured in the acute bleeding episode. Prompt identification of critically low levels of fibrinogen and early supplementation has the potential to correct trauma-induced coagulation and improve outcomes. Early estimation of hypofibrinogenemia is possible using surrogate markers of shock and hemorrhage; for example, hemoglobin and base excess. Rapid replacement with fibrinogen con...

  16. THE Low-level Radio Frequency System for the superconducting cavities of National Synchrotron Light Source II

    International Nuclear Information System (INIS)

    Ma, H.; Rose, J.; Holub, B.; Cupolo, J.; Oliva, J.; Sikora, R.; Yeddulla, M.

    2011-01-01

    A digital low-level radio frequency (LLRF) field controller has been developed for the storage ring of The National Synchrotron Light Source-II (NSLS-II). The primary performance goal for the LLRF is to support the required RF operation of the superconducting cavities with a beam current of 500mA and a 0.14 degree or better RF phase stability. The digital field controller is FPGA-based, in a standard format 19-inch/I-U chassis. It has an option of high-level control support with MATLAB running on a local host computer through a USB2.0 port. The field controller has been field tested with the high-power superconducting RF (SRF) at Canadian light Source, and successfully stored a high beam current of 250 mA. The test results show that required specifications for the cavity RF field stability are met. This digital field controller is also currently being used as a development platform for other functional modules in the NSLS-II RF systems.

  17. Shielding NSLS-II light source: Importance of geometry for calculating radiation levels from beam losses

    Science.gov (United States)

    Kramer, S. L.; Ghosh, V. J.; Breitfeller, M.; Wahl, W.

    2016-11-01

    Third generation high brightness light sources are designed to have low emittance and high current beams, which contribute to higher beam loss rates that will be compensated by Top-Off injection. Shielding for these higher loss rates will be critical to protect the projected higher occupancy factors for the users. Top-Off injection requires a full energy injector, which will demand greater consideration of the potential abnormal beam miss-steering and localized losses that could occur. The high energy electron injection beam produces significantly higher neutron component dose to the experimental floor than a lower energy beam injection and ramped operations. Minimizing this dose will require adequate knowledge of where the miss-steered beam can occur and sufficient EM shielding close to the loss point, in order to attenuate the energy of the particles in the EM shower below the neutron production threshold (weaknesses in the design before a high radiation incident occurs. The effort required to adequately define the accelerator geometry for these codes has been greatly reduced with the implementation of the graphical interface of FLAIR to FLUKA. This made the effective shielding process for NSLS-II quite accurate and reliable. The principles used to provide supplemental shielding to the NSLS-II accelerators and the lessons learned from this process are presented.

  18. An analysis of the job of strength and conditioning coach for football at the Division II level.

    Science.gov (United States)

    Massey, C Dwayne; Schwind, Justin J; Andrews, Donnie C; Maneval, Mark W

    2009-12-01

    The purpose of this investigation was to describe the working environment of the heretofore unexamined Division II football strength and conditioning coach (SCC). Data were collected on demographic characteristics, job satisfaction, major job duties and responsibilities, work environment, and professional and personal relationships. A total of 63 questionnaires were returned by the potential 155 institutions identified at the Division II level. Percentages were used in the reporting of data. The results indicate that this group is relatively young (34.1), new to the profession, have low job stability, a low rate of professional certification, make a salary less than their Division I-A counterparts, and assume more duties and responsibilities than their Division I-A colleagues. Despite these apparent drawbacks, by and large, these SCC appeared content with their career choice and circumstances.

  19. Spectrum of Singly Charged Uranium (U II : Theoretical Interpretation of Energy Levels, Partition Function and Classified Ultraviolet Lines

    Directory of Open Access Journals (Sweden)

    Ali Meftah

    2017-06-01

    Full Text Available In an attempt to improve U II analysis, the lowest configurations of both parities have been interpreted by means of the Racah-Slater parametric method, using Cowan codes. In the odd parity, including the ground state, 253 levels of the interacting configurations 5 f 3 7 s 2 + 5 f 3 6 d 7 s + 5 f 3 6 d 2 + 5 f 4 7 p + 5 f 5 are interpreted by 24 free parameters and 64 constrained ones, with a root mean square (rms deviation of 60 cm − 1 . In the even parity, the four known configurations 5 f 4 7 s , 5 f 4 6 d , 5 f 2 6 d 2 7 s , 5 f 2 6 d 7 s 2 and the unknown 5 f 2 6 d 3 form a basis for interpreting 125 levels with a rms deviation of 84 cm − 1 . Due to perturbations, the theoretical description of the higher configurations 5 f 3 7 s 7 p + 5 f 3 6 d 7 p remains unsatisfactory. The known and predicted levels of U II are used for a determination of the partition function. The parametric study led us to a re-investigation of high resolution ultraviolet spectrum of uranium recorded at the Meudon Observatory in the late eighties, of which the analysis was unachieved. In the course of the present study, a number of 451 lines of U II has been classified in the region 2344 –2955 Å. One new level has been established as 5 f 3 6 d 7 p ( 4 I 6 K ( J = 5.5 at 39113.98 ± 0.1 cm − 1 .

  20. Urological injuries following trauma

    International Nuclear Information System (INIS)

    Bent, C.; Iyngkaran, T.; Power, N.; Matson, M.; Hajdinjak, T.; Buchholz, N.; Fotheringham, T.

    2008-01-01

    Blunt renal trauma is the third most common injury in abdominal trauma following splenic and hepatic injuries, respectively. In the majority, such injuries are associated with other abdominal organ injuries. As urological injuries are not usually life-threatening, and clinical signs and symptoms are non-specific, diagnosis is often delayed. We present a practical approach to the diagnosis and management of these injuries based on our experience in a busy inner city trauma hospital with a review of the current evidence-based practice. Diagnostic imaging signs are illustrated

  1. Urological injuries following trauma

    Energy Technology Data Exchange (ETDEWEB)

    Bent, C. [Department of Diagnostic Imaging, Barts and The London NHS Trust, London (United Kingdom)], E-mail: clare.bent@bartsandthelondon.nhs.uk; Iyngkaran, T.; Power, N.; Matson, M. [Department of Diagnostic Imaging, Barts and The London NHS Trust, London (United Kingdom); Hajdinjak, T.; Buchholz, N. [Department of Urology, Barts and The London NHS Trust, London (United Kingdom); Fotheringham, T. [Department of Diagnostic Imaging, Barts and The London NHS Trust, London (United Kingdom)

    2008-12-15

    Blunt renal trauma is the third most common injury in abdominal trauma following splenic and hepatic injuries, respectively. In the majority, such injuries are associated with other abdominal organ injuries. As urological injuries are not usually life-threatening, and clinical signs and symptoms are non-specific, diagnosis is often delayed. We present a practical approach to the diagnosis and management of these injuries based on our experience in a busy inner city trauma hospital with a review of the current evidence-based practice. Diagnostic imaging signs are illustrated.

  2. Life Stories and Trauma

    DEFF Research Database (Denmark)

    Kongshøj, Inge Lise Lundsgaard; Bohn, Annette; Berntsen, Dorthe

    Research has shown a connection between Posttraumatic Stress Disorder (PTSD) and integration of traumatic experiences into the life story. Furthermore, empirical evidence suggests that life story formation begins in mid to late adolescence. Following these findings, the present study investigated...... whether experiencing trauma in youth was associated with a greater risk to integrate the trauma into the life story compared to adult traumatic exposure. Life stories were collected from 115 participants recruited via Amazon Mechanical Turk. Moreover, participants filled out questionnaires regarding...... often integrate the trauma into their life story? Results will be discussed in relation to theories of development of life stories and of PTSD....

  3. Dental Trauma Guide

    DEFF Research Database (Denmark)

    Andreasen, Jens Ove; Lauridsen, Eva Fejerskov; Christensen, Søren Steno Ahrensburg

    2012-01-01

    Diagnose and treatment of traumatic dental injuries is very complex due to the multiple trauma entities represented by 6 lunation types and 9 fracture types affecting both the primary and the permanent dentition. When it is further considered that fracture and lunation injuries are often combined...... problems in selecting proper treatment for some of these trauma types. To remedy this situation, an internet based knowledge base consisting of 4000 dental trauma cases with long term follow up is now available to the public and professionals, on the internet using the address www...

  4. Dental Trauma Guide

    DEFF Research Database (Denmark)

    Andreasen, Jens Ove; Lauridsen, Eva; Gerds, Thomas Alexander

    2012-01-01

    Diagnosis and treatment for traumatic dental injuries are very complex owing to the multiple trauma entities represented by six luxation types and nine fracture types affecting both the primary and the permanent dentition. When it is further considered that fracture and luxation injuries are often...... problems in selecting proper treatment for some of these trauma types. To remedy this situation, an Internet-based knowledge base consisting of 4000 dental trauma cases with long-term follow up is now available to the public and the professions on the Internet using the address http://www.Dental...

  5. Trauma Induced Coagulopathy

    DEFF Research Database (Denmark)

    Genét, Gustav Folmer; Johansson, Per; Meyer, Martin Abild Stengaard

    2013-01-01

    It remains debated whether traumatic brain injury (TBI) induces a different coagulopathy compared to non-TBI. This study investigated traditional coagulation tests, biomarkers of coagulopathy and endothelial damage in trauma patients with and without TBI. Blood from 80 adult trauma patients were...... sampled (median of 68 min (IQR 48-88) post-injury) upon admission to our trauma centre. Plasma/serum were retrospectively analysed for biomarkers reflecting sympathoadrenal activation (adrenaline, noradrenaline), coagulation activation/inhibition and fibrinolysis (protein C, activated protein C, tissue...

  6. CT of chest trauma

    International Nuclear Information System (INIS)

    Goodman, P.C.

    1986-01-01

    There appears to be a limited role for computed tomography in the evaluation of chest trauma. The literature contains few papers specifically addressing the use of CT in the setting of chest trauma. Another series of articles relates anecdotal experiences in this regard. This paucity of reports attests to the remarkable amount of information present on conventional chest radiographs as well as the lack of clear indications for CT in the setting of chest trauma. In this chapter traumatic lesions of various areas of the thorax are discussed. The conventional radiographic findings are briefly described and the potential or proven application of CT is addressed

  7. Platelet aggregation following trauma

    DEFF Research Database (Denmark)

    Windeløv, Nis A; Sørensen, Anne M; Perner, Anders

    2014-01-01

    We aimed to elucidate platelet function in trauma patients, as it is pivotal for hemostasis yet remains scarcely investigated in this population. We conducted a prospective observational study of platelet aggregation capacity in 213 adult trauma patients on admission to an emergency department (ED...... severity score (ISS) was 17; 14 (7%) patients received 10 or more units of red blood cells in the ED (massive transfusion); 24 (11%) patients died within 28 days of trauma: 17 due to cerebral injuries, four due to exsanguination, and three from other causes. No significant association was found between...... aggregation response and ISS. Higher TRAP values were associated with death due to cerebral injuries (P 

  8. Urological injuries following trauma.

    Science.gov (United States)

    Bent, C; Iyngkaran, T; Power, N; Matson, M; Hajdinjak, T; Buchholz, N; Fotheringham, T

    2008-12-01

    Blunt renal trauma is the third most common injury in abdominal trauma following splenic and hepatic injuries, respectively. In the majority, such injuries are associated with other abdominal organ injuries. As urological injuries are not usually life-threatening, and clinical signs and symptoms are non-specific, diagnosis is often delayed. We present a practical approach to the diagnosis and management of these injuries based on our experience in a busy inner city trauma hospital with a review of the current evidence-based practice. Diagnostic imaging signs are illustrated.

  9. Clinical significance of determination of changes of serum IGF-II, GM-CSF and TNF-α levels after treatment in children with acute nephritis

    International Nuclear Information System (INIS)

    Xu Xiaoyan; Zhou Hong; Xu Weiqin; Li Xinghua

    2008-01-01

    Objective: To explore the clinical significance of determination of changes of serum IGF-II, GM-CSF and TNF- α levels after treatment in children with acute nephritis. Methods: Serum IGF-II, GM-CSF and TNF-α levels (with RIA) were measured in 31 pediatric patients with acute nephritis and 35 controls. Results: Before treatment, the serum IGF-II, GM-CSF and TNF-α levels in the patients were significantly higher than those in controls (P< O.01). After treatment for 3 months, the serum IGF-II, GM-CSF and TNF-α levels, though markedly corrected, remained significantly higher than those in controls (P<0.05). Conclusion: Determination of changes of serum IGF-II, GM-CSF and TNF-α contents after treatment might be of prognostic importance in pediatric patients with acute nephritis. (authors)

  10. Level II scour analysis for Bridge 8 (BARTTH00020008) on Town Highway 2, crossing Roaring Brook, Barton, Vermont

    Science.gov (United States)

    Boehmler, Erick M.; Ivanoff, Michael A.

    1996-01-01

    This report provides the results of a detailed Level II analysis of scour potential at structure BARTTH00020008 on town highway 2 crossing Roaring Brook, Barton, Vermont (figures 1–8). A Level II study is a basic engineering analysis of the site, including a quantitative analysis of stream stability and scour (U.S. Department of Transportation, 1993). Results of a Level I scour investigation also are included in Appendix E of this report. A Level I investigation provides a qualitative geomorphic characterization of the study site. Information on the bridge, gleaned from VTAOT files, was compiled prior to conducting Level I and Level II analyses and can be found in Appendix D. The site is in the New England Upland section of the New England physiographic province of North-central Vermont in the town of Barton. The 9.89-mi2 drainage area is in a predominantly rural and forested basin. In the vicinity of the study site, the banks have woody vegetation coverage except for the downstream left bank, which has a few trees and grass and brush coverage. In the study area, Roaring Brook has an incised, sinuous channel with a slope of approximately 0.019 ft/ft, an average channel top width of 35 ft and an average channel depth of 3 ft. The predominant channel bed material is gravel/cobble (D50 is 49.1 mm or 0.161 ft). The geomorphic assessment at the time of the Level I and Level II site visit on October 18, 1994 indicated that the reach was laterally unstable. A cut-bank on the downstream right bank and overall channel configuration in the valley are indications of the lateral instability at this site. The town highway 2 crossing of Roaring Brook is a 30-ft-long, two-lane bridge consisting of one 26-foot span concrete T-beam type superstructure (Vermont Agency of Transportation, written communication, August 4, 1994). The bridge is supported by vertical, concrete abutments. The channel is skewed approximately 15 degrees to the opening while the opening-skew-to-roadway is

  11. [TraumaNetwork, Trauma Registry of the DGU®, Whitebook, S3 Guideline on Treatment of Polytrauma/Severe Injuries - An Approach for Validation by a Retrospective Analysis of 2304 Patients (2002-2011) of a Level 1 Trauma Centre].

    Science.gov (United States)

    Schoeneberg, C; Schilling, M; Keitel, J; Kauther, M D; Burggraf, M; Hussmann, B; Lendemans, S

    2017-04-01

    Background: In the last decades, a reduction in mortality in severely injured patients with an ISS ≥ 16 could be observed. Some authors report a death rate of about 22 %. Moreover, there were some new insights in the last years such as the reduction in mortality by use of whole-body CT and the introduction of the S3 guideline of the German Society of Trauma Surgery "Treatment of Patients with Severe and Multiple Injuries" have supported the evidence-based treatment of severely injured patients. Methods: A retrospective analysis of 2304 patients was performed between 2002 and 2011. The data of the authors' clinic for the trauma registry of the DGU® were used. After applying the inclusion criteria, ISS ≥ 16 and primary transfer from the accident site, 968 patients remained. Results: In the study population, a mean ISS of 29.81 and a mean GCS of 9.42 were found. The average age was 46.04 years. The mortality rate was 28.7 %. A significant difference between decedents and survivors was found at the ISS, GCS, RTS, new ISS, TRISS, RISC, AIS head, AIS skin, RR pre-clinical, pre-clinical heart rate and age. To test whether the lethality was reduced by the increased use of whole-body CT, a division into a group prior to and from 2009 was performed. Results revealed a significant increase in the whole-body CT rate from 56.96 to 71.7 %. The mortality rate declined from 32.3 to 24.5 %. In the same way it was verified whether the S3 guideline had an impact on mortality. Therefore, a division into groups before and from 2011 was conducted. Here, the mortality rate decreased from 30.4 to 18.4 %. In addition, a comparison between 2010 and 2011 was performed. Overall, there were statistically significant differences in the trauma room time, the surgical time, the volume infused, the rate of multiple organ failure and the rate of whole-body CTs performed. Conclusion: In the period from 2002 to 2011 a mortality rate of 28.7 % was found. The higher rate in

  12. Trauma no idoso Trauma in the elderly

    Directory of Open Access Journals (Sweden)

    JOSÉ ANTONIO GOMES DE SOUZA

    2002-03-01

    Full Text Available O crescimento populacional de idosos, associado a uma forma de vida mais saudável e mais ativa, deixa este grupo de pessoas mais exposto ao risco de acidentes. Em alguns países, o trauma do idoso responde por uma elevada taxa de mortalidade, a qual se apresenta de forma desproporcionalmente maior do que a observada entre a população de adultos jovens. Tal fato acarreta um grande consumo de recursos financeiros destinados à assistência da saúde e um elevado custo social. As características fisiológicas próprias do idoso, assim como a presença freqüente de doenças associadas, faz com que estes pacientes se comportem diferentemente e de forma mais complexa do que os demais grupos etários. Estas particularidades fazem com que o atendimento ao idoso vítima de trauma se faça de forma diferenciada. A presente revisão aborda aspectos da epidemiologia, da prevenção, da fisiologia, do atendimento e da reabilitação do idoso vítima de trauma.The populational growth of the elderly, associated to a healthier and more active life, make this group of people more exposed to accidents. In some countries, trauma in the elderly is responsible for a high mortality rate, desproportionately higher than in the adults. This fact consumes a great portion of health care resources and implies in a high social cost. The distinct physiologic characteristics of the elderly and the frequent presence of associated diseases make that these patients behave diferently and in a more complex way than patients of other ages. These particularities make that health care to the elderly victims of trauma have to be different. The present revision is about aspects of epidemiology, prevention, physiology, health care and reabilitation of the elderly victims of trauma.

  13. Clinical significance of estimation of changes in serum IGF-II, TNF-α and TSGF levels after chemotherapy in patients with acute leukemia

    International Nuclear Information System (INIS)

    Liu Huijie

    2011-01-01

    Objective: To explore the clinical significance of changes in serum IGF-II, TNF-α and TSGF levels after chemotherapy in patients with acute leukemia. Methods: Serum IGF-II, TNF-α (with RIA) and TSGF (with biochemistry) levels were determined in 33 patients with acute leukemia both before and after chemotherapy as well as in 35 normal healthy Controls. Results: Before chemotherapy, serum IGF-II, TNF-α and TSGF levels in the patients were significantly higher than those in controls (P<0.01), 6 months after chemotherapy the levels in 28 patients without recurrence dropped markedly and approached those in controls. However, in the 5 eases with recurrence, the levels after return again, approaching those before chemotherapy. Conclusion: Changes of serum levels on IGF-II, TNF-α and TSGF might be useful as indicative parameters for diagnosis and curative effect in patients with acute leukemia. (authors)

  14. Clinical significance of measurement of changes of serum IGF-II and NO levels after treatment in elderly patients with chronic bronchitis

    International Nuclear Information System (INIS)

    Gu Tao

    2006-01-01

    Objective: To study the clinical significance of changes of serum IGF-II and NO levels after treatment in elderly patients with chronic bronchitis. Methods: Serum IGF-II (with RIA) and NO (with Biochemical method) levels were measured in 42 elderly patients with chronic bronchitis both before and after treatment as well as in 30 controls. Results: Before treatment in the patients the serum IGF-II levels were significantly higher than those in controls (P<0.01), while the NO levels were significantly lower (P<0.01). After two weeks of treatment, the levels though dropped markedly, lemained higher than those in controls (P<0. 05). Conclusion: Serum IGF-II and NO levels changes could reflect the disease status as well as the progress of diseases. (authors)

  15. Clinical significance of determination of changes of serum NSE, IGF-II and TNF-α levels after chemotherapy in patients with lung cancer

    International Nuclear Information System (INIS)

    Ji Yajun; Yang Chengxi; Bian Baoxiang; Song Ziyan

    2008-01-01

    Objective: To detect the changes of serum NSE, IGF-II and TNF-α levels after chemotherapy in patients with lung cancer. Methods: Serum NSE, IGF-II and TNF-α levels were determined with RIA in 38 patients with lung cancer both be- fore and after chemotherapy as well as in 35 controls. Results: Before chemotherapy, serum NSE, IGF-II and TNF-α levels in the patients were significantly higher than those in the controls (P<0.01), After chemotherapy, in 25 cases without recurrence at 6 months, the levels were remained dropped markedly and approached those in controls. However in the 5 patients with recurrence, the levels increased again, approaching those before chemotherapy. Conclusion: Serum levels of NSE, IGF-II and TNF-α might be useful for diagnosis and predicting therapeutic effects after chemotherapy in patients with lung cancer. (authors)

  16. Current Trends in the Management of Ballistic Fractures of the Hand and Wrist: Experiences of a High-Volume Level I Trauma Center.

