THE PATIENT-SPECIFIC INJURY SCORE: PRECISION MEDICINE IN TRAUMA PATIENTS PREDICTS ORGAN DYSFUNCTION AND OUTCOMES

poster abstractIntroduction: Current injury scoring systems in polytraumatized patients are limited at predicting patient outcomes. We present a novel method that quantifies mechanical tissue damage and cumulative hypoperfusion using a precision medicine approach. We hypothesized that a Patient-Specific Injury score formulated from individualized injury indices would stratify patient risk for developing organ dysfunction after injury. We compared correspondence between PSI and the Injury Severity Score with outcomes of organ dysfunction and MOF. Methods: Fifty Multiply-injured-patients (MIPs) were studied. Tissue Damage Volume scores were measured from admission pan-axial CT scans using purpose-designed post-processing software to quantify volumetric magnitude and distribution of injuries. Ischemic injury was quantified using Shock Volumes. SV is a time-magnitude integration of shock index. Values above 0.9 were measured in the 24-hours after injury. Metabolic response was quantified by subtracting the lowest first 24 hr pH from 7.40. PSI combines these indices into the formula: PSI=[0.2TDV+SV]*MR. Correspondence coefficients from regression modeling between PSI and organ dysfunction, measured by the Marshall Multiple Organ Dysfunction score averaged from days 2-5 post-injury, were compared to similar regression models of ISS vs. day 2-5 MOD-scores. We compared PSI and ISS in patients that did or did not develop MOF. Results: PSI demonstrated better correlation to organ dysfunction (r2=0.576) in comparison to ISS (r2=0.393) using the MOD-score on days 2-5. Mean PSI increased 3.4x(58.5vs.17.0;p<0.02) and ISS scores increased 1.4x(39.0vs.28.0;p=0.10) in patients that developed MOF versus those that did not. Conclusions: This study shows that a precision medicine approach that integrates patient-specific indices of mechanical tissue damage, ischemic tissue injury, and metabolic response better corresponds to phenotypic changes including organ dysfunction and MOF compared to ISS in MIPs. The PSI-score can be calculated within 24 hours of injury, making it useful for stratifying risk and predicting the magnitude of organ dysfunction to anticipate

First Multicharged Ion Irradiation Results from the CUEBIT Facility at Clemson University

A new electron beam ion trap (EBIT) based ion source and beamline were recently commissioned at Clemson University to produce decelerated beams of multi- to highly-charged ions for surface and materials physics research. This user facility is the first installation of a DREEBIT-designedsuperconducting trap and ion source (EBIS-SC) in the U.S. and includes custom-designed target preparation and irradiation setups. An overview of the source, beamline, and other facilities as well as results from first measurements on irradiated targets are discussed here. Results include extracted charge state distributions and first data on a series of irradiated metal-oxide-semiconductor (MOS) device targets. For the MOS devices, we show that voltage-dependent capacitance can serve as a record of theelectronic component of ion stopping power for an irradiated, encapsulated oxide target

Investigating the Genetics of Chronic Intractable Migraine with Reactive Hypoglycemia

Migraines affect roughly 1-in-6 males and 1-in-5 females in the United States. Of these, approximately 5-30% experience intractable migraines, or migraines resistant to abortive treatments. Despite this large population, relatively little is known about intractable migraines compared to other types of migraines. Our recent work indicates that reactive hypoglycemia is common among these individuals. Additionally, empirical evidence suggests that individuals in families with chronic intractable migraines are more likely to have the same condition than people of the general population, suggesting a possible genetic link between both migraines and metabolic abnormalities. Previous Genome Wide Association Studies (GWAS) have found several genetic markers for migraines, but the studies have not differentiated groups by important factors including severity and frequency of migraines or treatment response. Furthermore, GWA studies investigate only common variation. Despite these limitations, a variant in the LEPR gene (rs751167), the leptin receptor gene was found to be significantly associated with migraines. Variants in the LEPR gene are associated with weight gain and metabolic syndrome, indicating a link between metabolism and migraines. In the present study, we aim to broaden the scope, investigating chronic intractable migraine with reactive hypoglycemia specifically, and using all variant types including small insertions/deletions, rare variants, and copy number variants. To investigate heritability, we will take pedigrees of individuals that fit this phenotype

Mercury sources to Lake Ozette and Lake Dickey : highly contaminated remote coastal lakes, Washington State, USA

Author Posting. © The Author(s), 2009. This is the author's version of the work. It is posted here by permission of Springer for personal use, not for redistribution. The definitive version was published in Water, Air, & Soil Pollution 208 (2009): 275-286, doi:10.1007/s11270-009-0165-y.Mercury concentrations in largemouth bass and mercury accumulation rates in age-dated sediment cores were examined at Lake Ozette and Lake Dickey in Washington State. Goals of the study were to compare concentrations in fish tissues at the two lakes with lakes in a larger statewide dataset and evaluate factors influencing lake loading at Ozette and Dickey, which may include: catchment disturbances, coastal mercury cycling, and the role of trans-Pacific Asian mercury. Mercury fish tissue concentrations at the lakes were among the highest recorded in Washington State. Wet deposition and historical atmospheric monitoring from the area show no indication of enhanced deposition from Asian sources or coastal atmospheric processes. Sediment core records from the lakes displayed rapidly increasing sedimentation rates coinciding with commercial logging. The unusually high mercury flux rates and mercury tissue concentrations recorded at Lake Ozette and Lake Dickey appear to be associated with logging within the catchments

