Prehospital trauma care reduces mortality. Ten-year results from a time-cohort and trauma audit study in Iraq

<p>Abstract</p> <p>Background</p> <p>Blunt implementation of Western trauma system models is not feasible in low-resource communities with long prehospital transit times. The aims of the study were to evaluate to which extent a low-cost prehospital trauma system reduces trauma deaths where prehospital transit times are long, and to identify specific life support interventions that contributed to survival.</p> <p>Methods</p> <p>In the study period from 1997 to 2006, 2,788 patients injured by land mines, war, and traffic accidents were managed by a chain-of-survival trauma system where non-graduate paramedics were the key care providers. The study was conducted with a time-period cohort design.</p> <p>Results</p> <p>37% of the study patients had serious injuries with Injury Severity Score ≥ 9. The mean prehospital transport time was 2.5 hours (95% CI 1.9 - 3.2). During the ten-year study period trauma mortality was reduced from 17% (95% CI 15 -19) to 4% (95% CI 3.5 - 5), survival especially improving in major trauma victims. In most patients with airway problems, in chest injured, and in patients with external hemorrhage, simple life support measures were sufficient to improve physiological severity indicators.</p> <p>Conclusion</p> <p>In case of long prehospital transit times simple life support measures by paramedics and lay first responders reduce trauma mortality in major injuries. Delegating life-saving skills to paramedics and lay people is a key factor for efficient prehospital trauma systems in low-resource communities.</p

A novel biomarker-based proxy for the spring phytoplankton bloom in Arctic and sub-arctic settings – HBI T25

Source at https://doi.org/10.1016/j.epsl.2019.06.038. The spring phytoplankton bloom is a characteristic feature of mid-high latitudes in modern times, but can be challenging to identify in palaeo records. In the current study, we investigated the absolute and relative distributions of two diatom-derived tri-unsaturated highly branched isoprenoid (HBI) lipids, at least one of which has previously been suggested to be a possible proxy for the productive region of the marginal ice zone (MIZ) in the Polar Regions. Based on a comparison of their distributions in surface sediments from the Barents Sea and neighbouring regions with a range of oceanographic parameters, we identify, via principal component analysis, a strong association between the relative proportion of the two HBIs and satellite-derived spring chlorophyll a (chl a) concentration. Further, based on agglomerative hierarchical clustering, we identify two clusters of HBI biomarker ratios and spring chl a together with a potential threshold biomarker ratio (termed HBI TR25) for the spring phytoplankton bloom. A modified version of HBI TR25 (i.e. HBI T25) provides a potentially more straightforward binary measure of the spring phytoplankton bloom. Analysis of HBI TR25 and HBI T25 values in a series of short (spanning recent centuries) and long (Holocene) sediment cores from the region provides an initial evaluation of the applicability of this novel proxy in the palaeo record. Outcomes are mainly consistent with the findings from the surface sediments and with other proxy-based reconstructions, including estimates of past sea ice cover, which is well-known to influence primary production in the region. Indeed, we suggest that the new HBI T25 phytoplankton bloom proxy may also represent an important new tool for characterising the MIZ in palaeo records, especially when used alongside well-established sea ice proxies, such as IP25 and PIP25. Despite the largely empirical nature of the study, we also provide a possible explanation for the observed biomarker ratio-chl a relationship. Thus, a previous laboratory investigation showed that the distributions of the same two HBIs analysed herein in their likely source (viz. Rhizosolenia setigera) was strongly influenced by culture temperature and growth rate. Confirmation of the generality of our findings and of the causal relationship between HBI T25 and the spring phytoplankton bloom will, however, require further laboratory- and field-based studies in the futur

Sea ice and primary production proxies in surface sediments from a High Arctic Greenland fjord : Spatial distribution and implications for palaeoenvironmental studies

In order to establish a baseline for proxy-based reconstructions for the Young Sound-Tyrolerfjord system (Northeast Greenland), we analysed the spatial distribution of primary production and sea ice proxies in surface sediments from the fjord, against monitoring data from the Greenland Ecosystem Monitoring Programme. Clear spatial gradients in organic carbon and biogenic silica contents reflected marine influence, nutrient availability and river-induced turbidity, in good agreement with in situ measurements. The sea ice proxy IP25 was detected at all sites but at low concentrations, indicating that IP25 records from fjords need to be carefully considered and not directly compared to marine settings. The sea ice-associated biomarker HBI III revealed an open-water signature, with highest concentrations near the mid-July ice edge. This proxy evaluation is an important step towards reliable palaeoenvironmental reconstructions that will, ultimately, contribute to better predictions for this High Arctic ecosystem in a warming climate.Peer reviewe