    Science.gov (United States)

    Ghareeb, Paul A; Daly, Charles; Liao, Albert; Payne, Diane

    2018-03-01

    Ballistic fractures of the carpus and hand are routinely treated in large urban centers. These injuries can be challenging due to many factors. Various treatment options exist for these complicated injuries, but there are limited data available. This report analyzes patient demographics, treatments, and outcomes at a large urban trauma center. All ballistic fractures of the hand and wrist of the patients who presented to a single center from 2011 to 2014 were retrospectively reviewed. Patient demographics, injury mechanism, treatment modalities, and outcomes were analyzed. Seventy-seven patients were identified; 70 were male, and 7 were female. Average age of the patients was 29.6 years. Seventy-five injuries were low velocity, whereas 2 were high velocity. Sixty-seven patients had fractures of a metacarpal or phalanx, whereas 4 had isolated carpal injuries. Six had combined carpal and metacarpal or phalanx fractures. Thirty-six patients had concomitant tendon, nerve, or vascular injuries requiring repair. Sixty-three patients underwent operative intervention, with the most common intervention being percutaneous fixation. Sixteen patients required secondary surgery. Eighteen complications were reported. The majority of patients in this report underwent early operative intervention with percutaneous fixation. Antibiotics were administered in almost all cases and can usually be discontinued within 24 hours after surgery. It is important to consider concomitant nerve, vascular, or tendon injuries requiring repair. We recommend early treatment of these injuries with debridement and stabilization. Due to lack of follow-up and patient noncompliance, early definitive treatment with primary bone grafting should be considered.

  17. About Military Sexual Trauma

    Medline Plus

    Full Text Available ... Try it free Find out why Close About Military Sexual Trauma Veterans Health Administration Loading... Unsubscribe from ... Veterans Health Administration 2,027 views 25:30 Language: English Location: United States Restricted Mode: Off History ...

  18. Trauma and Coagulation

    Directory of Open Access Journals (Sweden)

    Murat Yılmaz

    2011-08-01

    Full Text Available Bleeding and coagulation disorders related to trauma are pathological processes which are frequently seen and increase mortality. For the purpose, trauma patients should be protected from hypoperfusion, hypothermia, acidosis and hemodilution which may aggravate the increase in physiological responses to trauma as anticoagulation and fibrinolysis. Performing damage control surgery and resuscitation and transfusion of adequate blood and blood products in terms of amount and content as stated in protocols may increase the rate of survival. Medical treatments augmenting fibrin formation (fibrinogen, desmopressin, factor VIIa or preventing fibrin degradation (tranexamic acid have been proposed in selected cases but the efficacy of these agents in trauma patients are not proven. (Journal of the Turkish Society Intensive Care 2011; 9:71-6

  19. About Military Sexual Trauma

    Medline Plus

    Full Text Available ... count__/__total__ Find out why Close About Military Sexual Trauma Veterans Health Administration Loading... Unsubscribe from Veterans ... Loading... Loading... Rating is available when the video has been rented. This feature is not available right ...

  20. About Military Sexual Trauma

    Medline Plus

    Full Text Available ... it free Find out why Close About Military Sexual Trauma Veterans Health Administration Loading... Unsubscribe from Veterans ... is Cognitive Processing Therapy (CPT) [for posttraumatic stress disorder]? - Duration: 2:01. Veterans Health Administration 27,844 ...

  1. About Military Sexual Trauma

    Medline Plus

    Full Text Available ... Try it free Find out why Close About Military Sexual Trauma Veterans Health Administration Loading... Unsubscribe from ... 5:31 Get Fit for Life (8) Strength/Balance Training - Duration: 32:02. Veterans Health Administration 2, ...

  2. About Military Sexual Trauma

    Science.gov (United States)

    ... Try it free Find out why Close About Military Sexual Trauma Veterans Health Administration Loading... Unsubscribe from ... 5:31 Get Fit for Life (8) Strength/Balance Training - Duration: 32:02. Veterans Health Administration 2, ...

  3. Suspension Trauma / Orthostatic Intolerance

    Science.gov (United States)

    ... Suspension Trauma/Orthostatic Intolerance Safety and Health Information Bulletin SHIB 03-24-2004, updated 2011 This Safety ... the harness, the environmental conditions, and the worker's psychological state all may increase the onset and severity ...

  4. Anaesthesia for trauma patients

    African Journals Online (AJOL)

    casualty incident, or a natural disaster. ... Exposure/environmental control: completely undress the ... E. Figure 1: Advance Trauma Life Support® management priorities ..... requiring operative intervention: the patient too sick to anesthetize.

  5. ASPECT (Automated System-level Performance Evaluation and Characterization Tool), Phase II

    Data.gov (United States)

    National Aeronautics and Space Administration — SSCI has developed a suite of SAA tools and an analysis capability referred to as ASPECT (Automated System-level Performance Evaluation and Characterization Tool)....

  6. High-Level Waste Salt Disposition Systems Engineering Team Final Report, Volumes I, II, and III

    International Nuclear Information System (INIS)

    Piccolo, S.F.

    1999-01-01

    This report describes the process used and results obtained by the High Level Waste Salt Disposition Systems Engineering Team to select a primary and backup alternative salt disposition method for the Savannah River Site

  7. Scanning ion deep level transient spectroscopy: II. Ion irradiated Au-Si Schottky junctions

    International Nuclear Information System (INIS)

    Laird, J S; Jagadish, C; Jamieson, D N; Legge, G J F

    2006-01-01

    Here we introduce a new technique called scanning ion deep level transient spectroscopy (SIDLTS) for the spatial analysis of electrically active defects in devices. In the first part of this paper, a simple theory behind SIDLTS was introduced and factors determining its sensitivity and resolution were discussed. In this paper, we demonstrate the technique on MeV boron implantation induced defects in an Au-Si Schottky junction. SIDLTS measurements are compared with capacitance DLTS measurements over the temperature range, 100-300 K. SIDLTS analyses indicate the presence of two levels, one of which was positively identified as the E c - 0.23 eV divacancy level. The high sensitivity of SIDLTS is verified and the advantages and limitations of the technique are discussed in light of non-exponential components in the charge transient response. Reasons for several undetected levels are also discussed

  8. Blunt chest trauma.

    Science.gov (United States)

    Stewart, Daphne J

    2014-01-01

    Blunt chest trauma is associated with a wide range of injuries, many of which are life threatening. This article is a case study demonstrating a variety of traumatic chest injuries, including pathophysiology, diagnosis, and treatment. Literature on the diagnosis and treatment was reviewed, including both theoretical and research literature, from a variety of disciplines. The role of the advance practice nurse in trauma is also discussed as it relates to assessment, diagnosis, and treatment of patients with traumatic chest injuries.

  9. Investigating the causes for decreased levels of glutathione in individuals with type II diabetes.

    Directory of Open Access Journals (Sweden)

    Minette Lagman

    Full Text Available Tuberculosis (TB remains an eminent global burden with one third of the world's population latently infected with Mycobacterium tuberculosis (M. tb. Individuals with compromised immune systems are especially vulnerable to M. tb infection. In fact, individuals with Type 2 Diabetes Mellitus (T2DM are two to three times more susceptible to TB than those without T2DM. In this study, we report that individuals with T2DM have lower levels of glutathione (GSH due to compromised levels of GSH synthesis and metabolism enzymes. Transforming growth factor beta (TGF-β, a cytokine that is known to decrease the expression of the catalytic subunit of glutamine-cysteine ligase (GCLC was found in increased levels in the plasma samples from individuals with T2DM, explaining the possible underlying mechanism that is responsible for decreased levels of GSH in individuals with T2DM. Moreover, increased levels of pro-inflammatory cytokines such as interleukin-6 (IL-6 and interleukin-17 (IL-17 were observed in plasma samples isolated from individuals with T2DM. Increased levels of IL-6 and IL-17 was accompanied by enhanced production of free radicals further indicating an alternative mechanism for the decreased levels of GSH in individuals with T2DM. Augmenting the levels of GSH in macrophages isolated from individuals with T2DM resulted in improved control of M. tb infection. Furthermore, cytokines that are responsible for controlling M. tb infection at the cellular and granuloma level such as tumor necrosis factor alpha (TNF-α, interleukin-1β (IL-1β, interleukin-2 (IL-2, interferon-gamma (IFN-γ, and interleukin-12 (IL-12, were found to be compromised in plasma samples isolated from individuals with T2DM. On the other hand, interleukin-10 (IL-10, an immunosuppressive cytokine was increased in plasma samples isolated from individuals with T2DM. Overall, these findings suggest that lower levels of GSH in individuals with T2DM lead to their increased susceptibility

  10. Airway management in trauma.

    Science.gov (United States)

    Langeron, O; Birenbaum, A; Amour, J

    2009-05-01

    Maintenance of a patent and prevention of aspiration are essential for the management of the trauma patient, that requires experienced physicians in airway control techniques. Difficulties of the airway control in the trauma setting are increased by the vital failures, the risk of aspiration, the potential cervical spine injury, the combative patient, and the obvious risk of difficult tracheal intubation related to specific injury related to the trauma. Endotracheal intubation remains the gold standard in trauma patient airway management and should be performed via the oral route with a rapid sequence induction and a manual in-line stabilization maneuver, to decrease the risks previously mentioned. Different techniques to control the airway in trauma patients are presented: improvement of the laryngoscopic vision, lighted stylet tracheal intubation, retrograde technique for orotracheal intubation, the laryngeal mask and the intubating laryngeal mask airways, the combitube and cricothyroidotomy. Management of the airway in trauma patients requires regular training in these techniques and the knowledge of complementary techniques allowing tracheal intubation or oxygenation to overcome difficult intubation and to prevent major complications as hypoxemia and aspiration.

  11. Imaging of thoracic trauma

    International Nuclear Information System (INIS)

    Uffmann, M.; Herold, C.J.; Fuchs, M.

    1998-01-01

    Blunt trauma to the chest results from transfer of kinetic energy to the human body. It may cause a wide range of mostly life-threatening injuries, including fractures of the thoracic skeleton, disintegration of the pleural space, contusion or laceration of pulmonary parenchyma and damage to the mediastinal structures. For a systematic approach it may be helpful to follow an organ-based evaluation of thoracic trauma. However, it should be borne in mind that subtle injuries may be associated with serious complications. Trauma to the chest may affect different anatomic compartments at the same time, requiring and extending diagnostic approach. Conventional radiography plays a major role in diagnosting thoracic trauma, complemented by ultrasound examination of the pleura and abdomen. It is well documented that CT scanning represents a major technological improvement for assessment of thoracic trauma. With the advent of fast helical CT scanning this method becomes more applicable for severly traumatized patients and potentially replaces other time-consuming procedures. State-of-the-art imaging of both projection and cross-sectional techniques provides useful information for immediate and appropriate treatment mandatory in patients with thoracic trauma. (orig.) [de

  12. CT of laryngotracheal trauma

    International Nuclear Information System (INIS)

    Lupetin, A.R.; Daffner, R.H.

    1991-01-01

    This paper evaluates the usefulness of CT for the diagnosis of traumatic laryngotracheal abnormalities. The authors retrospectively evaluated the neck CT studies of 50 patients (36 males, 14 females; age range, 16-75 years) who presented to a level I trauma center after suffering a blunt or penetrating laryngotracheal injury. CT results were correlated with endoscopic or surgical findings in 43 cases. Three groups emerge. CT positive: hyloid bone or laryngotracheal cartilage injury; CT positive: soft-tissue injury only; and CT negative. In group 1, CT demonstrated all bony or cartilaginous injuries proved at surgery or suggested at endoscopy. CT failed to demonstrate laryngotracheal separation in 1 case. In group 2, CT demonstrated all soft-tissue injuries suggested at endoscopy. In group 3, CT findings agreed with those of endoscopy in 7 cases, but minor soft-tissue findings seen at endoscopy were missed in 3 cases. Seven patients were studied only with CT. Ct is an accurate technique for detecting bony or cartilaginous laryngotracheal traumatic abnormalities. However, laryngotracheal separation and minor soft-tissue injuries can be missed

  13. PRESTO-II: a low-level waste environmental transport and risk assessment code

    Energy Technology Data Exchange (ETDEWEB)

    Fields, D.E.; Emerson, C.J.; Chester, R.O.; Little, C.A.; Hiromoto, G.

    1986-04-01

    PRESTO-II (Prediction of Radiation Effects from Shallow Trench Operations) is a computer code designed for the evaluation of possible health effects from shallow-land and, waste-disposal trenches. The model is intended to serve as a non-site-specific screening model for assessing radionuclide transport, ensuing exposure, and health impacts to a static local population for a 1000-year period following the end of disposal operations. Human exposure scenarios considered include normal releases (including leaching and operational spillage), human intrusion, and limited site farming or reclamation. Pathways and processes of transit from the trench to an individual or population include ground-water transport, overland flow, erosion, surface water dilution, suspension, atmospheric transport, deposition, inhalation, external exposure, and ingestion of contaminated beef, milk, crops, and water. Both population doses and individual doses, as well as doses to the intruder and farmer, may be calculated. Cumulative health effects in terms of cancer deaths are calculated for the population over the 1000-year period using a life-table approach. Data are included for three example sites: Barnwell, South Carolina; Beatty, Nevada; and West Valley, New York. A code listing and example input for each of the three sites are included in the appendices to this report.

  14. PRESTO-II: a low-level waste environmental transport and risk assessment code

    International Nuclear Information System (INIS)

    Fields, D.E.; Emerson, C.J.; Chester, R.O.; Little, C.A.; Hiromoto, G.

    1986-04-01

    PRESTO-II (Prediction of Radiation Effects from Shallow Trench Operations) is a computer code designed for the evaluation of possible health effects from shallow-land and, waste-disposal trenches. The model is intended to serve as a non-site-specific screening model for assessing radionuclide transport, ensuing exposure, and health impacts to a static local population for a 1000-year period following the end of disposal operations. Human exposure scenarios considered include normal releases (including leaching and operational spillage), human intrusion, and limited site farming or reclamation. Pathways and processes of transit from the trench to an individual or population include ground-water transport, overland flow, erosion, surface water dilution, suspension, atmospheric transport, deposition, inhalation, external exposure, and ingestion of contaminated beef, milk, crops, and water. Both population doses and individual doses, as well as doses to the intruder and farmer, may be calculated. Cumulative health effects in terms of cancer deaths are calculated for the population over the 1000-year period using a life-table approach. Data are included for three example sites: Barnwell, South Carolina; Beatty, Nevada; and West Valley, New York. A code listing and example input for each of the three sites are included in the appendices to this report

  15. Lake Erie Water Level Study. Appendix A. Regulation. Volume II. Coordinated Basic Data and Computer Programs.

    Science.gov (United States)

    1981-07-01

    F- fta fm~p- ri- a V.- On ;a~V~ I’ .C1A 1" ~ P 0%AJfVtN Q I1’t I O a0 4 . 0 * a C C COO a * a ma. 93 *a Ob fu -E tvvP- fl NurvI M I-Al N Ir-N fuII...NU N4 -4ftfNA fmd .-. - -9 0 0 0r IL 0 w wow 00~ 0Nm(U a 0P.-CM@W aO 0 1.4- 41- &0 M Im -4 & - 40 0 P-0 om fc I- 20o w wwef -4 . aaW4 MMM a-MI- n0 4...O zq~ f-’ W 9 A o a i. po j -4 N NfUfJ .-. AD uw s )LA~L; 4DW L NANI f & ftA DNN W LL) mij 3 z I- -9 9 a -j -z~u nV1 0 ~ OPP~~.N fj- , MD0* n’DCL t cc

  16. [First aid system for trauma: development and status].

    Science.gov (United States)

    Chen, D K; Lin, W C; Zhang, P; Kuang, S J; Huang, W; Wang, T B

    2017-04-18

    With the great progress of the economy, the level of industrialization has been increasing year by year, which leads to an increase in accidental trauma accidents. Chinese annual death of trauma is already more than 400 000, which makes trauma the fifth most common cause of death, following malignant tumor, heart, brain and respiratory diseases. Trauma is the leading cause of the death of young adults. At the same time, trauma has become a serious social problem in peace time. Trauma throws great treats on human health and life. As an important part in the medical and social security system, the emergency of trauma system occupies a very important position in the emergency medical service system. In European countries as well as the United States and also many other developed countries, trauma service system had a long history, and progressed to an advanced stage. However, Chinese trauma service system started late and is still developing. It has not turned into a complete and standardized system yet. This review summarizes the histories and current situations of the development of traumatic first aid system separately in European countries, the United States and our country. Special attentions are paid to the effects of the pre- and in-hospital emergency care. We also further try to explore the Chinese trauma emergency model that adapts to the situations of China and characteristics of different regions of China. Our review also introduces the trauma service system that suits the situations of China proposed by Professor Jiang Baoguo's team in details, taking Chinese conditions into account, they conducted a thematic study and made an expert consensus on pre-hospital emergency treatment of severe trauma, providing a basic routine and guidance of severe trauma treatment for those pre-hospital emergency physicians. They also advised to establish independent trauma disciplines and trauma specialist training systems, and to build the regional trauma care system as

  17. Current trauma care system and trauma care training in China

    Directory of Open Access Journals (Sweden)

    Lian-Yang Zhang

    2018-04-01

    Full Text Available Trauma is a life-threatening “modern disease”. The outcomes could only be optimized by cost-efficient and prompt trauma care, which embarks on the improvement of essential capacities and conceptual revolution in addition to the disruptive innovation of the trauma care system. According to experiences from the developed countries, systematic trauma care training is the cornerstone of the generalization and the improvement on the trauma care, such as the Advance Trauma Life Support (ATLS. Currently, the pre-hospital emergency medical services (EMS has been one of the essential elements of infrastructure of health services in China, which is also fundamental to the trauma care system. Hereby, the China Trauma Care Training (CTCT with independent intellectual property rights has been initiated and launched by the Chinese Trauma Surgeon Association to extend the up-to-date concepts and techniques in the field of trauma care as well to reinforce the generally well-accepted standardized protocols in the practices. This article reviews the current status of the trauma care system as well as the trauma care training. Keywords: Trauma care system, Trauma care training, China

  18. Angiotensin II potentiates prostaglandin stimulation of cyclic AMP levels in intact bovine adrenal medulla cells but not adenylate cyclase in permeabilized cells.

    Science.gov (United States)

    Boarder, M R; Plevin, R; Marriott, D B

    1988-10-25

    The level of cyclic AMP in primary cultures of bovine adrenal medulla cells is elevated by prostaglandin E1. Angiotensin II is commonly reported to act on receptors linked to phosphoinositide metabolism or to inhibition of adenylate cyclase. We have investigated the effect of angiotensin II on prostaglandin E1-stimulated cyclic AMP levels in these primary cultures. Rather than reducing cyclic AMP levels, we have found that angiotensin II powerfully potentiates prostaglandin E1-stimulated cyclic AMP accumulation in intact cells, both in the presence and absence of phosphodiesterase inhibitors. The 50% maximal response was similar to that for stimulation of phosphoinositide breakdown by angiotensin II in these cultures. The potentiation of stimulated cyclic AMP levels was seen, although to a smaller maximum, with the protein kinase C (Ca2+/phospholipid-dependent enzyme) activating phorbol ester tetradecanoyl phorbolacetate and with the synthetic diacylglycerol 1-oleoyl-2-acetylglycerol; pretreatment (24 h) with active phorbol ester, which would be expected to diminish protein kinase C levels, attenuated the angiotensin II potentiation of cyclic AMP. Using digitonin-permeabilized cells we showed that adenylate cyclase activity was stimulated by prostaglandin E1 with the same dose-response relationship as was cyclic AMP accumulation in intact cells, but the permeabilized cells showed no response to angiotensin II. The results are discussed with respect to the hypothesis that the angiotensin II influence on cyclic AMP levels is mediated, in part, by diacylglycerol stimulation of protein kinase C.

  19. The Genesis of a Trauma Performance Improvement Plan.

    Science.gov (United States)

    Pidgeon, Kristopher

    2015-01-01

    The purpose of this article is to assist the trauma medical and program director with developing a performance improvement and patients safety plan (PIPS), which is a required component of a successful trauma verification process by the American College of Surgeons. This article will review trauma quality standards and will describe in detail the required elements of a successful trauma center's performance improvement plan including a written comprehensive plan that outlines the mission and vision of the PIPS Program, authority of the PIPS Program, PIPS Program Committee reporting structure to the other hospital committees, list of required PIPS multidisciplinary team members, the operational components of the utilized data management system (trauma registry), list of indicators/audit filters, levels of review, peer determinations, corrective action plan with implementation, event resolution, and reevaluation. Strategies to develop a successful trauma performance improvement plan are presented.

  20. Psychological debriefing (PD of trauma: a proposed model for Africa

    Directory of Open Access Journals (Sweden)

    E L Van Dyk

    2010-03-01

    Full Text Available Africa is a continent with severe trauma. Traumatic events include experiences of child soldiers, people living in war and conflict zones, and people struggling with the HIV/AIDS pandemic. These events cause high levels of trauma. The trauma causes psychological disorders like post traumatic stress disorder, acute stress disorder and combat stress reaction, specific in the military environment. This article focuses on a better understanding of the implications of trauma for military people and civilians. It discusses the different theories and models of psychological debriefing. Lastly the article discusses psychological debriefing models for military forces and the civil ian population to prevent severe psychopathology after traumatic incidents in Africa.