Nurses' experiences, expectations, and preferences for mind-body practices to reduce stress

BACKGROUND: Most research on the impact of mind-body training does not ask about participants\u27 baseline experience, expectations, or preferences for training. To better plan participant-centered mind-body intervention trials for nurses to reduce occupational stress, such descriptive information would be valuable. METHODS: We conducted an anonymous email survey between April and June, 2010 of North American nurses interested in mind-body training to reduce stress. The e-survey included: demographic characteristics, health conditions and stress levels; experiences with mind-body practices; expected health benefits; training preferences; and willingness to participate in future randomized controlled trials. RESULTS: Of the 342 respondents, 96% were women and 92% were Caucasian. Most (73%) reported one or more health conditions, notably anxiety (49%); back pain (41%); GI problems such as irritable bowel syndrome (34%); or depression (33%). Their median occupational stress level was 4 (0 = none; 5 = extreme stress). Nearly all (99%) reported already using one or more mind-body practices to reduce stress: intercessory prayer (86%), breath-focused meditation (49%), healing or therapeutic touch (39%), yoga/tai chi/qi gong (34%), or mindfulness-based meditation (18%). The greatest expected benefits were for greater spiritual well-being (56%); serenity, calm, or inner peace (54%); better mood (51%); more compassion (50%); or better sleep (42%). Most (65%) wanted additional training; convenience (74% essential or very important), was more important than the program\u27s reputation (49%) or scientific evidence about effectiveness (32%) in program selection. Most (65%) were willing to participate in a randomized trial of mind-body training; among these, most were willing to collect salivary cortisol (60%), or serum biomarkers (53%) to assess the impact of training. CONCLUSIONS: Most nurses interested in mind-body training already engage in such practices. They have greater expectations about spiritual and emotional than physical benefits, but are willing to participate in studies and to collect biomarker data. Recruitment may depend more on convenience than a program\u27s scientific basis or reputation. Knowledge of participants\u27 baseline experiences, expectations, and preferences helps inform future training and research on mind-body approaches to reduce stress

The worldwide NORM production and a fully automated gamma-ray spectrometer for their characterization

Materials containing radionuclides of natural origin, which is modified by human made processes and being subject to regulation because of their radioactivity are known as NORM. We present a brief review of the main categories of non-nuclear industries together with the levels of activity concentration in feed raw materials, products and waste, including mechanisms of radioisotope enrichments. The global management of NORM shows a high level of complexity, mainly due to different degrees of radioactivity enhancement and the huge amount of worldwide waste production. The future tendency of guidelines concerning environmental protection will require both a systematic monitoring based on the ever-increasing sampling and high performance of gamma ray spectroscopy. On the ground of these requirements a new low background fully automated high-resolution gamma-ray spectrometer MCA_Rad has been developed. The design of Pb and Cu shielding allowed to reach a background reduction of two order of magnitude with respect to laboratory radioactivity. A severe lowering of manpower cost is obtained through a fully automation system, which enables up to 24 samples to be measured without any human attendance. Two coupled HPGe detectors increase the detection efficiency, performing accurate measurements on sample volume (180 cc) with a reduction of sample transport cost of material. Details of the instrument calibration method are presented. MCA_Rad system can measure in less than one hour a typical NORM sample enriched in U and Th with some hundreds of Bq/kg, with an overall uncertainty less than 5%. Quality control of this method has been tested. Measurements of certified reference materials RGK-1, RGU-2 and RGTh-1 containing concentrations of K, U and Th comparable to NORM have been performed, resulting an overall relative discrepancy of 5% among central values within the reported uncertainty.Comment: 21 pages, 4 figures, 6 table

The Scope of Intentional Injury under \u3ci\u3eKawaauhau v. Geiger\u3c/i\u3e, 118 S. Ct. 974 (1998)

This Note examine the Supreme Court\u27s holding in Kawaauhau v. Geiger and the proper scope to be given to the term intent as used by the Court. First, this Note presents a history of the willful and malicious injury discharge exception in United States bankruptcy law including a summary of the Kawaauhau holding. Second, this Note examines the Supreme Court\u27s holding in Kawaauhau, which correctly interpreted willfulness under 11 U.S.C. § 523(a)(6) to require intent to injure. Finally, this Note examines the proper interpretation to be given to the term intent as used by the Court in Kawaauhau to enable the discharge exception to serve its function of excepting the discharge of debts arising from willful and malicious injuries