Attempting to validate the over/under triage matrix at a level I trauma center.

The Optimal Resources Document (ORD) mandates trauma activation based on injury mechanism, physiologic and anatomic criteria and recommends using the over/undertriage matrix (Matrix) to evaluate the appropriateness of trauma team activation. The purpose of this study was to assess the effectiveness of the Matrix method by comparing patients appropriately triaged with those undertriaged. We hypothesized that these two groups are different and Matrix does not discriminate the needs or outcomes of these different groups of patients.Trauma registry data, from 1/2013-12/2015, at a Level I trauma center were reviewed. Over and undertriage rates were calculated by Matrix. Patients with ISS ≥16 were classified by activation level (full, limited, consultation), and triage category by Matrix. Patients in the limited activation and consultation groups were compared to patients with full activation by demographics, injuries, initial vital signs, procedures, delays to procedure, ICU admission, length of stay, and mortality.7031 patients met activation criteria. Compliance with ACS tiered activation criteria was 99%. The Matrix overtriage rate was 45% and undertriage was 24%. Of 2282 patients with an ISS ≥16, 1026 were appropriately triaged (full activation), and 1256 were under triaged. Undertriaged patients had better GCS, blood pressure, and BD than patients with full activation. ICU admission, hospital stays, and mortality were lower in the undertriaged group. The under triaged group required fewer operative interventions with fewer delays to procedure.Despite having an ISS ≥ 16, patients with limited activations were dissimilar to patients with full activation. Level of activation and triage are not equivalent. The ACS-COT full and tiered activation criteria are a robust means to have the appropriate personnel present based on available pre-hospital information. Evaluation of the process of care, regardless of level of activation should be used to evaluate trauma center performance.Level III Therapeutic and Care managementThis is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal

Current outcomes of blunt open pelvic fractures: how modern advances in trauma care may decrease mortality.

Background:Open pelvic fracture, caused by a blunt mechanism, is an uncommon injury with a high mortality rate. In 2008, evidence-based algorithm for managing pelvic fractures in unstable patients was published by the Western Trauma Association (WTA). The use of massive transfusion protocols has become widespread as has the availability and use of pelvic angiography. The purpose of this study was to evaluate the outcome of open pelvic fractures in association with related advances in trauma care. Methods:A retrospective review was performed, at an American College of Surgeon verified level I trauma center, of patients with blunt open pelvic fractures from January 2010 to April 2016. The WTA algorithm, including massive transfusion protocol, and pelvic angiography were uniformly used. Data collected included injury severity score, demographic data, transfusion requirements, use of pelvic angiography, length of stay, and disposition. Data were compared with a similar study from 2005. Results:During the study period, 1505 patients with pelvic fractures were analyzed; 87 (6%) patients had open pelvic fractures. Of these, 25 were from blunt mechanisms and made up the study population. Patients in both studies had similar injury severity scores, ages, Glasgow Coma Scale, and gender distributions. Use of angiography was higher (44% vs. 16%; P=0.011) and mortality was lower (16% vs. 45%; P=0.014) than in the 2005 study. Conclusions:Changes in trauma care for patients with open blunt pelvic fracture include the use of an evidence-based algorithm, massive transfusion protocols and increased use of angioembolization. Mortality for open pelvic fractures has decreased with these advances. Level of evidence:Level IV

New light curves and ephemeris for the close eclipsing binary V963 PER

We have obtained CCD photometry in 2010-11 of V963 Per (=GSC3355 0394), which is a recently identified close binary star with unequal eclipse depths. The seven new eclipse timings yield an improved ephemeris, but we caution that secondary eclipse can be affected by variation of the light curve. This variation seems to be on a monthly timescale at the few percent level.Comment: 6 pages, 3 figure

Air Pollution Exposure in Relation to the Commute to School: A Bradford UK Case Study