  1. Impact of the severity of trauma on early retirement

    DEFF Research Database (Denmark)

    Kuhlman, Michael Bilde; Lohse, Nicolai; Sørensen, Anne Marie

    2014-01-01

    . SETTING: Level-one urban trauma centre. PARTICIPANTS: Patients aged 18-64 years entering the trauma centre in Copenhagen during 1999-2007 who were alive after three days were followed until early retirement, death or emigration. MAIN OUTCOME MEASURES: Primary outcome was early retirement, defined...... and gender. RESULTS: Of all 6687 patients admitted to the trauma centre, a total of 1722 trauma patients were included and followed for a median of 6.2 years (interquartile range (IQR) 3.7-9.1). Of these, 1305 (75.8%) were males, median age was 35.0 years (IQR 25.4-46.5), and median ISS was 16 (IQR 9...

  2. New Orleans Charity Hospital--your trauma center at work.

    Science.gov (United States)

    Stockinger, Zsolt T; Holloway, Vicki L; McSwain, Norman E; Thomas, Dwayne; Fontenot, Cathi; Hunt, John P; Mederos, Eileen; Hewitt, Robert L

    2004-01-01

    The Medical Center of Louisiana at New Orleans-Charity Hospital stands with pride as one of only two level I trauma centers in the state and one of the largest trauma centers in the United States, seeing over 4,000 trauma patients per year. Despite perennial funding issues, Charity Hospital's Emergency Department treated almost 200,000 patients in 2003. This brief report gives an overview of the emergency- and trauma-related services provided by Charity Hospital and underscores its value as a critical asset to healthcare in the Louisiana.

  3. Reactivity II: A Second Foundation-Level Course in Integrated Organic, Inorganic, and Biochemistry

    Science.gov (United States)

    Schaller, Chris P.; Graham, Kate J.; McIntee, Edward J.; Jones, T. Nicholas; Johnson, Brian J.

    2016-01-01

    A foundation-level course is described that integrates material related to reactivity in organic, inorganic, and biochemistry. Designed for second-year students, the course serves majors in chemistry, biochemistry, and biology, as well as prehealth-professions students. Building on an earlier course that developed concepts of nucleophiles and…

  4. Homemade Equipment for the Teaching of Electrochemistry at Advanced Level. Part II.

    Science.gov (United States)

    Chan, K. M.

    1985-01-01

    Provides a detailed description for the construction of equipment needed to investigate acid/base equilibria through the measurement of pH and potentiometric titrations. Suggested experiments and calibration techniques are explained. This information helps to solve the problems of inadequate, expensive equipment required for A-level chemistry…

  5. A study of the human immune response to Lolium perenne (rye) pollen and its components, Lol p I and Lol p II (Rye I and Rye II). II. Longitudinal variation of antibody levels in relation to symptomatology and pollen exposure and correction of seasonally elevated antibody levels to basal values.

    Science.gov (United States)

    Freidhoff, L R; Ehrlich-Kautzky, E; Meyers, D A; Marsh, D G

    1987-11-01

    This study used a standardized, dialyzed, Lolium perenne (ryegrass) pollen extract and two of its well-characterized components, Lol p I (Rye I) and Lol p II (Rye II), to characterize the longitudinal variation of both IgE and IgG antibody (Ab) levels, as well as total serum IgE levels, in 20 grass-allergic subjects followed for 13 months. Ab levels declined toward a basal level just before, and increased just after, the grass-pollination season, returning to the same basal level just before the next grass-pollination season. The least complex allergen, Lol II, demonstrated the most uniform pattern of variation in both IgE and IgG Ab levels. Total serum IgE levels demonstrated the least regular pattern of variation. Grass-pollen counts were strongly correlated with symptom-medication scores for these subjects (rs = 0.87). Initial values were correlated with the rise in total IgE and IgE Ab to Lol II across the grass-pollen season. Skin test results were correlated with initial IgE Ab levels for L. perenne pollen extract and Lol II. Finally, a procedure for correcting IgE Ab levels to basal values was proposed and tested. The correction procedure, for each IgE Ab, was based on the average rise during the grass-pollination season (or average decline after the grass-pollination season) observed for all subjects with that IgE Ab.

  6. Increased Serum Pepsinogen II Level as a Marker of Pangastritis and Corpus-Predominant Gastritis in Gastric Cancer Prevention.

    Science.gov (United States)

    Massarrat, Sadegh; Haj-Sheykholeslami, Arghavan

    2016-02-01

    Serum pepsinogen I and II are considered as indicators of changes in gastric morphology. Important publications from the last decades are reviewed with regard to the serum level of these biomarkers for the diagnosis of normal gastric mucosa, diffuse gastritis and its change to atrophic gastritis and intestinal metaplasia as well as gastric cancer. Due to the low sensitivity of serum biomarkers for diagnosis of gastric cancer, especially at its early stage and the poor prognosis of the tumor at the time of diagnosis, its prevention by eradication of H. pylori remains the mandatory strategy. On the other hand, the severity of regression and non-reversibility of precancerous lesions and intestinal metaplasia in gastric mucosa through eradication of H. pylori make it necessary to diagnose diffuse gastritis at its early stage. Increased serum pepsinogen II compared to normal serum pepsinogen I seems to indicate the presence of diffuse gastritis without precancerous lesions suitable for eradication of H. pylori infection, when it is serologically positive. A diagram illustrates the strategy of this therapeutic measure depending on the age of people and the level of serum biomarkers in areas with high gastric cancer prevalence.

  7. Background level of natural radioactivities in a giant water Cherenkov detector and its surrounding environment; KAMIOKANDE-II

    Energy Technology Data Exchange (ETDEWEB)

    Yamamoto, Masayoshi; Sakanoue, Masanobu; Komura, Kazuhisa; Ueno, Kaoru [Kanazawa Univ., Tatsunokuchi, Ishikawa (Japan). Low Level Radioactivity Lab.

    1989-12-01

    The KAMIOKANDE-II water Cherenkov detector for the measurement of nucleon decay and/or solar neutrino has been operating in the underground laboratory at a depth of 2,700 m.w.e. (meter water equivalent) in Kamioka mine of Gifu Prefecture. Concentrations of {sup 238}U, {sup 232}Th, {sup 226}Ra and {sup 222}Rn as the major background sources have been measured for various kinds of rocks, mine water, mine air and high purity water used as a detector during the period from August 1986 to December 1987. The concentration levels of these radionuclides and their seasonal variation have become clear. Some of these results have provided useful informations for decreasing the background level of water Cherenkov detector. (author).

  8. Does hemopericardium after chest trauma mandate sternotomy?

    Science.gov (United States)

    Thorson, Chad M; Namias, Nicholas; Van Haren, Robert M; Guarch, Gerardo A; Ginzburg, Enrique; Salerno, Tomas A; Schulman, Carl I; Livingstone, Alan S; Proctor, Kenneth G

    2012-06-01

    Recently, three patients with hemopericardium after severe chest trauma were successfully managed nonoperatively at our institution. This prompted the question whether these were rare or common events. Therefore, we reviewed our experience with similar injuries to test the hypothesis that trauma-induced hemopericardium mandates sternotomy. Records were retrospectively reviewed for all patients at a Level I trauma center (December 1996 to November 2011) who sustained chest trauma with pericardial window (PCW, n = 377) and/or median sternotomy (n = 110). Fifty-five (15%) patients with positive PCW proceeded to sternotomy. Penetrating injury was the dominant mechanism (n = 49, 89%). Nineteen (35%) were hypotensive on arrival or during initial resuscitation. Most received surgeon-performed focused cardiac ultrasound examinations (n = 43, 78%) with positive results (n = 25, 58%). Ventricular injuries were most common, with equivalent numbers occurring on the right (n = 16, 29%) and left (n = 15, 27%). Six (11%) with positive PCW had isolated pericardial lacerations, but 21 (38%) had no repairable cardiac or great vessel injury. Those with therapeutic versus nontherapeutic sternotomies were similar with respect to age, mechanisms of injury, injury severity scores, presenting laboratory values, resuscitation fluids, and vital signs. Multiple logistic regression revealed that penetrating trauma (odds ratio: 13.3) and hemodynamic instability (odds ratio: 7.8) were independent predictors of therapeutic sternotomy. Hemopericardium per se may be overly sensitive for diagnosing cardiac or great vessel injuries after chest trauma. Some stable blunt or penetrating trauma patients without continuing intrapericardial bleeding had nontherapeutic sternotomies, suggesting that this intervention could be avoided in selected cases. Therapeutic study, level III. Copyright © 2012 by Lippincott Williams & Wilkins.

  9. Patterns of ocular trauma

    International Nuclear Information System (INIS)

    Babar, T.F.; Khan, M.T.; Marwat, M.; Shah, A.; Murad, Y.; Khan, M.D.

    2007-01-01

    To describe the patterns of ocular trauma, cause of injury and its effects on eye. A retrospective case series. Medical records of 1105 patients admitted with ocular trauma were reviewed. The details of patients regarding age, gender, literacy, cause of injury and its effects on eye were entered into specially-designed performa. Sample selection consisted of all patients with history of ocular trauma and who were admitted to hospital. Population details consisted patients who were referred to the hospital from all parts of N.W.F.P. Thus, the frequency of trauma in the hospital admissions was analysed. Ophthalmic trauma comprised 6.78% of the hospital admission. One thousand one hundred and five patients presented with eye injuries. Out of them, 21 patients suffered from trauma to both eyes. Almost 80% patients were male and 69% patients were below 30 years of age. Delayed presentation was more common and 63.61% patients presented after one week. Open globe injuries were more common (520 eyes (46.18%)) than closed globe injuries (484 eyes (42.98%)). 23.26% of open globe injuries were associated with intraocular and intra-orbital foreign bodies. Superficial non-perforating, eyelid and adnexal and burns were seen in 122 eyes (10.83%). Among the complications, lens damage and hyphema was seen in more than 50% of the patients, 16.60% eyes were infected at the time of admission and 4.88% of eyes needed enucleation or evisceration. The common causes of injury were violence in 37.37%, occupational in 24.43% and domestic accidents in 19.18%. Ophthalmic trauma is a major public health problem. Majority of the involved are male and under 30 years of age. Delayed presentation is more common. Open globe injuries are more frequent. Violence and occupational injuries are the major causes. (author)

  10. Clinical significance of determination of changes of serum IGF-II, IL-6, IL-8 and hs-CRP levels after treatment in pediatric patients with bronchopneumonia

    International Nuclear Information System (INIS)

    Wang Guanghui; Chen Chuanbing; Wang Xianwu

    2009-01-01

    Objective: To explore the clinical significance of changes of serum IGF-II, IL-6, IL-8 and hs-CRP levels after treatment in pediatric patients with bronchopneumonia. Methods: Serum IGF-II, IL-6, IL-8 (with RIA) and hs-CRP (with immunoturbidity method) levels were determined in 36 pediatric patients with bronchopneumonia both before and after treatment as well as in 35 controls. Results: Before treatment, serum IGF-II, IL-6, IL-8 and hs-CRP levels in the patients were significantly higher than those in the controls (P 0.05). Conclusion: Determination of serum IGF-II, IL-6, IL-8 and hs-CRP levels in pediatric patients with bronchopneumonia was important for diagnosis and outcome prediction. (authors)

  11. Clinical significance of determination of changes of serum IGF-II, IL-6, IL-8, TNF-α levels after treatment in children with bronchopneumonia

    International Nuclear Information System (INIS)

    Feng Yue

    2011-01-01

    Objective: To explore the clinical significance of changes of serum IGF-II, IL-6, IL-8 and TNF-α levels after treatment in children with bronchopneumonia. Methods: Serum IGF-II, IL-6, IL-8 and TNF-α levels with RIA were detected both before and after treatment in 33 patients with children bronchopneumonia as well as in 35 controls. Results: Before treatment, serum IGF-II, IL-6, IL-8 and TNF-α levels were significantly higher in the patients than those in the controls (P 0.05). Conclusions: Serum IGF-II, IL-6, IL-8 and TNF-α could take part in the pathogenesis of children bronchopneumonia in various ways and determination of these levels was clinically important. (authors)

  12. Clinical significance of changes of serum IGF-II, IL-2 and SOD levels after treatment in pediatric patients with bronchial pneumonia

    International Nuclear Information System (INIS)

    Zhou Hong; Hu Yan; Wei Guoyu; Huang Jufeng

    2011-01-01

    Objective: To investigate the clinical significance of changes of serum IGF-II, IL-2 and SOD levels after treatment in pediatric patients with bronchial pneumonia. Methods: Serum IGF-II, IL-2 and SOD (with RIA) levels were measured in 33 pediatric patients with bronchial pneumonia both before and after treatment as well as in 35 controls. Results: Before treatment, serum IGF-II levels in the patients were significantly higher than those in controls (P 0.05). Conclusion: Changes of serum IGF-II, IL-2 and SOD levels both before and after treatment could reflect the diseases status of the patients as well as the progress of diseases, and might be of prognostic importance in pediatric patients with bronchial pneumonia. (authors)

  13. An Innovative Approach for Decreasing Fall Trauma Admissions from Geriatric Living Facilities: Preliminary Investigation.

    Science.gov (United States)

    Evans, Tracy; Gross, Brian; Rittenhouse, Katelyn; Harnish, Carissa; Vellucci, Ashley; Bupp, Katherine; Horst, Michael; Miller, Jo Ann; Baier, Ron; Chandler, Roxanne; Rogers, Frederick B

    2015-12-01

    Geriatric living facilities have been associated with a high rate of falls. We sought to develop an innovative intervention approach targeting geriatric living facilities that would reduce geriatric fall admissions to our Level II trauma center. In 2011, a Trauma Prevention Taskforce visited 5 of 28 local geriatric living facilities to present a fall prevention protocol composed of three sections: fall education, risk factor identification, and fall prevention strategies. To determine the impact of the intervention, the trauma registry was queried for all geriatric fall admissions attributed to patients living at local geriatric living facilities. The fall admission rate (total fall admissions/total beds) of the pre-intervention period (2010-2011) was compared with that of the postintervention period (2012-2013) at the 5 intervention and 23 control facilities. A P value fall admissions attributed to local geriatric living facilities (intervention: 179 fall admissions; control: 308 fall admissions). The unadjusted fall rate decreased at intervention facilities from 8.9 fall admissions/bed pre-intervention to 8.1 fall admissions/bed postintervention, whereas fall admission rates increased at control sites from 5.9 to 7.7 fall admissions/bed during the same period [control/intervention odds ratio (OR), 95% confidence interval (CI) = 1.32, 1.05-1.67; period OR, 95%CI = 1.55, 1.18-2.04, P = 0.002; interaction of control/intervention group and period OR 95% CI = 0.68, 0.46-1.00, P = 0.047]. An aggressive intervention program targeting high-risk geriatric living facilities resulted in a statistically significant decrease in geriatric fall admissions to our Level II trauma center.

  14. Prevalence, predictors and outcome of hypofibrinogenaemia in trauma

    DEFF Research Database (Denmark)

    Hagemo, Jostein S; Stanworth, Simon; Juffermans, Nicole P

    2014-01-01

    INTRODUCTION: Exsanguination due to trauma-induced coagulopathy is a continuing challenge in emergency trauma care. Fibrinogen is a crucial factor for haemostatic competence, and may be the factor that reaches critically low levels first. Early fibrinogen substitution is advocated by a number of ...

  15. Sleep Dependent Synaptic Down-Selection (II: Single Neuron Level Benefits for Matching, Selectivity, and Specificity

    Directory of Open Access Journals (Sweden)

    Atif eHashmi

    2013-10-01

    Full Text Available In a companion paper (Nere et al., this volume, we used computer simulations to show that a strategy of activity-dependent, on-line net synaptic potentiation during wake, followed by off-line synaptic depression during sleep, can provide a parsimonious account for several memory benefits of sleep at the systems level, including the consolidation of procedural and declarative memories, gist extraction, and integration of new with old memories. In this paper, we consider the theoretical benefits of this two-step process at the single neuron level and employ the theoretical notion of Matching between brain and environment to measure how this process increases the ability of the neuron to capture regularities in the environment and model them internally. We show that down-selection during sleep is beneficial for increasing or restoring Matching after learning, after integrating new with old memories, and after forgetting irrelevant material. By contrast, alternative schemes, such as additional potentiation in wake, potentiation in sleep, or synaptic renormalization in wake, decrease Matching. We also argue that, by selecting appropriate loops through the brain that tie feedforward synapses with feedback ones in the same dendritic domain, different subsets of neurons can learn to specialize for different contingencies and form sequences of nested perception-action loops. By potentiating such loops when interacting with the environment in wake, and depressing them when disconnected from the environment in sleep, neurons can learn to match the long-term statistical structure of the environment while avoiding spurious modes of functioning and catastrophic interference. Finally, such a two-step process has the additional benefit of desaturating the neuron's ability to learn and of maintaining cellular homeostasis. Thus, sleep-dependent synaptic renormalization offers a parsimonious account for both cellular and systems-level effects of sleep on learning

  16. Long-term variations in the geomagnetic activity level Part II: Ascending phases of sunspot cycles

    Directory of Open Access Journals (Sweden)

    V. Mussino

    1994-08-01

    Full Text Available Monthly averages of the Helsinki Ak-values have been reduced to the equivalent aa-indices to extend the aa-data set back to 1844. A periodicity of about five cycles was found for the correlation coefficient (r between geomagnetic indices and sunspot numbers for the ascending phases of sunspot cycles 9 to 22, confirming previous findings based on a minor number of sunspot cycles. The result is useful to researchers in topics related to solar-terrestrial physics, particularly for the interpretation of long-term trends in geomagnetic activity during the past, and to forecast geomagnetic activity levels in the future.

  17. Evaluating trauma care capabilities in Mexico with the World Health Organization's Guidelines for Essential Trauma Care publication.

    Science.gov (United States)

    Arreola-Risa, Carlos; Mock, Charles; Vega Rivera, Felipe; Romero Hicks, Eduardo; Guzmán Solana, Felipe; Porras Ramírez, Giovanni; Montiel Amoroso, Gilberto; de Boer, Melanie

    2006-02-01

    To identify affordable, sustainable methods to strengthen trauma care capabilities in Mexico, using the standards in the Guidelines for Essential Trauma Care, a publication that was developed by the World Health Organization and the International Society of Surgery to provide recommendations on elements of trauma care that should be in place in the various levels of health facilities in all countries. The Guidelines publication was used as a basis for needs assessments conducted in 2003 and 2004 in three Mexican states. The states were selected to represent the range of geographic and economic conditions in the country: Oaxaca (south, lower economic status), Puebla (center, middle economic status), and Nuevo León (north, higher economic status). The sixteen facilities that were assessed included rural clinics, small hospitals, and large hospitals. Site visits incorporated direct inspection of physical resources as well as interviews with key administrative and clinical staff. Human and physical resources for trauma care were adequate in the hospitals, especially the larger ones. The survey did identify some deficiencies, such as shortages of stiff suction tips, pulse oximetry equipment, and some trauma-related medications. All of the clinics had difficulties with basic supplies for resuscitation, even though some received substantial numbers of trauma patients. In all levels of facilities there was room for improvement in administrative functions to assure quality trauma care, including trauma registries, trauma-related quality improvement programs, and uniform in-service training. This study identified several low-cost ways to strengthen trauma care in Mexico. The study also highlighted the usefulness of the recommended norms in the Guidelines for Essential Trauma Care publication in providing a standardized template by which to assess trauma care capabilities in nations worldwide.

  18. Performances of the ATLAS RPC Level-1 Muon trigger during the Run-II data taking

    CERN Document Server

    Alberghi, Gian Luigi; The ATLAS collaboration

    2018-01-01

    The Level-1 Muon Barrel Trigger is one of the main elements of the event selection of the ATLAS experiment at the Large Hadron Collider. Its input stage consists of an array of processors receiving the full granularity of data from Resistive Plate Chambers in the central area of the ATLAS detector ("Barrel"). The RPCs, placed in the barrel region of the ATLAS detector, are arranged in three concentric double layers and operate in a strong magnetic toroidal field. RPC detectors cover the pseudo-rapidity range |η|<1.05 for a total surface of more than 4000 m2 and about 3600 gas volumes. The Level-1 Muon Trigger in the barrel region allows to select muon candidates with respect to their transverse momentum and associates them with the correct bunch-crossing number. The trigger system is able to take a decision within a latency of about 2 μs. We illustrate the selections, strategy and validation for an unbiased determination of the efficiency and timing of the RPC and the L1 from data; and show the results w...

  19. A computerized system to measure interproximal alveolar bone levels in epidemiologic, radiographic investigations. II

    International Nuclear Information System (INIS)

    Wouters, F.R.; Frithiof, L.; Soeder, P.Oe.; Hellden, L.; Lavstedt, S.; Salonen, L.

