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

A framework for reservoir restoration in The Midwest

Master of Landscape ArchitectureDepartment of Landscape Architecture/Regional and Community PlanningTimothy D. KeaneReservoirs are built to provide local flood control and recreational activities, but those benefits are often short lived due to the severe ecohydrological problems which come with the process of damming up a watershed. Issues such as sediment deposition, accelerated erosion and loss of natural flood plain will eventually hinder the reservoir from being used for recreation, and significantly decrease its flood storage capacity (Keane, 2019). These are not issues which will correct themselves overtime. In fact, they will begin to rapidly decrease the lifespan of the reservoir, as well as create more problems in the watershed both up and downstream of the dam. For these reasons, scientists and designers have been developing processes for reservoir assessment and restoration which aim to identify issues, and improve reservoir function. Depending on their field of expertise, reservoir exerts have different approaches for both reservoir assessment and restoration. This report explores an alternative approach to reservoir assessment and restoration which aims to layer new information about reservoir function on top of the pre-existing knowledge of reservoir experts

The origin of mafic–ultramafic rocks and felsic plutons along the Clarke River suture zone: implications for porphyry exploration in the northern Tasmanides

The Clarke River Fault in northeast Queensland records an early Paleozoic history of subduction, accretion and continental suturing. Samples of mafic–ultramafic rocks collected proximal to the Clarke River Fault record oceanic geochemical affinities and comprise alteration assemblages consistent with an ophiolitic origin. The ca 456 Ma Falls Creek Tonalite records a continental-arc geochemical signature and was formed in response to long-lived subduction beneath the Thomson Orogen. Ordovician subduction beneath the Thomson Orogen is broadly coeval with arc magmatism documented in the Lachlan Orogen, which has been associated with the formation of several large porphyry ore deposits. The Falls Creek Tonalite yields adakite-like geochemical signatures that reflect a fertile melt source conducive to the formation of porphyry ore deposits. The outcropping plutons record ductile deformation consistent with mid-crustal depths, and they were emplaced during late syntectonic activity. This implies that the Falls Creek Tonalite was emplaced at too great a depth to have formed porphyry ore deposits. The northern Charters Towers Province shares many geological similarities to the Greenvale Province, where the erosional level may be shallower, and the potential for porphyry deposit formation and preservation may be greater

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

Cu isotopes in groundwater for hydrogeochemical mineral exploration: A case study using the world-class Mount Isa Cu–Pb–Zn deposit (Australia)

Copper is the crux resource in the transition to renewable energy sources, with green technologies such as solar panels, wind turbines and batteries all relying on this critical metal for their componentry, and more importantly for connection to electrical grids. While demand intensifies, copper discovery rates continue to fall due to increased scarcity of deposits that are outcropping and/or detectable by conventional means. This has engendered novel methods of detecting Cu-bearing ore under cover, such as hydrogeochemical analyses to trace ore mineral interaction with natural waters. This notably includes the development of Cu isotope systematics in natural waters, wherein proximal to Cu-bearing ore bodies enrichment of water in the heavier Cu isotope occurs (e.g. from oxidative weathering), thus providing a fingerprint of water interaction with Cu-bearing sulfides. Here, Cu isotope compositions for eighteen groundwater samples overlying and distal to the world-class, sediment-hosted stratiform Mount Isa Cu–Zn–Pb deposit were analyzed to assess the utility of groundwater Cu isotope compositions as an exploration tool for Cu-bearing ore under cover. A further 12 chalcopyrite Cu isotope compositions were determined from two drill cores directly overlying the main Cu-bearing ore body, to establish a baseline Cu isotope composition for the Mt Isa deposit. Cu isotope data were synthesized together with field water parameters and placed within a geological context to construct a framework for interpretation. When accounting for industrially impacted sites and underlying geology, results show a clear trend towards heavy Cu isotope enrichment in groundwater proximal to known mineralization, with enrichments of ∼1 per mil (‰) or more relative to distal groundwater and primary deposit chalcopyrite. These results corroborate and expand upon similar work from surface and groundwater samples around porphyry, exotic and IOCG Cu-bearing deposits. Moreover, these results strongly indicate that groundwater Cu isotope systematics for exploration under cover has great potential as a vectoring tool, illustrating that thus far the technique is applicable across deposit types

Rearrests during mental health court supervision: Predicting rearrest and its association with final court disposition and post-court rearrests

Mental health courts are one means to address the involvement of persons with mental illness in the criminal justice system. Using a sample of 811 participants of a municipal mental health court, this study found that 23.2% of participants were rearrested during court supervision. This study also identified factors associated with these rearrests, as well as the effect of rearrests during supervision on program completion and rearrests in the 1-year period following program completion. This study concludes with implications for mental health court supervision