Walking School Buses (WSBs) provide a safe alternative to being driven to school. Children benefit from the contribution the exercise provides towards their daily exercise target, it gives children practical experience with respect to road safety and it helps to relieve traffic congestion around the entrance to their school. Walking routes are designed largely based in road safety considerations, catchment need and the availability of parent support. However, little attention is given to the air pollution exposure experienced by children during their journey to school, despite the commuting microenvironment being an important contributor to a child’s daily air pollution exposure. This study aims to quantify the air pollution exposure experienced by children walking to school and those being driven by car. A school was chosen in Bradford, UK. Three adult participants carried out the journey to and from school, each carrying a P-Trak ultrafine particle (UFP) count monitor. One participant travelled the journey to school by car while the other two walked, each on opposite sides of the road for the majority of the journey. Data collection was carried out over a period of two weeks, for a total of five journeys to school in the morning and five on the way home at the end of the school day. Results of the study suggest that car commuters experience lower levels of air pollution dose due to lower exposure and reduced commute times. The largest reductions in exposure for pedestrians can be achieved by avoiding close proximity to traffic queuing up at intersections, and, where possible, walking on the side of the road opposite the traffic, especially during the morning commuting period. Major intersections should also be avoided as they were associated with peak exposures. Steps to ensure that the phasing of lights is optimised to minimise pedestrian waiting time would also help reduce exposure. If possible, busy roads should be avoided altogether. By the careful design of WSB routes, taking into account air pollution, children will be able to experience the benefits that walking to school brings while minimizing their air pollution exposure during their commute to and from school

A preliminary checklist of fungi at the Boston Harbor Islands

Between December 2012 and May 2017, we conducted a fungal inventory at the Boston Harbor Islands National Recreation Area (BHI) in Massachusetts. We extensively sampled 4 sites (Grape Island, Peddocks Island, Thompson Island, and World's End peninsula) and occasionally visited 4 others for sampling (Calf Island, Great Brewster Island, Slate Island, and Webb Memorial State Park). We made over 900 collections, of which 313 have been identified. The survey yielded 172 species in 123 genera, 62 families, 24 orders, 11 classes, and 2 phyla. We report 4 species as new, but not formally described, in the genera Orbilia, Resupinatus, and Xylaria. Another collection in the genus Lactarius may be new to science, but further morphological and molecular work is needed to confirm this conclusion. Additionally, Orbilia aprilis is a new report for North America, Proliferodiscus earoleucus represents only the second report for the US, and Chrysosporium sulfureum, a common fungus of some cheeses, was discovered on woodlice (Crustacea: Malacostraca: Isopoda: Oniscidea). We discuss our findings in the light of DNA-based identifications using the ITS ribosomal DNA region, including the advantages and disadvantages of this approach, and stress the need for biodiversity studies in urbanized areas during all seasons

Research and Consultancy Services in the Mining Industry in Zimbabwe: A Coordinated Approach Through the Mineral Resources Centre

IMR Report.Education in the engineering fields can be considerably enhanced if it is designed to address the immediate and long-term needs of society. In this context education not only comprises the provision of basic training, but also includes the careful planning and execution of applied and fundamental research. This paper focuses on education and research institutions that provide services to the mining sector in Zimbabwe and describes a new approach to meeting high-quality teaching, research and consultancy requirements against a background of diminishing government funding. Key units within the University of Zimbabwe providing services to the mining industry include the Institute of Mining Research, The Departments of Geology and Physics in the Faculty of Science and Mining Engineering and Metallurgy in the Faculty of Engineering. Within government, services are provided principally by the Departments of Geological Survey, Metallurgy and Mining Engineering, and the Scientific and Industrial Research and Development Centre. The major source of funding for all of these institutions is Government. There is a degree of overlap between these institutions, some of which were established more than 30 years ago with terms of reference appropriate for the time. With decreasing funding exacerbated by a harsh economic climate in Zimbabwe there is need to revisit the charters of these organizations and to review the provision of services to the mining sector. Recognition of this situation has led the Department of Geology to spearhead a new initiative to establish an alternative structure through which consultancy and research in mining related topics can be coordinated at the University of Zimbabwe. The Mineral Resources Centre (MRC) was established to facilitate fund-raising activities through consultancy services, research, postgraduate training and capital investment. By representing a group of like-minded stakeholders, the MRC can address larger projects, and thus secure more funding than individual entities will be able to obtain. The MRC is designed to be a lightweight structure that will not replace any of the existing teaching and research departments. The MRC is not be bound to any particular faculty within the university, and may even include stakeholders from outside the university. Interested parties are invited to participate on a voluntary basis in accordance with the management and quality- control guidelines laid out by the MRC. Participation is on a contract basis and will be determined for each project. Service providers that participate in the MRC agree to use their resources in the best possible way, so that services can be presented in unison. In combining forces between various departments with expertise in Earth Sciences, it is envisaged that a wider audience can be reached, a better service can be provided and a larger resource base can be tapped both within the private and the public sectors. The MRC may help coordinate capital investment, and human resource development in the various participating entities. Considering the limited availability of financial and human resources in Zimbabwe, coordination and prevention of unnecessary overlap is in itself a valuable exercise