    1988-01-01

    The study was aimed at analyzing intra- and inter-examiner variations in computerized measurement and in non-measurability of alveolar bone level in a cross-sectional, epidemiologic material. At each interproximal tooth surface, alveolar bone height in percentage of root length (B/R) and tooth length (B/T) were determined twice by one examiner and once by a second examiner from X5-magnified periapical radiographs. The overall intra- and inter-examiner variations in measurement were 2.85% and 3.84% of root length and 1.97% and 2.82% of tooth length, respectively. The varations were different for different tooth groups and for different degrees of severity of marginal periodontitis. The overall proportions on non-measurable tooth surfaces varied with examiner from 32% to 39% and from 43% to 48% of the available interproximal tooth surfaces for B/R and B/T, respectively. With regard to the level of reliability, the computerized method reported is appropriate to cross-sectional, epidemiologic investigations from radiographs

  20. Male genital trauma

    International Nuclear Information System (INIS)

    Jordan, G.H.; Gilbert, D.A.

    1988-01-01

    We have attempted to discuss genital trauma in relatively broad terms. In most cases, patients present with relatively minimal trauma. However, because of the complexity of the structures involved, minimal trauma can lead to significant disability later on. The process of erection requires correct functioning of the arterial, neurologic, and venous systems coupled with intact erectile bodies. The penis is composed of structures that are compliant and distensible to the limits of their compliance. These structures therefore tumesce in equal proportion to each other, allowing for straight erection. Relatively minimal trauma can upset this balance of elasticity, leading to disabling chordee. Likewise, relatively minimal injuries to the vascular erectile structures can lead to significantly disabling spongiofibrosis. The urethra is a conduit of paramount importance. Whereas the development of stricture is generally related to the nature of the trauma, the extent of stricture and of attendant complications is clearly a function of the immediate management. Overzealous debridement can greatly complicate subsequent reconstruction. A delicate balance between aggressive initial management and maximal preservation of viable structures must be achieved. 38 references

  1. Effect of Captopril on Aqueous Levels of Angiotensin II and Its Correlation with Macular Edema in Diabetic Patients

    Directory of Open Access Journals (Sweden)

    Morteza Shahshahan

    2008-12-01

    Full Text Available

    PURPOSE: To determine whether angiotensin II (AT II levels in aqueous humor are related to diabetes mellitus and to evaluate the effect of captopril on this level. We also evaluated the correlation between severity of macular edema and captopril use. METHODS: In a case-control study, aqueous humor samples were obtained at the onset of cataract surgery from 58 eyes of 58 patients, of whom 37 were diabetic. From these latter subjects, 16 had taken captopril (captopril group for at least six months and 21 had not taken any angiotensin converting enzyme inhibitor (non-captopril group. AT II level was assessed by radioimmunoassay. Severity of macular edema was evaluated by clinical examination after surgery. RESULTS: The aqueous level of AT II was significantly higher in diabetic patients (31.0±7.3 pg/ml compared to non-diabetics (6.28±2.8 pg/ml (Mann Whitney U test, P < 0.0001. In diabetic patients, aqueous concentration of AT II in the captopril group (16.3±6.5 mg/ml was significantly lower than the non-captopril group (75.73±9.36 mg/ml (Mann Whitney U test, P < 0.0003. The severity of macular edema was significantly less in the captopril group compared to the non-captopril group: 68.75% of the captopril group vs 33.3% of the non-captopril group had no macular edema (P < 0.005. CONCLUSION: These findings suggest that the

  2. Frequency response testing at Experimental Breeder Reactor II using discrete-level periodic signals

    International Nuclear Information System (INIS)

    Rhodes, W.D.; Larson, H.A.

    1990-01-01

    The Experimental Breeder Reactor 2 (EBR-2) reactivity-to-power frequency-response function was measured with pseudo-random, discrete-level, periodic signals. The reactor power deviation was small with insignificant perturbation of normal operation and in-place irradiation experiments. Comparison of results with measured rod oscillator data and with theoretical predictions show good agreement. Moreover, measures of input signal quality (autocorrelation function and energy spectra) confirm the ability to enable this type of frequency response determination at EBR-2. Measurements were made with the pseudo-random binary sequence, quadratic residue binary sequence, pseudo-random ternary sequence, and the multifrequency binary sequence. 10 refs., 7 figs., 3 tabs

  3. Level II scour analysis for Bridge 81 (MARSUS00020081) on U.S. Highway 2, crossing the Winooski River, Marshfield, Vermont

    Science.gov (United States)

    Ivanoff, Michael A.

    1997-01-01

    This report provides the results of a detailed Level II analysis of scour potential at structure MARSUS00020081 on U.S. Highway 2 crossing the Winooski River, Marshfield, Vermont (figures 1–8). A Level II study is a basic engineering analysis of the site, including a quantitative analysis of stream stability and scour (U.S. Department of Transportation, 1993). Results of a Level I scour investigation also are included in Appendix E of this report. A Level I investigation provides a qualitative geomorphic characterization of the study site. Information on the bridge, gleaned from Vermont Agency of Transportation (VTAOT) files, was compiled prior to conducting Level I and Level II analyses and is found in Appendix D.

  4. Improving Limit Surface Search Algorithms in RAVEN Using Acceleration Schemes: Level II Milestone

    Energy Technology Data Exchange (ETDEWEB)

    Alfonsi, Andrea [Idaho National Laboratory (INL), Idaho Falls, ID (United States); Rabiti, Cristian [Idaho National Laboratory (INL), Idaho Falls, ID (United States); Mandelli, Diego [Idaho National Laboratory (INL), Idaho Falls, ID (United States); Cogliati, Joshua Joseph [Idaho National Laboratory (INL), Idaho Falls, ID (United States); Sen, Ramazan Sonat [Idaho National Laboratory (INL), Idaho Falls, ID (United States); Smith, Curtis Lee [Idaho National Laboratory (INL), Idaho Falls, ID (United States)

    2015-07-01

    The RAVEN code is becoming a comprehensive tool to perform Probabilistic Risk Assessment (PRA); Uncertainty Quantification (UQ) and Propagation; and Verification and Validation (V&V). The RAVEN code is being developed to support the Risk-Informed Safety Margin Characterization (RISMC) pathway by developing an advanced set of methodologies and algorithms for use in advanced risk analysis. The RISMC approach uses system simulator codes applied to stochastic analysis tools. The fundamental idea behind this coupling approach to perturb (by employing sampling strategies) timing and sequencing of events, internal parameters of the system codes (i.e., uncertain parameters of the physics model) and initial conditions to estimate values ranges and associated probabilities of figures of merit of interest for engineering and safety (e.g. core damage probability, etc.). This approach applied to complex systems such as nuclear power plants requires performing a series of computationally expensive simulation runs. The large computational burden is caused by the large set of (uncertain) parameters characterizing those systems. Consequently, exploring the uncertain/parametric domain, with a good level of confidence, is generally not affordable, considering the limited computational resources that are currently available. In addition, the recent tendency to develop newer tools, characterized by higher accuracy and larger computational resources (if compared with the presently used legacy codes, that have been developed decades ago), has made this issue even more compelling. In order to overcome to these limitations, the strategy for the exploration of the uncertain/parametric space needs to use at best the computational resources focusing the computational effort in those regions of the uncertain/parametric space that are “interesting” (e.g., risk-significant regions of the input space) with respect the targeted Figures Of Merit (FOM): for example, the failure of the system

  5. [Trauma in the elderly].

    Science.gov (United States)

    de Souza, José Antonio Gomes; Iglesias, Antonio Carlos R G

    2002-01-01

    The populational growth of the elderly, associated to a healthier and more active life, make this group of people more exposed to accidents. In some countries, trauma in the elderly is responsible for a high mortality rate, disproportionately higher than in the adults. This fact consumes a great portion of health care resources and implies in a high social cost. The distinct physiologic characteristics of the elderly and the frequent presence of associated diseases make that these patients behave differently and in a more complex way than patients of other ages. These particularities make that health care to the elderly victims of trauma have to be different. The present revision is about aspects of epidemiology, prevention, physiology, health care and rehabilitation of the elderly victims of trauma.

  6. Dynamical structure of center-of-pressure trajectories with and without functional taping in children with cerebral palsy level I and II of GMFCS.

    Science.gov (United States)

    Pavão, Silvia Leticia; Ledebt, Annick; Savelsbergh, Geert J P; Rocha, Nelci Adriana C F

    2017-08-01

    Postural control during quiet standing was examined in typical children (TD) and children with cerebral palsy (CP) level I and II of GMFCS. The immediate effect on postural control of functional taping on the thighs was analyzed. We evaluated 43 TD, 17 CP children level I, and 10 CP children level II. Participants were evaluated in two conditions (with and without taping). The trajectories of the center of pressure (COP) were analyzed by means of conventional posturography (sway amplitude, sway-path-length) and dynamic posturography (degree of twisting-and-turning, sway regularity). Both CP groups showed larger sway amplitude than the TD while only the CP level II showed more regular COP trajectories with less twisting-and-turning. Functional taping didn't affect sway amplitude or sway-path-length. TD children exhibited more twisting-and-turning with functional taping, whereas no effects on postural sway dynamics were observed in CP children. Functional taping doesn't result in immediate changes in quiet stance in CP children, whereas in TD it resulted in faster sway corrections. Children level II invest more attention in postural control than level I, and TD. While quiet standing was more automatized in children level I than in level II, both CP groups showed a less stable balance than TD. Copyright © 2017 Elsevier B.V. All rights reserved.

  7. The level and nature of autistic intelligence II: what about Asperger syndrome?

    Directory of Open Access Journals (Sweden)

    Isabelle Soulières

    Full Text Available A distinctively uneven profile of intelligence is a feature of the autistic spectrum. Within the spectrum, Asperger individuals differ from autistics in their early speech development and in being less likely to be characterized by visuospatial peaks. While different specific strengths characterize different autistic spectrum subgroups, all such peaks of ability have been interpreted as deficits: isolated, aberrant, and irreconcilable with real human intelligence. This view has recently been challenged by findings of autistic strengths in performance on Raven's Progressive Matrices (RPM, an important marker of general and fluid intelligence. We investigated whether these findings extend to Asperger syndrome, an autistic spectrum subgroup characterized by verbal peaks of ability, and whether the cognitive mechanisms underlying autistic and Asperger RPM performance differ. Thirty-two Asperger adults displayed a significant advantage on RPM over Wechsler Full-Scale and Performance scores relative to their typical controls, while in 25 Asperger children an RPM advantage was found over Wechsler Performance scores only. As previously found with autistics, Asperger children and adults achieved RPM scores at a level reflecting their Wechsler peaks of ability. Therefore, strengths in RPM performance span the autistic spectrum and imply a common mechanism advantageously applied to different facets of cognition. Autistic spectrum intelligence is atypical, but also genuine, general, and underestimated.

  8. Development of a Level-1 Track and Vertex Finder for the Phase II CMS experiment upgrade

    CERN Document Server

    AUTHOR|(INSPIRE)INSPIRE-00414391; Shepherd-Themistocleous, Claire

    The High Luminosity (HL-LHC) upgrade to the Large Hadron Collider will operate at an increased instantaneous luminosity, up to seven times the design value, in order to collect an integrated luminosity of $3,000$\\,fb$^{-1}$ in the decade following 2025. Proton bunches at the HL-LHC will cross every $25$\\,ns, producing an average of 140-200 pile-up proton-proton collisions per crossing. A new tracking detector is under development for use by the CMS experiment at the HL-LHC. A crucial requirement of this upgrade is to provide the ability to reconstruct charged particle tracks with transverse momentum above $2$--$3$\\,GeV within $4\\,\\upmu$s to be used in the Level-1 (L1) trigger decision. This thesis presents one of the main proposals for the final L1 Track Finding system, which exploits a fully time-multiplexed architecture based on high-speed FPGA electronics. The developed track finding algorithm makes use of the Hough Transform technique to identify track candidates, followed by a track fitting stage. Sever...

  9. The Level and Nature of Autistic Intelligence II: What about Asperger Syndrome?

    Science.gov (United States)

    Soulières, Isabelle; Dawson, Michelle; Gernsbacher, Morton Ann; Mottron, Laurent

    2011-01-01

    A distinctively uneven profile of intelligence is a feature of the autistic spectrum. Within the spectrum, Asperger individuals differ from autistics in their early speech development and in being less likely to be characterized by visuospatial peaks. While different specific strengths characterize different autistic spectrum subgroups, all such peaks of ability have been interpreted as deficits: isolated, aberrant, and irreconcilable with real human intelligence. This view has recently been challenged by findings of autistic strengths in performance on Raven's Progressive Matrices (RPM), an important marker of general and fluid intelligence. We investigated whether these findings extend to Asperger syndrome, an autistic spectrum subgroup characterized by verbal peaks of ability, and whether the cognitive mechanisms underlying autistic and Asperger RPM performance differ. Thirty-two Asperger adults displayed a significant advantage on RPM over Wechsler Full-Scale and Performance scores relative to their typical controls, while in 25 Asperger children an RPM advantage was found over Wechsler Performance scores only. As previously found with autistics, Asperger children and adults achieved RPM scores at a level reflecting their Wechsler peaks of ability. Therefore, strengths in RPM performance span the autistic spectrum and imply a common mechanism advantageously applied to different facets of cognition. Autistic spectrum intelligence is atypical, but also genuine, general, and underestimated. PMID:21991394

  10. An evaluation on the disposal alternatives for low- and intermediate- level radwaste (II)

    International Nuclear Information System (INIS)

    Park, Hun Hwee; Han, Kyung Won; Hahn, Pil Soo; Lee, Han Soo; Cho, Won Jin; Lee, Jae Dwan; Park, Chung Kyun; Lee, Myung Joo; Choi, Heui Joo; Lee, Youn Myoung

    1988-02-01

    An evaluation on the radioactive waste disposal alternatives for the low-and intermediate level wastes being produced from nuclear power generation and radioisotope application was carried out in view of the radiological safety, socio-political aspects and repository construction economics. Three types of possible alternatives-sample shallow land disposal method, engineered shallow land disposal method and engineered rock cavern disposal method are investigated. The safety assessment consists of radiological dose calculation and nonradiological impacts which is expressed as total number of injuries and fatalities during construction, operation and transportation. The sociopolitical assessment is done in terms of site conditions including easiness for land acquisition, technical feasibility and public acceptance. The economic assessment is performed by cost comparison regarding land acquisition, construction, operation and closure for each alternatives. The evaluation shows that engineered rock cavern disposal method has remarkable favour in safety than others. And also an integrated evaluation using AHP results the engineered rock cavern disposal method as the most favorable option

  11. Transfusion practices in trauma

    Directory of Open Access Journals (Sweden)

    V Trichur Ramakrishnan

    2014-01-01

    Full Text Available Resuscitation of a severely traumatised patient with the administration of crystalloids, or colloids along with blood products is a common transfusion practice in trauma patients. The determination of this review article is to update on current transfusion practices in trauma. A search of PubMed, Google Scholar, and bibliographies of published studies were conducted using a combination of key-words. Recent articles addressing the transfusion practises in trauma from 2000 to 2014 were identified and reviewed. Trauma induced consumption and dilution of clotting factors, acidosis and hypothermia in a severely injured patient commonly causes trauma-induced coagulopathy. Early infusion of blood products and early control of bleeding decreases trauma-induced coagulopathy. Hypothermia and dilutional coagulopathy are associated with infusion of large volumes of crystalloids. Hence, the predominant focus is on damage control resuscitation, which is a combination of permissive hypotension, haemorrhage control and haemostatic resuscitation. Massive transfusion protocols improve survival in severely injured patients. Early recognition that the patient will need massive blood transfusion will limit the use of crystalloids. Initially during resuscitation, fresh frozen plasma, packed red blood cells (PRBCs and platelets should be transfused in the ratio of 1:1:1 in severely injured patients. Fresh whole blood can be an alternative in patients who need a transfusion of 1:1:1 thawed plasma, PRBCs and platelets. Close monitoring of bleeding and point of care coagulation tests are employed, to allow goal-directed plasma, PRBCs and platelets transfusions, in order to decrease the risk of transfusion-related acute lung injury.

  12. Trial storage of high-level waste cylinders in the Asse II salt mine

    International Nuclear Information System (INIS)

    1984-01-01

    This report covers the contract period 1976-77, as well as some of the tasks carried out during the extension in 1978, in the framework of the R and D programme for disposal of radioactive waste in salt formations. With regard to the in-situ tests for the liberation and migration of brine, the testing devices were examined successfully. Laboratory examinations carried out showed a stepwise liberation of the water contents in halite in dependence on the temperature. The amount of brine liberated stood in good agreement with the in situ results. A temperature test for borehole convergence resulted in definite convergence rates. Simultaneously no influence was registered in the stability of the surrounding rocks. For the realization of an integrated major experiment, temperature test field IV was mined on the 750 m level of the Asse Salt Mine and heater- as well as measurement drillings were carried out. Extensive rheological examinations are concentrated particularly on the halite and secondly on the Carnallite. They are chiefly based on uni- and multiaxial pressure tests. Computer programmes are developed to examine the heat generation in wastes as well as in salt. In comparison, the programme development of computer codes for the stability behaviour of rocks is still at a relatively early stage, because it has to build up on the results of heat generation. The works for the development of a transport container with a shielding combination are at a very advanced stage. An integrated disposal- and retrieval system was developed, tested and successfully demonstrated. A monitoring system in the mine has also been developed in its essential parts

  13. Sonography of scrotal trauma

    International Nuclear Information System (INIS)

    Rao, Meka Srinivasa; Arjun, Kalyanpur

    2012-01-01

    The purpose of this article is to depict the spectrum of scrotal injuries in blunt trauma. Scrotal injuries are not very common and are mostly due to blunt trauma from direct injury, sports injuries or motor vehicle accidents. To minimize complications and ensure testicular salvage, rapid and accurate diagnosis is necessary. High-resolution USG is the investigation of choice, as it is readily available, accurate and has been seen to improve outcomes. An understanding of and familiarity with the sonographic appearance of scrotal injuries on the part of the radiologist/sonographer is therefore of key importance

  14. Sonography of scrotal trauma

    Directory of Open Access Journals (Sweden)

    Meka Srinivasa Rao

    2012-01-01

    Full Text Available The purpose of this article is to depict the spectrum of scrotal injuries in blunt trauma. Scrotal injuries are not very common and are mostly due to blunt trauma from direct injury, sports injuries or motor vehicle accidents. To minimize complications and ensure testicular salvage, rapid and accurate diagnosis is necessary. High-resolution USG is the investigation of choice, as it is readily available, accurate and has been seen to improve outcomes. An understanding of and familiarity with the sonographic appearance of scrotal injuries on the part of the radiologist/sonographer is therefore of key importance.

  15. Blunt cardiac trauma

    OpenAIRE

    Alvarado, Camilo; Vargas, Fernando; Guzmán, Fernando; Zárate, Alejandro; Correa, José L.; Ramírez, Alejandro; M. Quintero, Diana; Ramírez, Erika M.

    2016-01-01

    El trauma cardiaco constituye una de las primeras causas de mortalidad en la población general. Requiere alto índice de sospecha en trauma cerrado severo, mecanismo de desaceleración y en presencia de signos indirectos como: equimosis, huella del volante o del cinturón en el tórax anterior. Las lesiones incluyen: conmoción cardiaca, ruptura cardiaca, lesión cardiaca indirecta como la trombosis coronaria aguda, lesión aórtica, lesión del pericardio y herniación cardiaca. Entre las manifestacio...

  16. Trauma cardiaco cerrado

    OpenAIRE

    Camilo Alvarado; Fernando Vargas; Fernando Guzmán; Alejandro Zárate; José L. Correa; Alejandro Ramírez; Diana M. Quintero; Erika M. Ramírez

    2016-01-01

    El trauma cardiaco constituye una de las primeras causas de mortalidad en la población general. Requiere alto índice de sospecha en trauma cerrado severo, mecanismo de desaceleración y en presencia de signos indirectos como: equimosis, huella del volante o del cinturón en el tórax anterior. Las lesiones incluyen: conmoción cardiaca, ruptura cardiaca, lesión cardiaca indirecta como la trombosis coronaria aguda, lesión aórtica, lesión del pericardio y herniación cardiaca. Entre las manifestacio...

  17. Radiology of thoracic trauma

    International Nuclear Information System (INIS)

    Stark, P.

    1987-01-01

    This course provides an overview of the radiologic manifestations of trauma to the chest. The basic mechanisms of injury are discussed. The effect of trauma on the chest wall, the lung parenchyma, and the pleural space is described. Rib fractures, sternal fractures, lung contusion, lung hematoma, lung laceration, post-traumatic atelectasis, hemothorax, chylothorax, pneumothorax, and adult respiratory distress syndrome are discussed and illustrated. Injuries to the tracheobronchial tree, the aorta and brachiocephalic vessels, the esophagus, the diaphragm, and the heart are also presented. The purpose of the lecture is to familiarize the audience with common and unusual radiologic presentations of traumatic injury to the thorax

  18. Eye trauma in boxing.

    Science.gov (United States)

    Corrales, Gustavo; Curreri, Anthony

    2009-10-01

    In boxing, along with a few other sports, trauma is inherent to the nature of the sport; therefore it is considered a high-risk sport for ocular injuries. The long-term morbidity of ocular injuries suffered by boxers is difficult to estimate due to the lack of structured long-term follow-up of these athletes. Complications of blunt ocular trauma may develop years after the athlete has retired from the ring and is no longer considered to be at risk for boxing-related injuries. This article describes the wide range of eye injuries a boxer can sustain, and their immediate and long-term clinical management.