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

The effect of nonthermal dielectric barrier discharge plasma on salmonella enterica and campylobacter jejuni on raw poultry

Foodborne illness is a major health concern with an estimated 76 million cases annually. A great deal of effort and finances are focused on reducing and eliminating the incidence of foodborne illness. Salmonella spp. and Campylobacter jejuni, pathogens commonly found on raw poultry are the leading causes of foodborne illness in the United States. If food is cooked to an appropriate temperature the pathogens are killed and the food is safe for consumption. However, consumer handling often creates the risk for foodborne illness due to situations such as temperature abuse and cross-contamination. Chicken are known to harbor both Salmonella and Campylobacter in their intestines and readily shed them through feces. Shedding of these pathogens can lead to contamination of whole flocks. Campylobacter is carried asymptomatically in chickens making it difficult to detect in the animal. Once in the processing facility pathogens both internalized in the chicken as well as carried on skin and feathers create a risk of a contaminated finished product. Poultry processing plants have many interventions such as chemical rinses like chlorine and tri-sodium phosphate (TSP) established to reduce these pathogens from the surface of the chickens, yet Salmonella spp. and Campylobacter jejuni are still present on products available to consumers and they are still the leading cause of foodborne illness. Irradiation technology has been proven to substantially reduce pathogens on the surface of food including poultry but has not been embraced by consumers. This leaves a serious need for an intervention technology that can be utilized, in conjunction with other methods in place to further reduce or eliminate pathogens on the surface of food. When considering raw chicken it is important to find an intervention that is non-thermal, producing no heat to cook the meat or cause any adverse effects to the sensory aspects of the food. Safety for the consumer and cost to the processing company are also important. Non-thermal atmospheric pressure plasma is a new technology that has the potential to be an effective intervention. Being non-thermal it will not partially cook the food and leaves no residual material on the surface that can be harmful to the consumer.consumers. This leaves a serious need for an intervention technology that can be utilized, in conjunction with other methods in place to further reduce or eliminate pathogens on the surface of food. When considering raw chicken it is important to find an intervention that is non-thermal, producing no heat to cook the meat or cause any adverse effects to the sensory aspects of the food. Safety for the consumer and cost to the processing company are also important. Non-thermal atmospheric pressure plasma is a new technology that has the potential to be an effective intervention. Being non-thermal it will not partially cook the food and leaves no residual material on the surface that can be harmful to the consumer. were significantly reduced on both surfaces after only 15 seconds. Reduction was less impressive on background microflora on the surface of the chicken. No adverse effects were noticed on the surface of the chicken after plasma application. This study demonstrates the feasibility of DBD plasma as a non-thermal intervention to further reduce foodborne pathogens on the surface of raw poultry.M.S., Biological Sciences -- Drexel University, 201

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

Physiological effects of water flow induced swimming exercise in seabream Sparus aurata

A longer on-land rearing period of Gilthead seabream Sparus aurata before transfer to sea-cages would allow the farmer to benefit from exercise-enhanced growth, resilience, and robustness as induced by increasing water flow in the tanks. In this study, the physiological effects of flow-conditioning were investigated by subjecting large groups of experimental fish to minimal flow or to flow regimes inducing swimming exercise at 1 or 2 body length (BL) s−1 for a period of 8 months (February–October) in 1,500 L tanks. Fish representing the three treatment groups were then used for: (1) a stress challenge netting test and plasma cortisol measurement (baseline, peaking, and recovery levels), (2) blood plasma measurements of glucose, triglycerides, lactate, cholesterol, growth hormone (GH), and insulin-like growth factor 1 (IGF1), and (3) heart and muscle gene expression of the GH and IGF1 receptors and the muscle transcriptome by deep RNA sequencing (RNAseq). Fish size after 8 months of flow conditioning was 92 ± 27 g body weight (BW) for fish under minimal flow, 106 ± 24 g BW (+15%) at 1 BL s−1, and 125 ± 27 g BW (+36%) at 2 BL s−1. Flow conditioning at 1 BL s−1 provided optimal conditions for growth and uniformity, but also stress (lowest baseline plasma cortisol), robustness (higher condition factor and larger hearts), and energy mobilization (increased plasma glucose). Although flow enhanced growth linearly with swimming speed, also the percentage of lordotic fish increased with exercise, particularly high for swimming at 2 BL s−1. The absence of important differences in plasma GH and IGF1, and expression levels of their receptors in heart and white skeletal muscle, indicated that other factors may be involved in growth enhancement. RNAseq of the white skeletal muscle showed upregulated expression of genes involved in muscle contraction, muscle development and its molecular regulation, and immune genes that may play a role in the muscle repair mechanism. An exercise regime of swimming at 1 BL s−1 can be considered as optimal for farming robust seabream although the increase of skeletal deformities should be avoided.info:eu-repo/semantics/publishedVersio