Seasonal sea ice persisted through the Holocene Thermal Maximum at 80°N

AbstractThe cryospheric response to climatic warming responsible for recent Arctic sea ice decline can be elucidated using marine geological archives which offer an important long-term perspective. The Holocene Thermal Maximum, between 10 and 6 thousand years ago, provides an opportunity to investigate sea ice during a warmer-than-present interval. Here we use organic biomarkers and benthic foraminiferal stable isotope data from two sediment cores in the northernmost Barents Sea (&gt;80 °N) to reconstruct seasonal sea ice between 11.7 and 9.1 thousand years ago. We identify the continued persistence of sea-ice biomarkers which suggest spring sea ice concentrations as high as 55%. During the same period, high foraminiferal oxygen stable isotopes and elevated phytoplankton biomarker concentrations indicate the influence of warm Atlantic-derived bottom water and peak biological productivity, respectively. We conclude that seasonal sea ice persisted in the northern Barents Sea during the Holocene Thermal Maximum, despite warmer-than-present conditions and Atlantic Water inflow.</jats:p

Barriers and facilitators to provide effective pre-hospital trauma care for road traffic injury victims in Iran: a grounded theory approach

BACKGROUND: Road traffic injuries are a major global public health problem. Improvements in pre-hospital trauma care can help minimize mortality and morbidity from road traffic injuries (RTIs) worldwide, particularly in low- and middle-income countries (LMICs) with a high rate of RTIs such as Iran. The current study aimed to explore pre-hospital trauma care process for RTI victims in Iran and to identify potential areas for improvements based on the experience and perception of pre-hospital trauma care professionals. METHODS: A qualitative study design using a grounded theory approach was selected. The data, collected via in-depth interviews with 15 pre-hospital trauma care professionals, were analyzed using the constant comparative method. RESULTS: Seven categories emerged to describe the factors that hinder or facilitate an effective pre-hospital trauma care process: (1) administration and organization, (2) staff qualifications and competences, (3) availability and distribution of resources, (4) communication and transportation, (5) involved organizations, (6) laypeople and (7) infrastructure. The core category that emerged from the other categories was defined as "interaction and common understanding". Moreover, a conceptual model was developed based on the categories. CONCLUSIONS: Improving the interaction within the current pre-hospital trauma care system and building a common understanding of the role of the Emergency Medical Services (EMS) emerged as key issues in the development of an effective pre-hospital trauma care process

Epidemiology of injuries presenting to the national hospital in Kampala, Uganda: implications for research and policy

BackgroundDespite the growing burden of injuries in LMICs, there are still limited primary epidemiologic data to guide health policy and health system development. Understanding the epidemiology of injury in developing countries can help identify risk factors for injury and target interventions for prevention and treatment to decrease disability and mortality.AimTo estimate the epidemiology of the injury seen in patients presenting to the government hospital in Kampala, the capital city of Uganda.MethodsA secondary analysis of a prospectively collected database collected by the Injury Control Centre-Uganda at the Mulago National Referral Hospital, Kampala, Uganda, 2004-2005.ResultsFrom 1 August 2004 to 12 August 2005, a total of 3,750 injury-related visits were recorded; a final sample of 3,481 records were analyzed. The majority of patients (62%) were treated in the casualty department and then discharged; 38% were admitted. Road traffic injuries (RTIs) were the most common causes of injury for all age groups in this sample, except for those under 5 years old, and accounted for 49% of total injuries. RTIs were also the most common cause of mortality in trauma patients. Within traffic injuries, more passengers (44%) and pedestrians (30%) were injured than drivers (27%). Other causes of trauma included blunt/penetrating injuries (25% of injuries) and falls (10%). Less than 5% of all patients arriving to the emergency department for injuries arrived by ambulance.ConclusionsRoad traffic injuries are by far the largest cause of both morbidity and mortality in Kampala. They are the most common cause of injury for all ages, except those younger than 5, and school-aged children comprise a large proportion of victims from these incidents. The integration of injury control programs with ongoing health initiatives is an urgent priority for health and development

Clinical and Organizational Factors Related to the Reduction of Mechanical Restraint Application in an Acute Ward: An 8-Year Retrospective Analysis

Background: The purpose of this study was to describe the frequency of mechanical restraint use in an acute psychiatric ward and to analyze which variables may have significantly influenced the use of this procedure. Methods: This retrospective study was conducted in the Servizio Psichiatrico di Diagnosi e Cura (SPDC) of Modena Centro. The following variables of our sample, represented by all restrained patients admitted from 1-1-2005 to 31-12-2012, were analyzed: age, gender, nationality, psychiatric diagnoses, organic comorbidity, state and duration of admission, motivation and duration of restraints, nursing shift and hospitalization day of restraint, number of patients admitted at the time of restraint and institutional changes during the observation period. The above variables were statistically compared with those of all other non-restrained patients admitted to our ward in the same period. Results: Mechanical restraints were primarily used as a safety procedure to manage aggressive behavior of male patients, during the first days of hospitalization and night shifts. Neurocognitive disorders, organic comorbidity, compulsory state and long duration of admission were statistically significantly related to the increase of restraint use (p<.001, multivariate logistic regression). Institutional changes, especially more restricted guidelines concerning restraint application, were statistically significantly related to restraint use reduction (p<.001, chi2 test, multivariate logistic regression). Conclusion: The data obtained highlight that mechanical restraint use was influenced not only by clinical factors, but mainly by staff and policy factors, which have permitted a gradual but significant reduction in the use of this procedure through a multidimensional approach