  19. Level II scour analysis for Bridge 37 (DUXBTH00120037) on Town Highway 12, crossing Ridley Brook, Duxbury, Vermont

    Science.gov (United States)

    Wild, Emily C.; Ivanhoff, Michael A.

    1997-01-01

    This report provides the results of a detailed Level II analysis of scour potential at structure DUXBTH00120037 on Town Highway 12 crossing Ridley Brook, Duxbury, Vermont (figures 1–8). A Level II study is a basic engineering analysis of the site, including a quantitative analysis of stream stability and scour (U.S. Department of Transportation, 1993). Results of a Level I scour investigation also are included in Appendix E of this report. A Level I investigation provides a qualitative geomorphic characterization of the study site. Information on the bridge, gleaned from Vermont Agency of Transportation (VTAOT) files, was compiled prior to conducting Level I and Level II analyses and is found in Appendix D. The site is in the Green Mountain section of the New England physiographic province in north central Vermont. The 10.1-mi2 drainage area is in a predominantly rural and forested basin. In the vicinity of the study site, the surface cover is forest upstream and downstream of the bridge. In the study area, Ridley Brook has an incised, straight channel with a slope of approximately 0.04 ft/ft, an average channel top width of 67 ft and an average bank height of 9 ft. The channel bed material ranges from gravel to boulders with a median grain size (D50) of 123 mm (0.404 ft). The geomorphic assessment at the time of the Level I and Level II site visit on July 1, 1996, indicated that the reach was stable. The Town Highway 12 crossing of Ridley Brook is a 33-ft-long, two-lane bridge consisting of five 30-ft steel rolled beams (Vermont Agency of Transportation, written communication, October 13, 1995). The opening length of the structure parallel to the bridge face is 30 ft. The bridge is supported by vertical, concrete abutments with wingwalls. The channel is skewed approximately 50 degrees to the opening while the measured opening-skew-to-roadway is 20 degrees. A scour hole 2 ft deeper than the mean thalweg depth was observed along the right abutment and downstream

  20. Level II scour analysis for Bridge 17 (LYNDTH00020017) on Town Highway 2, crossing Hawkins Brook, Lyndon, Vermont

    Science.gov (United States)

    Wild, Emily C.; Medalie, Laura

    1997-01-01

    This report provides the results of a detailed Level II analysis of scour potential at structure LYNDTH00020017 on Town Highway 2 crossing Hawkins Brook, Lyndon, Vermont (figures 1–8). A Level II study is a basic engineering analysis of the site, including a quantitative analysis of stream stability and scour (U.S. Department of Transportation, 1993). Results of a Level I scour investigation also are included in Appendix E of this report. A Level I investigation provides a qualitative geomorphic characterization of the study site. Information on the bridge, gleaned from Vermont Agency of Transportation (VTAOT) files, was compiled prior to conducting Level I and Level II analyses and is found in Appendix D.The site is in the Green Mountain section of the New England physiographic province in northeastern Vermont. The 7.7-mi2 drainage area is in a predominantly rural and forested basin. In the vicinity of the study site, the surface cover is forest on the left and right upstream overbanks. The downstream left and right overbanks are brushland.In the study area, Hawkins Brook has an incised, sinuous channel with a slope of approximately 0.02 ft/ft, an average channel top width of 78 ft and an average bank height of 7.3 ft. The channel bed material ranges from sand to boulder with a median grain size (D50) of 46.6 mm (0.153 ft). The geomorphic assessment at the time of the Level I and Level II site visit on August 4, 1995, indicated that the reach was laterally unstable with the presence of point bars and side bars.The Town Highway 2 crossing of Hawkins Brook is a 49-ft-long, two-lane bridge consisting of a 46-foot steel-stringer span (Vermont Agency of Transportation, written communication, March 27, 1995). The opening length of the structure parallel to the bridge face is 43 ft. The bridge is supported by vertical, concrete abutments with wingwalls. The channel is skewed approximately 45 degrees to the opening while the computed opening-skew-to-roadway is zero

  1. Level II scour analysis for Bridge 7H (HUNTTH0001007H) on Town Highway 1, crossing Cobb Brook, Huntington, Vermont

    Science.gov (United States)

    Wild, Emily C.

    1997-01-01

    This report provides the results of a detailed Level II analysis of scour potential at structure HUNTTH001007H on Town Highway 1 crossing the Cobb Brook, Huntington, Vermont (figures 1–10). A Level II study is a basic engineering analysis of the site, including a quantitative analysis of stream stability and scour (U.S. Department of Transportation, 1993). Results of a Level I scour investigation also are included in Appendix E of this report. A Level I investigation provides a qualitative geomorphic characterization of the study site. Information on the bridge, gleaned from Vermont Agency of Transportation (VTAOT) files, was compiled prior to conducting Level I and Level II analyses and is found in Appendix D.In August 1976, Hurricane Belle caused flooding at this site which resulted in road and bridge damage (figures 7-8). This was approximately a 25-year flood event (U.S. Department of Housing and Urban Development, 1978). The site is in the Green Mountain section of the New England physiographic province in central Vermont. The 4.20-mi2 drainage area is in a predominantly rural and forested basin. In the vicinity of the study site, the surface cover is forest upstream of the bridge. Downstream of the bridge is brushland and pasture.In the study area, the Cobb Brook has an incised, straight channel with a slope of approximately 0.03 ft/ft, an average channel top width of 43 ft and an average bank height of 6 ft. The channel bed material ranges from sand to boulders with a median grain size (D50) of 65.5 mm (0.215 ft). The geomorphic assessment at the time of the Level I and Level II site visit on June 24, 1996, indicated that the reach was stable. The Town Highway 1 crossing of the Cobb Brook is a 23-ft-long, two-lane bridge consisting of one 20-foot concrete slab span (Vermont Agency of Transportation, written communication, June 21, 1996). The bridge is supported by vertical, concrete abutments with wingwalls. The channel is skewed approximately 15 degrees

  2. Level II scour analysis for Bridge 18 (SHEFTH00410018) on Town Highway 41, crossing Millers Run, Sheffield, Vermont

    Science.gov (United States)

    Wild, Emily C.; Boehmler, Erick M.

    1997-01-01

    This report provides the results of a detailed Level II analysis of scour potential at structure SHEFTH00410018 on Town Highway 41 crossing Millers Run, Sheffield, Vermont (figures 1–8). A Level II study is a basic engineering analysis of the site, including a quantitative analysis of stream stability and scour (U.S. Department of Transportation, 1993). Results of a Level I scour investigation also are included in Appendix E of this report. A Level I investigation provides a qualitative geomorphic characterization of the study site. Information on the bridge, gleaned from Vermont Agency of Transportation (VTAOT) files, was compiled prior to conducting Level I and Level II analyses and is found in Appendix D. The site is in the White Mountain section of the New England physiographic province in northeastern Vermont. The 16.2-mi2 drainage area is in a predominantly rural and forested basin. In the vicinity of the study site, the surface cover is grass upstream and downstream of the bridge while the immediate banks have dense woody vegetation. In the study area, Millers Run has an incised, straight channel with a slope of approximately 0.01 ft/ft, an average channel top width of 50 ft and an average bank height of 6 ft. The channel bed material ranges from sand to boulder with a median grain size (D50) of 50.9 mm (0.167 ft). The geomorphic assessment at the time of the Level I and Level II site visit on August 1, 1995, indicated that the reach was laterally unstable, which is evident in the moderate to severe fluvial erosion in the upstream reach. The Town Highway 41 crossing of the Millers Run is a 30-ft-long, one-lane bridge consisting of a 28-foot steel-stringer span (Vermont Agency of Transportation, written communication, March 28, 1995). The opening length of the structure parallel to the bridge face is 22.2 ft. The bridge is supported by vertical, concrete abutments with wingwalls. The channel is skewed approximately 20 degrees to the opening. The computed

  3. Level II scour analysis for Bridge 36 (DUXBTH00040036) on Town Highway 4, crossing Crossett Brook, Duxbury, Vermont

    Science.gov (United States)

    Wild, Emily C.; Degnan, James R.

    1997-01-01

    This report provides the results of a detailed Level II analysis of scour potential at structure DUXBTH00040036 on Town Highway 4 crossing the Crossett Brook, Duxbury, Vermont (figures 1–8). A Level II study is a basic engineering analysis of the site, including a quantitative analysis of stream stability and scour (U.S. Department of Transportation, 1993). Results of a Level I scour investigation also are included in Appendix E of this report. A Level I investigation provides a qualitative geomorphic characterization of the study site. Information on the bridge, gleaned from Vermont Agency of Transportation (VTAOT) files, was compiled prior to conducting Level I and Level II analyses and is found in Appendix D.The site is in the Green Mountain section of the New England physiographic province in north-central Vermont. The 4.9-mi2 drainage area is in a predominantly rural and forested basin. In the vicinity of the study site, the surface cover on the upstream left overbank is pasture. The upstream and downstream right overbanks are forested. The downstream left overbank is brushland, while the immediate banks have dense woody vegetation.In the study area, the Crossett Brook has an incised, sinuous channel with a slope of approximately 0.006 ft/ft, an average channel top width of 55 ft and an average bank height of 9 ft. The channel bed material ranges from gravel to bedrock with a median grain size (D50) of 51.6 mm (0.169 ft). The geomorphic assessment at the time of the Level I and Level II site visit on July 1, 1996, indicated that the reach was stable.The Town Highway 4 crossing of the Crossett Brook is a 29-ft-long, two-lane bridge consisting of a 26-foot concrete slab span (Vermont Agency of Transportation, written communication, October 13, 1995). The opening length of the structure parallel to the bridge face is 26 ft. The bridge is supported by vertical, concrete abutments with wingwalls. The channel is skewed approximately 35 degrees to the opening while

  4. Level II scour analysis for Bridge 46 (LINCTH00060046) on Town Highway 6, crossing the New Haven River, Lincoln, Vermont

    Science.gov (United States)

    Wild, Emily C.

    1998-01-01

    This report provides the results of a detailed Level II analysis of scour potential at structure LINCTH00060046 on Town Highway 6 crossing the New Haven River, Lincoln, Vermont (figures 1–8). A Level II study is a basic engineering analysis of the site, including a quantitative analysis of stream stability and scour (FHWA, 1993). Results of a Level I scour investigation also are included in appendix E of this report. A Level I investigation provides a qualitative geomorphic characterization of the study site. Information on the bridge, gleaned from Vermont Agency of Transportation (VTAOT) files, was compiled prior to conducting Level I and Level II analyses and is found in appendix D. The site is in the Green Mountain section of the New England physiographic province in west-central Vermont. The 45.9-mi2 drainage area is in a predominantly suburban and forested basin. In the vicinity of the study site, the surface cover is forest upstream of the bridge. The downstream right overbank near the bridge is suburban with buildings, homes, lawns, and pavement (less than fifty percent). The downstream left overbank is brushland while the immediate banks have dense woody vegetation. In the study area, the New Haven River has an incised, sinuous channel with a slope of approximately 0.01 ft/ft, an average channel top width of 95 ft and an average bank height of 7 ft. The channel bed material ranges from sand to bedrock with a median grain size (D50) of 120.7 mm (0.396 ft). The geomorphic assessment at the time of the Level I and Level II site visit on June 13, 1996, indicated that the reach was stable. The Town Highway 34 crossing of the New Haven River is a 85-ft-long, two-lane bridge consisting of an 80-foot steel arch truss (Vermont Agency of Transportation, written communication, December 14, 1995). The opening length of the structure parallel to the bridge face is 69 feet. The bridge is supported by vertical, concrete abutments with wingwalls. The channel is skewed

  5. Level II scour analysis for Bridge 67 (MTHOTH00120067) on Town Highway 12, crossing Freeman Brook, Mount Holly, Vermont

    Science.gov (United States)

    Wild, Emily C.; Severance, Timothy

    1998-01-01

    This report provides the results of a detailed Level II analysis of scour potential at structure MTHOTH00120067 on Town Highway 12 crossing Freeman Brook, Mount Holly, Vermont (figures 1–8). A Level II study is a basic engineering analysis of the site, including a quantitative analysis of stream stability and scour (FHWA, 1993). Results of a Level I scour investigation also are included in appendix E of this report. A Level I investigation provides a qualitative geomorphic characterization of the study site. Information on the bridge, gleaned from Vermont Agency of Transportation (VTAOT) files, was compiled prior to conducting Level I and Level II analyses and is found in appendix D. The site is in the Green Mountain section of the New England physiographic province in south-central Vermont. The 11.4-mi2 drainage area is in a predominantly rural and forested basin. In the vicinity of the study site, the surface cover is forested. In the study area, Freeman Brook has an incised, sinuous channel with a slope of approximately 0.01 ft/ft, an average channel top width of 51 ft and an average bank height of 6 ft. The channel bed material ranges from sand to boulders with a median grain size (D50) of 55.7 mm (0.183 ft). The geomorphic assessment at the time of the Level I and Level II site visit on October 5, 1995, indicated that the reach was stable. The Town Highway 12 crossing of Freeman Brook is a 34-ft-long, two-lane bridge consisting of a 30-foot prestressed concrete-slab span (Vermont Agency of Transportation, written communication, March 15, 1995). The opening length of the structure parallel to the bridge face is 29.5 ft. The bridge is supported by vertical, concrete abutments with wingwalls. The channel is skewed approximately 50 degrees to the opening while the opening-skew-to-roadway is 15 degrees. Along the upstream right wingwall, the right abutment and the downstream right wingwall, a scour hole approximately 1.0 to 2.0 ft deeper than the mean thalweg

  6. Level II scour analysis for Bridge 8 (NEWFTH00010008) on Town Highway 1, crossing Wardsboro Brook, Newfane, Vermont

    Science.gov (United States)

    Wild, Emily C.; Degnan, James

    1998-01-01

    This report provides the results of a detailed Level II analysis of scour potential at structure NEWFTH00010008 on Town Highway 1 crossing Wardsboro Brook, Newfane, Vermont (figures 1–8). A Level II study is a basic engineering analysis of the site, including a quantitative analysis of stream stability and scour (Federal Highway Administration, 1993). Results of a Level I scour investigation also are included in appendix E of this report. A Level I investigation provides a qualitative geomorphic characterization of the study site. Information on the bridge, gleaned from Vermont Agency of Transportation (VTAOT) files, was compiled prior to conducting Level I and Level II analyses and is found in appendix D. The site is in the New England Upland section of the New England physiographic province in southestern Vermont. The 6.91-mi2 drainage area is in a predominantly rural and forested basin. In the vicinity of the study site, the surface cover is forest on the upstream right overbank and downstream left and right overbanks. The surface cover on the upstream left overbank is pasture. In the study area, Wardsboro Brook has an incised, sinuous channel with a slope of approximately 0.02 ft/ft, an average channel top width of 63 ft and an average bank height of 9 ft. The channel bed material ranges from gravel to boulders with a median grain size (D50) of 95.4 mm (0.313 ft). The geomorphic assessment at the time of the Level I and Level II site visit on August 21, 1996, indicated that the reach was stable. The Town Highway 1 crossing of the Wardsboro Brook is a 32-ft-long, two-lane bridge consisting of a 26-foot concrete tee-beam span (Vermont Agency of Transportation, written communication, April 6, 1995). The opening length of the structure parallel to the bridge face is 26.7 ft. The bridge is supported by vertical, concrete abutments with wingwalls. The channel is skewed approximately 45 degrees to the computed opening while the openingskew-to-roadway is 45 degrees

  7. Level II scour analysis for Bridge 25 (ROCHTH00400025) on Town Highway 40, crossing Corporation Brook, Rochester, Vermont

    Science.gov (United States)

    Wild, Emily C.; Weber, Matthew A.

    1998-01-01

    This report provides the results of a detailed Level II analysis of scour potential at structure ROCHTH00400025 on Town Highway 40 crossing Corporation Brook, Rochester, Vermont (figures 1–8). A Level II study is a basic engineering analysis of the site, including a quantitative analysis of stream stability and scour (FHWA, 1993). Results of a Level I scour investigation also are included in appendix E of this report. A Level I investigation provides a qualitative geomorphic characterization of the study site. Information on the bridge, from Vermont Agency of Transportation files, was compiled prior to conducting Level I and Level II analyses and is found in appendix D. The site is in the Green Mountain section of the New England physiographic province in central Vermont. The 4.97-mi2 drainage area is in a predominantly rural and forested basin. In the vicinity of the study site, the surface cover is forest on the upstream left and right overbanks, and the downstream left overbank. On the downstream right overbank, the surface cover is predominately brushland. In the study area, Corporation Brook has an incised, sinuous channel with a slope of approximately 0.04 ft/ft, an average channel top width of 37 ft and an average bank height of 6 ft. The channel bed material ranges from gravel to boulders with a median grain size (D50) of 101 mm (0.332 ft). The geomorphic assessment at the time of the Level I site visit on April 12, 1995 and Level I and II site visit on July 8, 1996, indicated that the reach was stable. The Town Highway 40 crossing of Corporation Brook is a 31-ft-long, one-lane bridge consisting of a 26-foot steel stringer span (Vermont Agency of Transportation, written communication, March 22, 1995). The opening length of the structure parallel to the bridge face is 24 ft. The bridge is supported by vertical, concrete abutments. The channel is skewed approximately 15 degrees to the opening while the opening-skew-to-roadway is 15 degrees. A scour hole 1

  8. Level II scour analysis for Bridge 32 (TUNBTH00600032) on Town Highway 60, crossing First Branch White River, Tunbridge, Vermont

    Science.gov (United States)

    Wild, Emily C.

    1998-01-01

    This report provides the results of a detailed Level II analysis of scour potential at structure TUNBTH00600032 on Town Highway 60 crossing the First Branch White River, Tunbridge, Vermont (figures 1–8). A Level II study is a basic engineering analysis of the site, including a quantitative analysis of stream stability and scour (U.S. Department of Transportation, 1993). Results of a Level I scour investigation also are included in appendix E of this report. A Level I investigation provides a qualitative geomorphic characterization of the study site. Information on the bridge, gleaned from Vermont Agency of Transportation (VTAOT) files, was compiled prior to conducting Level I and Level II analyses and is found in appendix D. The site is in the New England Upland section of the New England physiographic province in central Vermont. The 92.9-mi2 drainage area is in a predominantly rural and forested basin. In the vicinity of the study site, the surface cover is pasture upstream and downstream of the bridge, while woody vegetation sparsely covers the immediate banks. In the study area, the First Branch White River has a sinuous channel with a slope of approximately 0.001 ft/ft, an average channel top width of 82 ft and an average bank height of 7 ft. The channel bed material ranges from sand to gravel with a median grain size (D50) of 24.4 mm (0.08 ft). The geomorphic assessment at the time of the Level I and Level II site visit on October 18, 1995, indicated that the reach was laterally unstable, as a result of block failure of moderately eroded banks. The Town Highway 60 crossing of the First Branch White River is a 74-ft-long, one-lane bridge consisting of a 71-foot timber thru-truss span (Vermont Agency of Transportation, written communication, August 24, 1994). The opening length of the structure parallel to the bridge face is 64 ft.The bridge is supported by vertical, laid-up stone abutments with upstream wingwalls. The channel is not skewed to the opening

  9. Level II scour analysis for Bridge 34 (WWINTH00370034) on Town Highway 37, crossing Mill Brook, West Windsor, Vermont

    Science.gov (United States)

    Boehmler, Erick M.; Wild, Emily C.

    1998-01-01

    This report provides the results of a detailed Level II analysis of scour potential at structure WWINTH00370034 on Town Highway 37 crossing Mill Brook, West Windsor, Vermont (figures 1–8). A Level II study is a basic engineering analysis of the site, including a quantitative analysis of stream stability and scour (FHWA, 1993). Results of a Level I scour investigation also are included in appendix E of this report. A Level I investigation provides a qualitative geomorphic characterization of the study site. Information on the bridge, gleaned from Vermont Agency of Transportation (VTAOT) files, was compiled prior to conducting Level I and Level II analyses and is found in appendix D. The site is in the New England Upland section of the New England physiographic province in east-central Vermont. The 16.6-mi2 drainage area is in a predominantly rural and forested basin. In the vicinity of the study site, the surface cover is pasture except for the upstream left bank where there is mostly shrubs and brush. In the study area, Mill Brook has a sinuous channel with a slope of approximately 0.003 ft/ ft, an average channel top width of 52 ft and an average bank height of 5 ft. The channel bed material ranges from sand to cobbles with a median grain size (D50) of 43.4 mm (0.142 ft). The geomorphic assessment at the time of the Level I and Level II site visit on June 5, 1996, indicated that the reach was laterally unstable. Point bars were observed upstream and downstream of this site. Furthermore, slip failure of the bank material was noted downstream at a cut-bank on the left side of the channel across from a point bar. The Town Highway 37 crossing of Mill Brook is a 37-ft-long, one-lane covered bridge consisting of one 32-foot wood thru-truss span (Vermont Agency of Transportation, written communication, March 23, 1995). The opening length of the structure parallel to the bridge face is 29.6 ft. The bridge is supported by vertical, laid-up stone abutment walls with

  10. Level II scour analysis for Bridge 31 (JERITH00350031) on Town Highway 35, crossing Mill Brook, Jericho, Vermont

    Science.gov (United States)

    Wild, Emily C.