An Analysis of Readmissions to a Mental Health Court

Mental health courts (MHCs) have emerged as one option to address the needs of people with severe mental illness who enter the criminal justice system. Little is known about defendants having multiple referrals to MHCs or the outcomes of subsequent admissions. This study included a sample of 1,084 defendants referred to municipal MHC. During the 13-year study period, 14.3% of defendants had a second admission, with an estimated probability of readmission of 17.4%. Key factors associated with readmission included being eligible to participate in the court but choosing not to do so, being rearrested during court supervision, and having a negative termination from supervision. Defendants who had a second admission during the study period had poorer outcomes than those with one admission. When defendants are referred for readmission to MHCs, careful assessment is required to ensure that these courts are the best alternative for them

Progress in Agricultural Research at the North Central Substation

Thousands of acres of farm land in the north central part of South Dakota have their productive future tied up with the 240 acres used for experimental research at the Substation at Eureka. Established nearly 50 years ago by the state legislature, which set aside state school lands for agricultural research, the North Central Substation is the proving ground for new agricultural methods and a living record of the accumulative effects of the old. As early as 1908, rotation experiments were started which became the first historical record in the northern plains area of the effects of cropping practices on the soil. At that time, the entire surrounding country was in wheat. There were no crop rotations, since the organic matter of the soil was good and the fertility level high. Also, there was no weed problem then. Later, the Experiment Station was to be accused of scattering weeds in one of the most interesting stories to be uncovered in the development of experimental research in this area. Foreseeing the time when the fertility of the land might become dangerously lowered by the practice of continuous cropping which was being carried on at that time, the Substation set up experimental plots. These included the basic crops of rotation-cultivated crops, small grain and legumes. In this case, the legume was sweet clover. (See more in Text

EFSUMB Recommendations and Guidelines for Gastrointestinal Ultrasound - Part 1: Examination Techniques and Normal Findings (Short version)

Abstract ▼ In October 2014 the European Federation of Societies for Ultrasound in Medicine and Biology formed a Gastrointestinal Ultrasound (GIUS) task force group to promote the use of GIUS in a clinical setting. One of the main objectives of the task force group was to develop clinical recommendations and guidelines for the use of GIUS under the auspices of EFSUMB. The first part, gives an overview of the examination techniques for GIUS recommended by experts in the field. It also presents the current evidence for the interpretation of normal sonoanatomical and physiological features as examined with different ultrasound modalities

EFSUMB Recommendations and Guidelines for Gastrointestinal Ultrasound - Part 1: Examination Techniques and Normal Findings (Long version).

Abstract ▼ In October 2014 the European Federation of Societies for Ultrasound in Medicine and Biology formed a Gastrointestinal Ultrasound (GIUS) task force group to promote the use of GIUS in a clinical setting. One of the main objectives of the task force group was to develop clinical recommendations and guidelines for the use of GIUS under the auspices of EFSUMB. The first part, gives an overview of the examination techniques for GIUS recommended by experts in the field. It also presents the current evidence for the interpretation of normal sonoanatomical and physiological features as examined with different ultrasound modalities