    1997-01-01

    This report provides the results of a detailed Level II analysis of scour potential at structure JERITH00350031 on Town Highway 35 crossing Mill Brook, Jericho, Vermont (figures 1– 8). A Level II study is a basic engineering analysis of the site, including a quantitative analysis of stream stability and scour (U.S. Department of Transportation, 1993). Results of a Level I scour investigation also are included in Appendix E of this report. A Level I investigation provides a qualitative geomorphic characterization of the study site. Information on the bridge, gathered from Vermont Agency of Transportation (VTAOT) files, was compiled prior to conducting Level I and Level II analyses and is found in Appendix D. The site is in the Green Mountain section of the New England physiographic province and the Champlain section of the St. Lawrence physiographic province in northwestern Vermont. The 15.7-mi2 drainage area is in a predominantly rural and forested basin. In the vicinity of the study site, the surface cover is forest upstream of the bridge. The downstream left overbank is pasture. The downstream right overbank is brushland. In the study area, the Mill Brook has an incised, sinuous channel with a slope of approximately 0.02 ft/ft, an average channel top width of 117 ft and an average bank height of 11 ft. The channel bed material ranges from gravel to boulders with a median grain size (D50) of 81.1 mm (0.266 ft). The geomorphic assessment at the time of the Level I and Level II site visit on July 3, 1996, indicated that the reach was laterally unstable. The Town Highway 35 crossing of the Mill Brook is a 53-ft-long, one-lane bridge consisting of a 50-foot steel-beam span with a wooden deck (Vermont Agency of Transportation, written communication, November 30, 1995). The opening length of the structure parallel to the bridge face is 48 ft. The bridge is supported by a vertical, concrete abutment with wingwalls on the left. On the right, the abutment and wingwalls

  11. Level II scour analysis for Bridge 51 (JERITH00590051) on Town Highway 59, crossing The Creek, Jericho, Vermont

    Science.gov (United States)

    Wild, Emily C.

    1998-01-01

    This report provides the results of a detailed Level II analysis of scour potential at structure JERITH00590051 on Town Highway 59 crossing The Creek, Jericho, Vermont (figures 1– 8). A Level II study is a basic engineering analysis of the site, including a quantitative analysis of stream stability and scour (Federal Highway Administration, 1993). Results of a Level I scour investigation also are included in appendix E of this report. A Level I investigation provides a qualitative geomorphic characterization of the study site. Information on the bridge, gleaned from Vermont Agency of Transportation (VTAOT) files, was compiled prior to conducting Level I and Level II analyses and is found in appendix D. The site is in the Green Mountain section of the New England physiographic province and the Champlain section of the St. Lawrence physiographic province in northwestern Vermont. The 10.9-mi2 drainage area is in a predominantly rural and forested basin. In the vicinity of the study site, the surface cover is pasture on the left and right overbanks, upstream and downstream of the bridge while the immediate banks have dense woody vegetation. In the study area, The Creek has a sinuous channel with a slope of approximately 0.004 ft/ft, an average channel top width of 45 ft and an average bank height of 6 ft. The channel bed material ranges from silt to cobble with a median grain size (D50) of 58.6 mm (0.192 ft). The geomorphic assessment at the time of the Level I and Level II site visit on July 3, 1996, indicated that the reach was stable. The Town Highway 59 crossing of The Creek is a 33-ft-long, two-lane bridge consisting of a 28-foot steel-stringer span (Vermont Agency of Transportation, written communication, December 11, 1995). The opening length of the structure parallel to the bridge face is 26 ft. The bridge is supported by vertical, concrete abutments with wingwalls. The channel is skewed approximately 10 degrees to the opening while the computed opening

  12. Level II scour analysis for Bridge 40 (ROCKTH00140040) on Town Highway 14, crossing the Williams River, Rockingham, Vermont

    Science.gov (United States)

    Burns, Ronda L.; Wild, Emily C.

    1998-01-01

    This report provides the results of a detailed Level II analysis of scour potential at structure ROCKTH00140040 on Town Highway 14 crossing the Williams River, Rockingham, Vermont (figures 1–8). A Level II study is a basic engineering analysis of the site, including a quantitative analysis of stream stability and scour (FHWA, 1993). Results of a Level I scour investigation also are included in appendix E of this report. A Level I investigation provides a qualitative geomorphic characterization of the study site. Information on the bridge, gleaned from Vermont Agency of Transportation (VTAOT) files, was compiled prior to conducting Level I and Level II analyses and is found in appendix D. The site is in the New England Upland section of the New England physiographic province in southeastern Vermont. The 99.2-mi2 drainage area is in a predominantly rural and forested basin. In the vicinity of the study site, the surface cover is pasture downstream of the bridge. Upstream of the bridge, the left bank is forested and the right bank is suburban. In the study area, the Williams River has an incised, sinuous channel with a slope of approximately 0.005 ft/ft, an average channel top width of 154 ft and an average bank height of 11 ft. The channel bed material ranges from silt and clay to cobble with a median grain size (D50) of 45.4 mm (0.149 ft). The geomorphic assessment at the time of the Level I and Level II site visit on September 4, 1996, indicated that the reach was stable. The Town Highway 14 crossing of the Williams River is a 106-ft-long, one-lane covered bridge consisting of two steel-beam spans with a maximum span length of 73 ft (Vermont Agency of Transportation, written communication, April 6, 1995). The opening length of the structure parallel to the bridge face is 94.5 ft. The bridge is supported by a vertical, concrete abutment with wingwalls on the left, a vertical, laid-up stone abutment on the right and a concrete pier. The channel is skewed

  13. Level II scour analysis for Bridge 28 (ROCHTH00370028) on Town Highway 37, crossing Brandon Brook, Rochester, Vermont

    Science.gov (United States)

    Wild, Emily C.; Weber, Matthew A.

    1998-01-01

    This report provides the results of a detailed Level II analysis of scour potential at structure ROCHTH00370028 on Town Highway 37 crossing Brandon Brook, Rochester, Vermont (figures 1–8). A Level II study is a basic engineering analysis of the site, including a quantitative analysis of stream stability and scour (FHWA, 1993). Results of a Level I scour investigation also are included in appendix E of this report. A Level I investigation provides a qualitative geomorphic characterization of the study site. Information on the bridge, gleaned from VTAOT files, was compiled prior to conducting Level I and Level II analyses and is found in appendix D. The site is in the Green Mountain section of the New England physiographic province in central Vermont. The 8.0-mi2 drainage area is in a predominantly rural and forested basin. In the vicinity of the study site, the surface cover is pasture on the upstream left overbank although the immediate banks have dense woody vegetation. The upstream right overbank and downstream left and right overbanks are forested. In the study area, the Brandon Brook has an incised, sinuous channel with a slope of approximately 0.01 ft/ft, an average channel top width of 44 ft and an average bank height of 7 ft. The channel bed material ranges from gravel to cobbles with a median grain size (D50) of 84.2 mm (0.276 ft). The geomorphic assessment at the time of the Level I site visit on April 12, 1995 and Level II site visit on July 8, 1996, indicated that the reach was stable. The Town Highway 37 crossing of the Brandon Brook is a 33-ft-long, one-lane bridge consisting of a 31-foot timber-stringer span (Vermont Agency of Transportation, written communication, March 22, 1995). The opening length of the structure parallel to the bridge face is 29.6 ft. The bridge is supported by vertical, timber log cribbing abutments with wingwalls. The channel is skewed approximately 5 degrees to the opening while the computed opening-skew-to-roadway is zero

  14. Level II scour analysis for Bridge 46 (FFIETH00470046) on Town Highway 47, crossing Black Creek, Fairfield, Vermont

    Science.gov (United States)

    Wild, Emily C.; Flynn, Robert H.

    1998-01-01

    This report provides the results of a detailed Level II analysis of scour potential at structure FFIETH00470046 on Town Highway 47 crossing Black Creek, Fairfield, Vermont (figures 1–8). A Level II study is a basic engineering analysis of the site, including a quantitative analysis of stream stability and scour (FHWA, 1993). Results of a Level I scour investigation also are included in appendix E of this report. A Level I investigation provides a qualitative geomorphic characterization of the study site. Information on the bridge, gathered from Vermont Agency of Transportation (VTAOT) files, was compiled prior to conducting Level I and Level II analyses and is found in appendix D. The site is in the Green Mountain section of the New England physiographic province in northwestern Vermont. The 37.8 mi2 drainage area is in a predominantly rural and forested basin. In the vicinity of the study site, the surface cover is pasture upstream and downstream of the bridge while the immediate banks have dense woody vegetation. In the study area, Black Creek has a meandering channel with a slope of approximately 0.0005 ft/ft, an average channel top width of 51 ft and an average bank height of 6 ft. The channel bed material ranges from sand to bedrock with a median grain size (D50) of 0.189 mm (0.00062 ft). The geomorphic assessment at the time of the Level I and Level II site visit on July 12, 1995, indicated that the reach was stable. The Town Highway 47 crossing of Black Creek is a 35-ft-long, one-lane bridge consisting of one 31-ft steel-stringer span (Vermont Agency of Transportation, written communication, March 8, 1995). The opening length of the structure parallel to the bridge face is 28.0 ft. The bridge is supported by vertical, laid-up stone abutments with wingwalls. The channel is skewed approximately zero degrees to the opening and the opening-skew-toroadway is zero degrees. A scour hole 6.0 ft deeper than the mean thalweg depth was observed just downstream of the

  15. Level II scour analysis for Bridge 34 (ROCHTH00210034) on Town Highway 21, crossing the White River, Rochester, Vermont

    Science.gov (United States)

    Wild, Emily C.; Degnan, James

    1997-01-01

    This report provides the results of a detailed Level II analysis of scour potential at structure ROCHTH00210034 on Town Highway 21 crossing the White River, Rochester, Vermont (figures 1–8). A Level II study is a basic engineering analysis of the site, including a quantitative analysis of stream stability and scour (U.S. Department of Transportation, 1993). Results of a Level I scour investigation also are included in Appendix E of this report. A Level I investigation provides a qualitative geomorphic characterization of the study site. Information on the bridge, obtained from Vermont Agency of Transportation (VTAOT) files, was compiled prior to conducting Level I and Level II analyses and is found in Appendix D.The site is in the Green Mountain section of the New England physiographic province in central Vermont. The 74.8-mi2 drainage area is in a predominantly rural and forested basin. In the vicinity of the study site, the surface cover is suburban on the upstream and downstream left overbanks, though brush prevails along the immediate banks. On the upstream and downstream right overbanks, the surface cover is pasture with brush and trees along the immediate banks.In the study area, the White River has an incised, straight channel with a slope of approximately 0.002 ft/ft, an average channel top width of 102 ft and an average bank height of 5 ft. The channel bed material ranges from sand to cobble with a median grain size (D50) of 74.4 mm (0.244 ft). The geomorphic assessment at the time of the Level I and Level II site visit on July 23, 1996, indicated that the reach was stable.The Town Highway 21 crossing of the White River is a 72-ft-long, two-lane bridge consisting of 70-foot steel stringer span (Vermont Agency of Transportation, written communication, March 22, 1995). The opening length of the structure parallel to the bridge face is 67.0 ft. The bridge is supported by vertical, concrete abutments with wingwalls. The channel is skewed approximately 15

  16. Level II scour analysis for Bridge 15 (BOLTTH00150015) on Town Highway 15, crossing Joiner Brook, Bolton, Vermont

    Science.gov (United States)

    Burns, Ronda L.; Wild, Emily C.

    1998-01-01

    This report provides the results of a detailed Level II analysis of scour potential at structure BOLTTH00150015 on Town Highway 15 crossing Joiner Brook, Bolton, Vermont (figures 1–8). A Level II study is a basic engineering analysis of the site, including a quantitative analysis of stream stability and scour (FHWA, 1993). Results of a Level I scour investigation also are included in appendix E of this report. A Level I investigation provides a qualitative geomorphic characterization of the study site. Information on the bridge, gleaned from Vermont Agency of Transportation (VTAOT) files, was compiled prior to conducting Level I and Level II analyses and is found in appendix D. The site is in the Green Mountain section of the New England physiographic province in north central Vermont. The 9.6-mi2 drainage area is in a predominantly rural and forested basin. In the vicinity of the study site, the surface cover is pasture (lawn) downstream of the bridge and on the upstream right bank. The surface cover on the upstream left bank is shrub and brushland. In the study area, Joiner Brook has an incised, straight channel with a slope of approximately 0.01 ft/ft, an average channel top width of 61 ft and an average bank height of 7 ft. The channel bed material ranges from gravel to cobble with a median grain size (D50) of 43.6 mm (0.143 ft). The geomorphic assessment at the time of the Level I and Level II site visit on June 27, 1996, indicated that the reach was stable. The Town Highway 15 crossing of Joiner Brook is a 39-ft-long, two-lane bridge consisting of one 36-foot concrete tee-beam span (Vermont Agency of Transportation, written communication, November 3, 1995). The opening length of the structure parallel to the bridge face is 34.6 ft. The bridge is supported by nearly vertical, concrete abutments with wingwalls. The channel is skewed approximately 10 degrees to the opening while the opening-skew-to-roadway is zero degrees. A scour hole 1.5 ft deeper than the

  17. Level II scour analysis for Bridge 8 (ANDOTH00010008) on Town Highway 1, crossing Andover Branch, Andover, Vermont

    Science.gov (United States)

    Flynn, Robert H.; Wild, Emily C.

    1997-01-01

    This report provides the results of a detailed Level II analysis of scour potential at structure ANDOTH00010008 on Town Highway 1 crossing the Andover Branch, Andover , Vermont (figures 1–8). A Level II study is a basic engineering analysis of the site, including a quantitative analysis of stream stability and scour (U.S. Department of Transportation, 1993). Results of a Level I scour investigation also are included in Appendix E of this report. A Level I investigation provides a qualitative geomorphic characterization of the study site. Information on the bridge, gleaned from Vermont Agency of Transportation (VTAOT) files, was compiled prior to conducting Level I and Level II analyses and is found in Appendix D.The site is in the Green Mountain section of the New England physiographic province in south-central Vermont. The 5.30-mi2 drainage area is in a predominantly rural and forested basin. In the vicinity of the study site, the surface cover along the immediate banks, both upstream and downstream of the bridge, is grass while farther upstream and downstream, the surface cover is primarily forest.In the study area, the Andover Branch has an incised, straight channel with a slope of approximately 0.01 ft/ft, an average channel top width of 35 ft and an average bank height of 3 ft. The channel bed material ranges from gravel to boulder with a median grain size (D50) of 63.6 mm (0.209 ft). The geomorphic assessment at the time of the Level I and Level II site visit on August 27, 1996, indicated that the reach was stable.The Town Highway 1 crossing of the Andover Branch is a 54-ft-long, two-lane bridge consisting of one 51-foot steel-beam span (Vermont Agency of Transportation, written communication, March 28, 1995). The bridge is supported by vertical, concrete abutments with wingwalls. The channel is skewed approximately 45 degrees to the opening while the opening-skew-to-roadway is 30 degrees.A scour hole 0.7 ft deeper than the mean thalweg depth was observed

  18. Level II scour analysis for Bridge 44 (LINCTH00330044) on Town Highway 33, crossing the New Haven River, Lincoln, Vermont

    Science.gov (United States)

    Burns, Ronda L.; Wild, Emily C.

    1997-01-01

    This report provides the results of a detailed Level II analysis of scour potential at structure LINCTH00330044 on Town Highway 33 crossing the New Haven River, Lincoln, Vermont (figures 1–8). A Level II study is a basic engineering analysis of the site, including a quantitative analysis of stream stability and scour (U.S. Department of Transportation, 1993). Results of a Level I scour investigation also are included in Appendix E of this report. A Level I investigation provides a qualitative geomorphic characterization of the study site. Information on the bridge, gleaned from Vermont Agency of Transportation (VTAOT) files, was compiled prior to conducting Level I and Level II analyses and is found in Appendix D.The site is in the Green Mountain section of the New England physiographic province in west-central Vermont. The 6.3-mi2 drainage area is in a predominantly rural and forested basin. In the vicinity of the study site, the surface cover is forest.In the study area, the New Haven River has an incised, sinuous channel with a slope of approximately 0.02 ft/ft, an average channel top width of 56 ft and an average bank height of 6 ft. The channel bed material ranges from gravel to boulder with a median grain size (D50) of 101.9 mm (0.334 ft). The geomorphic assessment at the time of the Level I and Level II site visit on June 10, 1996, indicated that the reach was stable.The Town Highway 33 crossing of the New Haven River is a 33-ft-long, one-lane bridge consisting of one 31-foot timber-beam span (Vermont Agency of Transportation, written communication, December 14, 1995). The opening length of the structure parallel to the bridge face is 29.3 ft. The bridge is supported by vertical, wood-beam crib abutments with wingwalls. The channel is skewed approximately 25 degrees to the opening while the opening-skew-to-roadway is zero degrees.A scour hole 1.0 ft deeper than the mean thalweg depth was observed along the right abutment during the Level I assessment. The

  19. Level II scour analysis for Bridge 13 (LINCTH00010013) on Town Highway 1, crossing Cota Brook, Lincoln, Vermont

    Science.gov (United States)

    Wild, Emily C.

    1998-01-01

    This report provides the results of a detailed Level II analysis of scour potential at structure LINCTH00010013 on Town Highway 1 crossing Cota Brook, Lincoln, Vermont (figures 1–8). A Level II study is a basic engineering analysis of the site, including a quantitative analysis of stream stability and scour (FHWA, 1993). Results of a Level I scour investigation also are included in appendix E of this report. A Level I investigation provides a qualitative geomorphic characterization of the study site. Information on the bridge, gleaned from Vermont Agency of Transportation (VTAOT) files, was compiled prior to conducting Level I and Level II analyses and is found in appendix D. The site is in the Green Mountain section of the New England physiographic province in west-central Vermont. The 3.0-mi2 drainage area is in a predominantly rural and forested basin. In the vicinity of the study site, the surface cover is forest along the upstream right bank and brushland along the upstream left bank. Downstream of the bridge, the surface cover is pasture along the left and right banks. In the study area, Cota Brook has an sinuous channel with a slope of approximately 0.01 ft/ ft, an average channel top width of 30 ft and an average bank height of 2 ft. The channel bed material ranges from sand to cobble with a median grain size (D50) of 34.7 mm (0.114 ft). The geomorphic assessment at the time of the Level I and Level II site visit on June 10, 1996, indicated that the reach was laterally unstable due to cut-banks and wide, vegetated point bars upstream and downstream of the bridge. The Town Highway 1 crossing of Cota Brook is a 38-ft-long, two-lane bridge consisting of a 36-foot steel-stringer span (Vermont Agency of Transportation, written communication, December 14, 1995). The opening length of the structure parallel to the bridge face is 34.4 ft. The bridge is supported by vertical, concrete abutments. The channel is skewed approximately 15 degrees to the opening while

  20. Level II scour analysis for Bridge 38 (JERITH0020038) on Town Highway 20, crossing the Lee River, Jericho, Vermont

    Science.gov (United States)

    Wild, Emily C.; Degnan, James R.

    1997-01-01

    This report provides the results of a detailed Level II analysis of scour potential at structure JERITH00200038 on Town Highway 20 crossing the Lee River, Jericho, Vermont (figures 1–8). A Level II study is a basic engineering analysis of the site, including a quantitative analysis of stream stability and scour (U.S. Department of Transportation, 1993). Results of a Level I scour investigation also are included in Appendix E of this report. A Level I investigation provides a qualitative geomorphic characterization of the study site. Information on the bridge, obtained from Vermont Agency of Transportation (VTAOT) files, was compiled prior to conducting Level I and Level II analyses and is found in Appendix D. The site is in the Green Mountain section of the New England physiographic province and the Champlain section of the St. Lawrence physiographic province in northwestern Vermont. The 12.9-mi2 drainage area is in a predominantly rural and forested basin. In the vicinity of the study site, the surface cover on the upstream and downstream right overbank is pasture while the immediate banks have dense woody vegetation. The surface cover on the upstream and downstream left overbank is forested. In the study area, the Lee River has an incised, sinuous channel with a slope of approximately 0.02 ft/ft, an average channel top width of 89 ft and an average bank height of 14 ft. The channel bed material ranges from sand to boulder with a median grain size (D50) of 45.9 mm (0.151 ft). The geomorphic assessment at the time of the Level I and Level II site visit on July 2, 1996, indicated that the reach was stable. The Town Highway 20 crossing of the Lee River is a 49-ft-long, one-lane bridge consisting of a steel through truss span (Vermont Agency of Transportation, written communication, December 12, 1995). The opening length of the structure parallel to the bridge face is 44 ft. The bridge is supported by vertical, concrete abutments with wingwalls. The channel is

  1. Thrombelastography and rotational thromboelastometry early amplitudes in 182 trauma patients with clinical suspicion of severe injury

    DEFF Research Database (Denmark)

    Meyer, Anna Sina P; Meyer, Martin A S; Sørensen, Anne Marie

    2014-01-01

    BACKGROUND: Viscoelastic hemostatic assays may provide means for earlier detection of trauma-induced coagulopathy (TIC). METHODS: This is a prospective observational study of 182 trauma patients admitted to a Level 1 trauma center. Clinical data, thrombelastography (TEG), and rotational thromboel...

  2. Splenic trauma: Is splenectomy redundant?

    Directory of Open Access Journals (Sweden)

    S Tandon

    2013-01-01

    Full Text Available 41 year old male, serving air warrior sustained blunt abdominal trauma, CECT revealed grade III splenic injury. He was managed conservatively with good clinical outcome. Conservatism is the new approach to splenic trauma.

  3. Complex-wide review of DOE's Low-Level Waste Management ES ampersand H vulnerabilities. Volume II. Final report

    International Nuclear Information System (INIS)

    1996-05-01

    Volume I of this report presents a summary of DOE's complex-wide review of its low-level waste management system, including the assessment scope and methodology, site-specific and complex-wide vulnerabilities, and DOE's conclusions and recommendations. Volume II presents a more detailed discussion of the assessment methodology and evaluation instruments developed by the Assessment Working Group for identifying site-specific vulnerabilities, categorizing and classifying vulnerabilities, and identifying and analyzing complex-wide vulnerabilities. Attachments A and B of this volume contain, respectively, the Site Evaluation Survey and the Vulnerability Assessment Form used in those processes. Volume III contains the site-specific assessment reports for the 36 sites (38 facilities) assessed in the complex-wide review from which the complex-wide vulnerabilities were drawn

  4. Enhancements to the CALIOP Aerosol Subtyping and Lidar Ratio Selection Algorithms for Level II Version 4

    Science.gov (United States)

    Omar, A. H.; Tackett, J. L.; Vaughan, M. A.; Kar, J.; Trepte, C. R.; Winker, D. M.

    2016-12-01

    This presentation describes several enhancements planned for the version 4 aerosol subtyping and lidar ratio selection algorithms of the Cloud-Aerosol Lidar with Orthogonal Polarization (CALIOP) instrument. The CALIOP subtyping algorithm determines the most likely aerosol type from CALIOP measurements (attenuated backscatter, estimated particulate depolarization ratios δe, layer altitude), and surface type. The aerosol type, so determined, is associated with a lidar ratio (LR) from a discrete set of values. Some of these lidar ratios have been updated in the version 4 algorithms. In particular, the dust and polluted dust will be adjusted to reflect the latest measurements and model studies of these types. Version 4 eliminates the confusion between smoke and clean marine aerosols seen in version 3 by modifications to the elevated layer flag definitions used to identify smoke aerosols over the ocean. In the subtyping algorithms pure dust is determined by high estimated particulate depolarization ratios [δe > 0.20]. Mixtures of dust and other aerosol types are determined by intermediate values of the estimated depolarization ratio [0.075limited to mixtures of dust and smoke, the so called polluted dust aerosol type. To differentiate between mixtures of dust and smoke, and dust and marine aerosols, a new aerosol type will be added in the version 4 data products. In the revised classification algorithms, polluted dust will still defined as dust + smoke/pollution but in the marine boundary layer instances of moderate depolarization will be typed as dusty marine aerosols with a lower lidar ratio than polluted dust. The dusty marine type introduced in version 4 is modeled as a mixture of dust + marine aerosol. To account for fringes, the version 4 Level 2 algorithms implement Subtype Coalescence Algorithm for AeRosol Fringes (SCAARF) routine to detect and classify fringe of aerosol plumes that are detected at 20 km or 80 km horizontal resolution at the plume base. These

  5. Relationship of serum S1P and HC-II levels with vasoactive substances and cytokines in patients with cerebral vascular restenosis after stent implantation

    Directory of Open Access Journals (Sweden)

    Yong Liu

    2017-04-01

    Full Text Available Objective: To study the relationship of serum sphingosine 1-phosphate (S1P and heparin cofactor II (HCII levels with vasoactive substances and cytokines in patients with cerebral vascular restenosis after stent implantation. Methods: 52 patients who received cerebrovascular stent implantation and developed restenosis in our hospital between May 2012 and December 2015 were collected as observation group, and 40 healthy patients with cerebrovascular stent implantation who had re-examination in our hospital during the same period were selected as control group. ELISA method was used to detect serum S1P and HC-II levels as well as vasoactive substance and inflammatory factor contents. Spearman correlation analysis was used to evaluate the relationship of serum S1P and HC-II levels with vasoactive substances and inflammatory factors. Results: Serum S1P and HC-II levels of observation group were lower than those of control group (P<0.05; serum vasoactive substances endothelin (ET, angiotensin II (AngII and thromboxane B2 (TXB2 contents of observation group were higher than those of control group while nitric oxide (NO content was lower than that of control group (P<0.05; serum inflammatory factors hypersensitive C-reactive protein (hs-CRP, interleukin-1 (IL-1, IL-6, IL-8 and IL-11 contents of observation group were higher than those of control group (P<0.05. Serum S1P and HC-II levels in patients with cerebral vascular restenosis after stent implantation were directly correlated with vasoactive substance and inflammatory factor contents. Conclusion: Serum S1P and HC-II levels decrease in patients with cerebral vascular restenosis after stent implantation, and it is an important cause of cerebral vascular dysfunction and systemic inflammatory response.

  6. Level II scour analysis for Bridge 29 (DORSTH00100029) on Town Highway 10, crossing the Mettawee River, Dorset, Vermont

    Science.gov (United States)

    Wild, Emily C.

    1997-01-01

    This report provides the results of a detailed Level II analysis of scour potential at structure DORSTH00100029 on Town Highway 10 crossing the Mettawee River, Dorset, Vermont (figures 1–8). A Level II study is a basic engineering analysis of the site, including a quantitative analysis of stream stability and scour (U.S. Department of Transportation, 1993). Results of a Level I scour investigation also are included in Appendix E of this report. A Level I investigation provides a qualitative geomorphic characterization of the study site. Information on the bridge, gleaned from Vermont Agency of Transportation (VTAOT) files, was compiled prior to conducting Level I and Level II analyses and is found in Appendix D. The site is in the Taconic section of the New England physiographic province in southwestern Vermont. The 9.5-mi2 drainage area is in a predominantly rural and forested basin. In the vicinity of the study site, the surface cover is forest on the upstream left overbank and the upstream and downstream right overbanks. The downstream left overbank is pasture and brushland. In the study area, the Mettawee River has an incised, sinuous channel with a slope of approximately 0.02 ft/ft, an average channel top width of 66 ft and an average bank height of 8 ft. The channel bed material ranges from gravel to boulders with a median grain size (D50) of 79.0 mm (0.259 ft). The geomorphic assessment at the time of the Level I and Level II site visit on August 5, 1996, indicated that the reach was stable. The Town Highway 10 crossing of the Mettawee River is a 26-ft-long, two-lane bridge consisting of a 24-ft steel-stringer span (Vermont Agency of Transportation, written communication, September 28, 1995). The opening length of the structure parallel to the bridge face is 24.1 ft. The bridge is supported by vertical, concrete abutments with wingwalls. The channel is skewed approximately 45 degrees to the opening while the opening-skew-to-roadway is zero degrees. At the

  7. Level II scour analysis for Bridge 13 (SHARTH00040013) on Town Highway 4, crossing Broad Brook, Sharon, Vermont

    Science.gov (United States)

    Wild, Emily C.; Weber, Matthew A.

    1997-01-01

    This report provides the results of a detailed Level II analysis of scour potential at structure SHARTH00040013 on Town Highway 4 crossing Broad Brook, Sharon, Vermont (figures 1–8). A Level II study is a basic engineering analysis of the site, including a quantitative analysis of stream stability and scour (U.S. Department of Transportation, 1993). Results of a Level I scour investigation also are included in Appendix E of this report. A Level I investigation provides a qualitative geomorphic characterization of the study site. Information on the bridge, gleaned from Vermont Agency of Transportation (VTAOT) files, was compiled prior to conducting Level I and Level II analyses and is found in Appendix D.The site is in the New England Upland section of the New England physiographic province in central Vermont. The 16.6-mi2 drainage area is in a predominantly rural and forested basin. In the vicinity of the study site, the surface cover is brushland on the downstream left overbank and row crops on the right overbank, while the immediate banks have dense woody vegetation. Upstream of the bridge, the overbanks are forested.In the study area, Broad Brook has an incised, sinuous channel with a slope of approximately 0.02 ft/ft, an average channel top width of 69 ft and an average bank height of 5 ft. The channel bed material ranges from sand to boulder with a median grain size (D50) of 112 mm (0.369 ft). The geomorphic assessment at the time of the Level I site visit on April 11, 1995 and Level II site visit on July 23, 1996, indicated that the reach was stable.The Town Highway 4 crossing of Broad Brook is a 34-ft-long, two-lane bridge consisting of one 31-foot concrete tee beam span (Vermont Agency of Transportation, written communication, March 23, 1995). The opening length of the structure parallel to the bridge face is 30.1 ft. The bridge is supported by vertical, concrete abutments with wingwalls. The channel is skewed approximately 10 degrees to the opening while

  8. Level II scour analysis for Bridge 24 (MANCUS00070024) on U.S. Route 7, crossing Lye Brook, Manchester, Vermont

    Science.gov (United States)

    Olson, Scott A.

    1997-01-01

    This report provides the results of a detailed Level II analysis of scour potential at structure MANCUS00070024 on U.S. Route 7 crossing Lye Brook, Manchester, Vermont (figures 1–8). A Level II study is a basic engineering analysis of the site, including a quantitative analysis of stream stability and scour (U.S. Department of Transportation, 1993). Results of a Level I scour investigation also are included in Appendix E of this report. A Level I investigation provides a qualitative geomorphic characterization of the study site. Information on the bridge, gleaned from Vermont Agency of Transportation (VTAOT) files, was compiled prior to conducting Level I and Level II analyses and is found in Appendix D. The site is in the Taconic section of the New England physiographic province in southwestern Vermont. The 8.13-mi2 drainage area is in a predominantly rural and forested basin. In the vicinity of the study site, the primary surface cover consists of brush and trees. In the study area, Lye Brook has an incised, sinuous channel with a slope of approximately 0.03 ft/ft, an average channel top width of 66 ft and an average bank height of 11 ft. The channel bed material ranges from gravel to boulder with a median grain size (D50) of 90.0 mm (0.295 ft). The geomorphic assessment at the time of the Level I and Level II site visit on August 6, 1996, indicated that the reach was stable. Although, the immediate reach is considered stable, upstream of the bridge the Lye Brook valley is very steep (0.05 ft/ft). Extreme events in a valley this steep may quickly reveal the instability of the channel. In the Flood Insurance Study for the Town of Manchester (Federal Emergency Management Agency, January, 1985), Lye Brook’s overbanks were described as “boulder strewn” after the August 1976 flood. The U.S. Route 7 crossing of Lye Brook is a 28-ft-long, two-lane bridge consisting of one 25-foot concrete span (Vermont Agency of Transportation, written communication, September

  9. Effects of Botulinum Toxin-A and Goal-Directed Physiotherapy in Children with Cerebral Palsy GMFCS Levels I & II.

    Science.gov (United States)

    Löwing, Kristina; Thews, Karin; Haglund-Åkerlind, Yvonne; Gutierrez-Farewik, Elena M

    2017-08-01

    To evaluate short and long-term effects of botulinum toxin-A combined with goal-directed physiotherapy in children with cerebral palsy (CP). A consecutive selection of 40 children, ages 4-12 years, diagnosed with unilateral or bilateral CP, and classified in GMFCS levels I-II. During the 24 months, 9 children received one BoNT-A injection, 10 children two injections, 11 children three injections, and 10 children received four injections. 3D gait analysis, goal-attainment scaling, and body function assessments were performed before and at 3, 12, and 24 months after initial injections. A significant but clinically small long-term improvement in gait was observed. Plantarflexor spasticity was reduced after three months and remained stable, while passive ankle dorsiflexion increased after 3 months but decreased slightly after 12 months. Goal-attainment gradually increased, reached the highest levels at 12 months, and levels were maintained at 24 months. The treatments' positive effect on spasticity reduction was identified, but did not relate to improvement in gait or goal-attainment. No long-term positive change in passive ankle dorsiflexion was observed. Goal attainment was achieved in all except four children. The clinical significance of the improved gait is unclear. Further studies are recommended to identify predictors for positive treatment outcome.

  10. The role of childhood and adulthood trauma and appraisal of self-discrepancy in overgeneral memory retrieval.

    Science.gov (United States)

    Ono, Miyuki; Devilly, Grant J

    2013-01-01

    The aim of this study was to examine the contributory role of childhood and adulthood trauma events and the appraisal of self-discrepancy (the magnitude and distress) in overgeneral memory retrieval (OGM) using a non-clinical sample. Participants with a history of childhood trauma (n=29); adulthood trauma only (n=17) or no-trauma (n=26) participated in this study. The childhood trauma group showed a significantly higher level of general negative memory retrieval than the no-trauma group. Conversely, the adulthood trauma group showed a significantly higher level of general threat memory retrieval than the no-trauma group. The perceived similarity and distress relating to the perceived similarity between participants' "actual self" and "feared self" significantly predicted the level of OGM, even after controlling for the impact of a history of adult or child trauma.

  11. Emergency Department Management of Trauma

    DEFF Research Database (Denmark)

    MacKenzie, Colin; Lippert, Freddy

    1999-01-01

    Initial assessment and management of severely injured patients may occur in a specialized area of an emergency department or in a specialized area of a trauma center. The time from injury until definitive management is of essence for survival of life-threatening trauma. The initial care delivered...... injured patients after these patients reach a hospital emergency department or a trauma center....

  12. Determination of subnanomolar levels of mercury (II) by using a graphite paste electrode modified with MWCNTs and Hg(II)-imprinted polymer nanoparticles.

    Science.gov (United States)

    Alizadeh, Taher; Hamidi, Negin; Ganjali, Mohamad Reza; Rafiei, Faride

    2017-12-05

    Mercury ion-imprinted polymer nanoparticles (Hg-IP-NPs) were synthesized via precipitation polymerization by using itaconic acid as a functional monomer. A carbon paste electrode was impregnated with the synthesized Hg-IP-NPs and MWCNTs to obtain a highly sensitive and selective electrode for determination of Hg(II). Mercury ion is first accumulated on the electrode surface via an open circuit procedure. After reduction of Hg(II) ions to its metallic form at a negative pre-potential, square wave anodic stripping voltammetry was applied to generate the electrochemical signal. The high affinity of the Hg-IP-NPs for Hg(II) was substantiated by comparing of the signals of electrodes with imprinted and non-imprinted polymer. The beneficial effect of MWCNTs on the voltammetric signal is also demonstrated. Under the optimized conditions and at a typical working potential of +0.05 V (vs. Ag/AgCl), the electrode has a linear response in the 0.1-20 nmol L -1 Hg(II) concentration range and a 29 pM detection limit. The electrochemical sensitivity is as high as 1441 A·M -1 ·cm -2 which is among the best values known. The electrode was applied to the determination of Hg(II) in water samples. Graphical abstract Schematic representation of the sensor electrode modified with mercury-imprinted polymer nanoparticles, and the recognition and voltammetric determination steps.

  13. Gênero e trauma Gender and trauma

    Directory of Open Access Journals (Sweden)

    Gláucio Ary Dillon Soares

    2005-04-01

    Full Text Available As conseqüências sociais e psicológicas da violência urbana sobre os parentes e amigos de pessoas vitimadas por mortes violentas (homicídio, suicídio ou acidentes são analisadas à luz das diferenças de gênero. A literatura especializada nesta área propõe que mulheres e homens vivenciam experiências traumáticas de forma peculiar. Porém, os traumas típicos são diferentes em cada gênero, deixando em aberto a questão sobre quanto das diferenças entre as respostas se devem a gênero e quanto se devem ao tipo de trauma. Testamos a hipótese de que as mulheres são mais suscetíveis à desordem de estresse pós-trauma (DEPT numa situação traumática comum, usando dados qualitativos e quantitativos. Comparamos os sintomas do trauma e as percepções sobre o significado da perda de seus entes queridos. A amostra, de 425 mulheres (62% e 265 homens (38%, foi retirada de uma lista de parentes de pessoas que sofreram morte violenta na cidade do Rio de Janeiro. Incluímos trinta relatos de parentes e amigos próximos das vítimas diretas. Os resultados revelaram que 54% das mulheres e 41% dos homens tiveram o cotidiano alterado depois da morte de um parente/amigo. Há diferenças estatisticamente significativas nos problemas de saúde e na diversão. Essa área foi a mais afetada, atingindo metade dos entrevistados. Uma variável intimamente correlacionada com os sintomas da DEPT é o contato com o corpo: controlando a extensão do contato (fez o reconhecimento do corpo; viu, mas não reconheceu e nem viu nem reconheceu. Em cada uma dessas categorias, as mulheres foram mais afetadas do que os homens. O artigo conclui que as mulheres sentem mais as perdas do que os homens, mas que parte das diferenças não são internas aos gêneros, mas externas a eles, dependendo das interações e dos contatos pessoais.The social and psychological consequences endured by friends and relatives of people victimized by violent death (homicide, suicide or

  14. Effect of Age-Related Cartilage Turnover on Serum C-Telopeptide of Collagen Type II and Osteocalcin Levels in Growing Rabbits with and without Surgically Induced Osteoarthritis

    Directory of Open Access Journals (Sweden)

    Chung-Cheng Huang

    2014-01-01

    Full Text Available This study aims to determine the effect of age-related cartilage turnover on the serum C-telopeptide of type II collagen (CTX-II and osteocalcin (OC levels in growing rabbits with and without surgically induced osteoarthritis. Twenty-four New Zealand male 3-month-old rabbits were randomized into three operated groups (n = 6 per group, with surgically induced osteroarthritis in the right knee; after blood sampling, the knees were harvested following euthanization at 2, 3, and 6 months after surgery and a control group (n = 6, blood samples were obtained monthly between 3 and 15 months. Histomorphologically, the medial femoral condyles, particularly the central parts, harbored the most severe osteoarthritic changes among the operated rabbits. The serum levels of CTX-II and OC decreased in the controls from 3 to 11 months and then remained stable. No significant differences in the serum CTX-II and OC levels between the osteoarthritic rabbits and controls were observed. The osteoarthritic-to-normal ratios (ONRs, the ratios of serum CTX-II or OC levels in osteoarthritic rabbits to those of the controls at same ages enabled an overall assessment of osteoarthritis and age-related cartilage turnover. Elevated CTX-II ONRs were observed in rabbits with mild to advanced osteoarthritis. However, the OC ONRs were unhelpful in assessing osteoarthritic growing rabbits.

  15. The role of DSM-5 borderline personality symptomatology and traits in the link between childhood trauma and suicidal risk in psychiatric patients.

    Science.gov (United States)

    Bach, Bo; Fjeldsted, Rita

    2017-01-01

    Childhood traumas appear to be linked to suicidal behavior. However, the factors that mediate between these two phenomena are not sufficiently understood. Recent findings suggest that borderline personality disorder (BPD) may explain some of the association. The present study investigated the potential mediating role of BPD symptomatology and traits between reported childhood trauma and suicidal risk in adult psychiatric outpatients ( N  = 124). BPD symptomatology was measured with DSM-5 Section II criterion-counts (SCID-II; Structured Clinical Interview for DSM-IV Axis II), whereas BPD traits were measured with specified DSM-5 Section III traits (PID-5; Personality Inventory for DSM-5). Childhood traumas were self-reported (CTQ; Childhood Trauma Questionnaire), whereas level of suicidal risk was measured with a structured interview (MINI Suicidality Module; Mini International Neuropsychiatric Interview). Mediation effects were tested by bias-corrected (10.000 boot-strapped samples) confidence intervals. BPD features account for a considerable part of the cross-sectional association between childhood trauma and level of suicidal risk, even when controlling for the influence of gender, age, and educational level. This finding remained stable when testing the model without the suicidality-related BPD criterion and PID-5 items. DSM-5 Section II BPD criterion-counts explained 67% of the total effect, whereas DSM-5 Section III BPD traits accounted for 82% of the total effect. The specific DSM-5 Section III trait facets of "Depressivity" (52%) and "Perceptual Dysregulation" (37%) accounted for most of this effect. The findings provide preliminary support for the proposed mediation model indicating that BPD features may help explain relations between childhood trauma and elevated suicidal risk in adult life, in particular for DSM-5 Section III personality traits of depressivity (e.g., pessimism, guilt, and shame) and perceptual dysregulation (e.g., dissociation). To

  16. About Military Sexual Trauma

    Medline Plus

    Full Text Available ... Get YouTube Red. Working... Not now Try it free Find out why Close About Military Sexual Trauma ... MST. http://www.mentalhealth.va.gov/msthom... Category Education License Standard YouTube License Show more Show less ...

  17. Haemostatic resuscitation in trauma

    DEFF Research Database (Denmark)

    Stensballe, Jakob; Ostrowski, Sisse Rye; Johansson, Par I.

    2016-01-01

    of a ratio driven strategy aiming at 1 : 1 : 1, using tranexamic acid according to CRASH-2, and applying haemostatic monitoring enabling a switch to a goal-directed approach when bleeding slows. Haemostatic resuscitation is the mainstay of trauma resuscitation and is associated with improved survival...

  18. Trauma Aware & Safety Ready

    Science.gov (United States)

    Paterson, Jim

    2017-01-01

    The interwoven issues of trauma and safety have swept through college campuses over the last decade, and they've arrived at doors of admission offices, encouraging officials to think more carefully about those concerns and take a closer look at how they handle them. Experts recommend in this atmosphere that admission offices discuss these topics…

  19. Understanding Child Trauma

    Science.gov (United States)

    ... help of a trained professional. When needed, a mental health professional trained in evidence-based trauma treatment can help children and families cope and move toward recovery. Ask your pediatrician, family physician, school counselor, or clergy member for a referral. Visit ...

  20. Imaging of vertebral trauma

    International Nuclear Information System (INIS)

    Daffner, R.H.

    1999-01-01

    This translation of the toolbook published in the 'US-ART' series, offers invaluable help to medical radiologists in the diagnostic imaging and evaluation of complex vertebral traumas which are on the rise, inter alia due to increasingly dangerous leisure sports. (orig./CB) [de

  1. When Trauma Hinders Learning

    Science.gov (United States)

    Barr, Donald A.

    2018-01-01

    Many kindergarten teachers have encountered children who enter school lacking the ability to control their behavior, but they may not understand the social and biological processes behind these children's disruptive behavior. The author reviews research into early childhood brain development to explain how trauma and chronic stress can make it…

  2. About Military Sexual Trauma

    Medline Plus

    Full Text Available ... count__/__total__ Find out why Close About Military Sexual Trauma Veterans Health Administration Loading... Unsubscribe from Veterans ... MST. http://www.mentalhealth.va.gov/msthom... Category Education License Standard YouTube License Show more Show less ...

  3. Early Childhood Trauma

    Science.gov (United States)

    National Child Traumatic Stress Network, 2010

    2010-01-01

    Early childhood trauma generally refers to the traumatic experiences that occur to children aged 0-6. Because infants' and young children's reactions may be different from older children's, and because they may not be able to verbalize their reactions to threatening or dangerous events, many people assume that young age protects children from the…

  4. Trauma patient discharge and care transition experiences: Identifying opportunities for quality improvement in trauma centres.

    Science.gov (United States)

    Gotlib Conn, Lesley; Zwaiman, Ashley; DasGupta, Tracey; Hales, Brigette; Watamaniuk, Aaron; Nathens, Avery B

    2018-01-01

    Challenges delivering quality care are especially salient during hospital discharge and care transitions. Severely injured patients discharged from a trauma centre will go either home, to rehabilitation or another acute care hospital with complex management needs. This purpose of this study was to explore the experiences of trauma patients and families treated in a regional academic trauma centre to better understand and improve their discharge and care transition experiences. A qualitative study using inductive thematic analysis was conducted between March and October 2016. Telephone interviews were conducted with trauma patients and/or a family member after discharge from the trauma centre. Data collection and analysis were completed inductively and iteratively consistent with a qualitative approach. Twenty-four interviews included 19 patients and 7 family members. Participants' experiences drew attention to discharge and transfer processes that either (1) Fostered quality discharge or (2) Impeded quality discharge. Fostering quality discharge was ward staff preparation efforts; establishing effective care continuity; and, adequate emotional support. Impeding discharge quality was perceived pressure to leave the hospital; imposed transfer decisions; and, sub-optimal communication and coordination around discharge. Patient-provider communication was viewed to be driven by system, rather than patient need. Inter-facility information gaps raised concern about receiving facilities' ability to care for injured patients. The quality of trauma patient discharge and transition experiences is undermined by system- and ward-level processes that compete, rather than align, in producing high quality patient-centred discharge. Local improvement solutions focused on modifiable factors within the trauma centre include patient-oriented discharge education and patient navigation; however, these approaches alone may be insufficient to enhance patient experiences. Trauma patients

  5. The interaction between radiation and complexes of cis-Pt(II) and Rh(II): studies at the molecular and cellular level

    International Nuclear Information System (INIS)

    Chibber, R.

    1985-01-01

    As a first step in gaining an understanding of the relative cellular effects of the transition metal/nitroimidazole complexes the authors have examined the effect of radiation given to cells in the presence of metal complexes not containing a nitroimidazole ligand. The compounds used in the cellular work are a series of Rh(II) carboxylates, cisplatin and JM8 (CBDCA, cis-diammine-1, 1-cyclobutane dicarboxylate platinum (II)). In radiation chemical experiments, Rh(II) acetate and cisplatin were chosen to represent model systems. Results from these radiation chemical and cellular experiments then allow interpretation of the changes in biological response caused by these agents, which are discussed in terms of the mechanism(s) thought to be operative in radiosensitization. (author)

  6. MANAGEMENT OF LIVER TRAUMA

    Directory of Open Access Journals (Sweden)

    Dova Subba

    2016-03-01

    Full Text Available AIM To estimate the incidence of Liver Trauma injuries and grade their severity of injury. To assess the factors responsible for morbidity and mortality after Liver Trauma. To study the postoperative complications and the management of Liver Trauma. MATERIALS AND METHODS The present prospective study was conducted on 100 patients who were admitted to Department of General Surgery for treatment who were managed operatively or non-operatively for abdominal trauma and having liver injury forms the material of the study. This study was conducted over a span of 24 months from June 2013 to November 2015. RESULTS Maximum number of patients are in the age group of 21-30 years (46%. 85% patients (85/100 are males and 15% of patients (15/100 are females. Lapse time of injury and admission varied from 25 minutes to 66 hours and 30 minutes. 75 % of the patients (75/100 presented within 24 hours after injury. Death rate of patients who reached hospital after 24 hours of injury was higher than the patients who reached hospital within 24 hours of injury. 28% of patients (28/100 had associated bony injuries, out of which 5% of patients (5/100 expired due to primary haemorrhage of fractured femur. More than one segment was injured in many patients. Segment V is involved commonly making 55% (55/100 of patients. Next common segment involved is segment VII, making 39% (39/100. CONCLUSION Mechanism of injury is the important factor which is responsible for morbidity in liver injury. Nonoperative management proved to be safe and effective and often has been used to treat patients with liver trauma.

  7. Penetrating ureteral trauma

    Directory of Open Access Journals (Sweden)

    Gustavo P. Fraga

    2007-04-01

    Full Text Available OBJECTIVE: The purpose of this series is to report our experience in managing ureteral trauma, focusing on the importance of early diagnosis, correct treatment, and the impact of associated injuries on the management and morbid-mortality. MATERIALS AND METHODS: From January 1994 to December 2002, 1487 laparotomies for abdominal trauma were performed and 20 patients with ureteral lesions were identified, all of them secondary to penetrating injury. Medical charts were analyzed as well as information about trauma mechanisms, diagnostic routine, treatment and outcome. RESULTS: All patients were men. Mean age was 27 years. The mechanisms of injury were gunshot wounds in 18 cases (90% and stab wounds in two (10%. All penetrating abdominal injuries had primary indication of laparotomy, and neither excretory urography nor computed tomography were used in any case before surgery. The diagnosis of ureteric injury was made intra-operatively in 17 cases (85%. Two ureteral injuries (10% were initially missed. All patients had associated injuries. The treatment was dictated by the location, extension and time necessary to identify the injury. The overall incidence of complications was 55%. The presence of shock on admission, delayed diagnosis, Abdominal Trauma Index > 25, Injury Severity Score > 25 and colon injuries were associated to a high complication rate, however, there was no statistically significant difference. There were no mortalities in this group. CONCLUSIONS: A high index of suspicion is required for diagnosis of ureteral injuries. A thorough exploration of all retroperitoneal hematoma after penetrating trauma should be an accurate method of diagnosis; even though it failed in 10% of our cases.

  8. Imaging in spinal trauma

    International Nuclear Information System (INIS)

    Goethem, J.W.M. van; Maes, Menno; Oezsarlak, Oezkan; Hauwe, Luc van den; Parizel, Paul M.

    2005-01-01

    Because it may cause paralysis, injury to the spine is one of the most feared traumas, and spinal cord injury is a major cause of disability. In the USA approximately 10,000 traumatic cervical spine fractures and 4000 traumatic thoracolumbar fractures are diagnosed each year. Although the number of individuals sustaining paralysis is far less than those with moderate or severe brain injury, the socioeconomic costs are significant. Since most of the spinal trauma patients survive their injuries, almost one out of 1000 inhabitants in the USA are currently being cared for partial or complete paralysis. Little controversy exists regarding the need for accurate and emergent imaging assessment of the traumatized spine in order to evaluate spinal stability and integrity of neural elements. Because clinicians fear missing occult spine injuries, they obtain radiographs for nearly all patients who present with blunt trauma. We are influenced on one side by fear of litigation and the possible devastating medical, psychologic and financial consequences of cervical spine injury, and on the other side by pressure to reduce health care costs. A set of clinical and/or anamnestic criteria, however, can be very useful in identifying patients who have an extremely low probability of injury and who consequently have no need for imaging studies. Multidetector (or multislice) computed tomography (MDCT) is the preferred primary imaging modality in blunt spinal trauma patients who do need imaging. Not only is CT more accurate in diagnosing spinal injury, it also reduces imaging time and patient manipulation. Evidence-based research has established that MDCT improves patient outcome and saves money in comparison to plain film. This review discusses the use, advantages and disadvantages of the different imaging techniques used in spinal trauma patients and the criteria used in selecting patients who do not need imaging. Finally an overview of different types of spinal injuries is given

  9. Imaging in spinal trauma

    Energy Technology Data Exchange (ETDEWEB)

    Goethem, J.W.M. van [Universitair Ziekenhuis Antwerpen, University of Antwerp, Belgium, Department of Radiology, Edegem (Belgium); Algemeen Ziekenhuis Maria Middelares, Department of Radiology, Sint-Niklaas (Belgium); Maes, Menno; Oezsarlak, Oezkan; Hauwe, Luc van den; Parizel, Paul M. [Universitair Ziekenhuis Antwerpen, University of Antwerp, Belgium, Department of Radiology, Edegem (Belgium)

    2005-03-01

    Because it may cause paralysis, injury to the spine is one of the most feared traumas, and spinal cord injury is a major cause of disability. In the USA approximately 10,000 traumatic cervical spine fractures and 4000 traumatic thoracolumbar fractures are diagnosed each year. Although the number of individuals sustaining paralysis is far less than those with moderate or severe brain injury, the socioeconomic costs are significant. Since most of the spinal trauma patients survive their injuries, almost one out of 1000 inhabitants in the USA are currently being cared for partial or complete paralysis. Little controversy exists regarding the need for accurate and emergent imaging assessment of the traumatized spine in order to evaluate spinal stability and integrity of neural elements. Because clinicians fear missing occult spine injuries, they obtain radiographs for nearly all patients who present with blunt trauma. We are influenced on one side by fear of litigation and the possible devastating medical, psychologic and financial consequences of cervical spine injury, and on the other side by pressure to reduce health care costs. A set of clinical and/or anamnestic criteria, however, can be very useful in identifying patients who have an extremely low probability of injury and who consequently have no need for imaging studies. Multidetector (or multislice) computed tomography (MDCT) is the preferred primary imaging modality in blunt spinal trauma patients who do need imaging. Not only is CT more accurate in diagnosing spinal injury, it also reduces imaging time and patient manipulation. Evidence-based research has established that MDCT improves patient outcome and saves money in comparison to plain film. This review discusses the use, advantages and disadvantages of the different imaging techniques used in spinal trauma patients and the criteria used in selecting patients who do not need imaging. Finally an overview of different types of spinal injuries is given

  10. Is trauma in Switzerland any different? epidemiology and patterns of injury in major trauma - a 5-year review from a Swiss trauma centre.

    Science.gov (United States)

    Heim, C; Bosisio, F; Roth, A; Bloch, J; Borens, O; Daniel, R T; Denys, A; Oddo, M; Pasquier, M; Schmidt, S; Schoettker, P; Zingg, T; Wasserfallen, J B

    2014-01-01

    Switzerland, the country with the highest health expenditure per capita, is lacking data on trauma care and system planning. Recently, 12 trauma centres were designated to be reassessed through a future national trauma registry by 2015. Lausanne University Hospital launched the first Swiss trauma registry in 2008, which contains the largest database on trauma activity nationwide. Prospective analysis of data from consecutively admitted shock room patients from 1 January 2008 to 31 December 2012. Shock room admission is based on physiology and mechanism of injury, assessed by prehospital physicians. Management follows a surgeon-led multidisciplinary approach. Injuries are coded by Association for the Advancement of Automotive Medicine (AAAM) certified coders. Over the 5 years, 1,599 trauma patients were admitted, predominantly males with a median age of 41.4 years and median injury severity score (ISS) of 13. Rate of ISS >15 was 42%. Principal mechanisms of injury were road traffic (40.4%) and falls (34.4%), with 91.5% blunt trauma. Principal patterns were brain (64.4%), chest (59.8%) and extremity/pelvic girdle (52.9%) injuries. Severe (abbreviated injury scale [AIS] score ≥ 3) orthopaedic injuries, defined as extremity and spine injuries together, accounted for 67.1%. Overall, 29.1% underwent immediate intervention, mainly by orthopaedics (27.3%), neurosurgeons (26.3 %) and visceral surgeons (13.9%); 43.8% underwent a surgical intervention within the first 24 hours and 59.1% during their hospitalisation. In-hospital mortality for patients with ISS >15 was 26.2%. This is the first 5-year report on trauma in Switzerland. Trauma workload was similar to other European countries. Despite high levels of healthcare, mortality exceeds published rates by >50%. Regardless of the importance of a multidisciplinary approach, trauma remains a surgical disease and needs dedicated surgical resources.

  11. need for screening for alcohol and drugs in emergency trauma units

    African Journals Online (AJOL)

    2013-05-05

    May 5, 2013 ... Therefore trauma patients require routine toxicological screening to provide basis ... (ii) to identify sociodemographic characteristics that correlated with injury ..... an error in AIS scoring is transferred to the ISS, different injury ...

  12. Trauma care system in Iran

    Directory of Open Access Journals (Sweden)

    Zargar Moussa

    2011-06-01

    Full Text Available 【Abstract】Objective: The high burden of injuries in Iran necessitates the establishment of a comprehensive trauma care system. The purpose of this paper is to de- scribe the current status of trauma system regarding the components and function. Methods: The current status of trauma system in all components of a trauma system was described through ex- pert panels and semi-structured interviews with trauma spe- cialists and policy makers. Results: Currently, various organizations are involved in prevention, management and rehabilitation of injuries, but an integrative system approach to trauma is rather deficient. There has been ongoing progress in areas of pub- lic education through media, traffic regulation reinforcement, hospital care and prehospital services. Meanwhile, there are gaps regarding financing, legislations and education of high risk groups. The issues on education and training stan- dards of the front line medical team and continuing educa- tion and evaluation are yet to be addressed. Trauma regis- try has been piloted in some provinces, but as it needs the well-developed infrastructure (regarding staff, maintenance, financial resources, it is not yet established in our system of trauma care. Conclusions: It seems that one of the problems with trauma care in Iran is lack of coordination among trauma system organizations. Although the clinical management of trauma patients has improved in our country in the recent decade, decreasing the burden of injuries necessitates an organized approach to prevention and management of trauma in the context of a trauma system. Key words: Emergency medical services; Trauma centers; Wounds and injuries

  13. Evaluating trauma center structural performance: The experience of a Canadian provincial trauma system

    Directory of Open Access Journals (Sweden)

    Lynne Moore

    2013-01-01

    Full Text Available Background: Indicators of structure, process, and outcome are required to evaluate the performance of trauma centers to improve the quality and efficiency of care. While periodic external accreditation visits are part of most trauma systems, a quantitative indicator of structural performance has yet to be proposed. The objective of this study was to develop and validate a trauma center structural performance indicator using accreditation report data. Materials and Methods: Analyses were based on accreditation reports completed during on-site visits in the Quebec trauma system (1994-2005. Qualitative report data was retrospectively transposed onto an evaluation grid and the weighted average of grid items was used to quantify performance. The indicator of structural performance was evaluated in terms of test-retest reliability (kappa statistic, discrimination between centers (coefficient of variation, content validity (correlation with accreditation decision, designation level, and patient volume and forecasting (correlation between visits performed in 1994-1999 and 1998-2005. Results: Kappa statistics were >0.8 for 66 of the 73 (90% grid items. Mean structural performance score over 59 trauma centers was 47.4 (95% CI: 43.6-51.1. Two centers were flagged as outliers and the coefficient of variation was 31.2% (95% CI: 25.5% to 37.6%, showing good discrimination. Correlation coefficients of associations with accreditation decision, designation level, and volume were all statistically significant (r = 0.61, -0.40, and 0.24, respectively. No correlation was observed over time (r = 0.03. Conclusion: This study demonstrates the feasibility of quantifying trauma center structural performance using accreditation reports. The proposed performance indicator shows good test-retest reliability, between-center discrimination, and construct validity. The observed variability in structural performance across centers and over-time underlines the importance of

  14. Trauma Tactics: Rethinking Trauma Education for Professional Nurses.

    Science.gov (United States)

    Garvey, Paula; Liddil, Jessica; Eley, Scott; Winfield, Scott

    2016-01-01

    According to the National Trauma Institute (2015), trauma accounts for more than 180,000 deaths each year in the United States. Nurses play a significant role in the care of trauma patients and therefore need appropriate education and training (L. ). Although several courses exist for trauma education, many nurses have not received adequate education in trauma management (B. ; L. ). Trauma Tactics, a 2-day course that focuses on high-fidelity human patient simulation, was created to meet this educational need. This descriptive study was conducted retrospectively to assess the effectiveness of the Trauma Tactics course. Pre- and postsurveys, tests, and simulation performance were used to evaluate professional nurses who participated in Trauma Tactics over a 10-month period. Fifty-five nurses were included in the study. Pre- and postsurveys revealed an increase in overall confidence, test scores increased by an average of 2.5 points, and simulation performance scores increased by an average of 16 points. Trauma Tactics is a high-quality course that provides a valuable and impactful educational experience for nurses. Further research is needed to evaluate the long-term effects of Trauma Tactics and its impacts on quality of care and patient outcomes.

  15. Abusive Head Trauma in Children: A Literature Review

    Directory of Open Access Journals (Sweden)

    Nahara R.L. Lopes

    2013-09-01

    Conclusions: : Considering the severity of abusive head trauma in children, it is critical that prevention strategies be implemented and evaluated in the Brazilian context. It is suggested that its incidence indicators be assessed at the national level.

  16. Clinical significance of measurement of changes of serum IGF-II, SCC and CYFRA21-1 levels after operation in patients with carcinoma of uterine cervix

    International Nuclear Information System (INIS)

    Kuang Lei

    2010-01-01

    Objective: To explore the clinical significance of changes of serum IGF-II, SCC and CYFRA21-1 levels after operation in patients with carcinoma uterine cervix. Methods: Serum levels of IGF-II, SCC and CYFRA21-1 were determined with RIA repeatedly in 31 patients with carcinoma of uterine cervix (before operation 1 month after operation and 6 month after operation) and once in 35 controls. Results: Before operation,serum levels of IGF-II, SCC and CYFRA21-1 in the patients were significantly higher than those in the controls (P<0.01). One month after operation all the serum levels were approaching normal. Six month later,the levels in the patients without recurrence remained normal. However, the levels in the 6 patients with recurrence returned to those before operation again. Conclusion: Changes of serum IGF-II, SCC and CYFRA21-1 levels are closely related to the tumor burden and may be of prognostic importance. (authors)

  17. Results of level-ii oncoplasty in breast cancer patients: an early experience from a tertiary care hospital in pakistan

    International Nuclear Information System (INIS)

    Qureshi, S.; Ghazanfar, S.; Quraishy, S.; Iqbal, S.

    2014-01-01

    Objective: To assess the oncologic and cosmetic outcomes for breast cancer patients who underwent breast conservation therapy using Level II oncoplasty techniques. Methods: The prospective, non-randomised and descriptive study was conducted at the Department of Surgery, Unit IV of Civil Hospital, Karachi, from December 2009 to November 2011 in which 21 consecutive women with breast carcinoma who underwent wide local excision with remodeling mammoplasty were enrolled. All patients were reviewed by the surgeon and medical oncologist every 3 months for the first year. A grading system of 5-1 (excellent to poor) was employed and those with 3 or more were considered to have acceptable results. Results: The mean patient age was 45.38+-10.09 years (range: 26-70); 11 (52.3%) were premenopausal and 10 (47.7%) were postmenopausal; and 5 (27.8%) had family history of breast cancer. The mean size of the tumour determined by histology was 59.9+-3.18 mm (range: 25-150). Eight (30%) patients received preoperative chemotherapy to downsize the tumour. Three (14.2%) patients received preoperative radiotherapy. Mean operative time was 1.59+-0.52 hours (range: 1-2.5 hours). Mean volume of breast tissue excised from the breast containing the tumour was 545.27+-412.06 cm3 (range: 43.70-1456). Assessment of excision margins showed no tumour at the margins of 19 (90.4%) patients. Two (9.5%) patients had close but negative margins. The mean hospital stay was 7.10+-3.30 days (range: 4-15). There were early complications in 4 (19%) patients. One (4.76%) patient had late complications. Two (9.5%) patients developed tumour recurrence; both had an ipsilateral tumour recurrence. None of the patients developed metastases and one died of cardiac problem. Twenty (95.2%) patients had an acceptable post-surgical cosmetic result. Conclusion: Level II oncoplasty was a safe option in breast conservation allowing large sized and difficult-location tumour excision with good cosmetic outcome in the study