A novel streamlined trauma response team training improves imaging efficiency for pediatric blunt abdominal trauma patients

Background/purpose The morbidity and mortality of children with traumatic injuries are directly related to the time to definitive management of their injuries. Imaging studies are used in the trauma evaluation to determine the injury type and severity. The goal of this project is to determine if a formal streamlined trauma response improves efficiency in pediatric blunt trauma by evaluating time to acquisition of imaging studies and definitive management. Methods This study is a chart review of patients < 18 years who presented to a pediatric trauma center following blunt trauma requiring trauma team activation. 413 records were reviewed to determine if training changed the efficiency of CT acquisition and 652 were evaluated for FAST efficiency. The metrics used for comparison were time from ED arrival to CT image, FAST, and disposition. Results Time from arrival to CT acquisition decreased from 37 (SD 23) to 28 (SD27) min (p < 0.05) after implementation. The proportion of FAST scans increased from 315 (63.5%) to 337 (80.8%) and the time to FAST decreased from 18 (SD15) to 8 (SD10) min (p < 0.05). The time to operating room (OR) decreased after implementation. Conclusion The implementation of a streamlined trauma team approach is associated with both decreased time to CT, FAST, OR, and an increased proportion of FAST scans in the pediatric trauma evaluation. This could result in the rapid identification of injuries, faster disposition from the ED, and potentially improve outcomes in bluntly injured children

B-line quantification: comparing learners novice to lung ultrasound assisted by machine artificial intelligence technology to expert review

Background: The goal of this study was to assess the ability of machine artificial intelligence (AI) to quantitatively assess lung ultrasound (LUS) B-line presence using images obtained by learners novice to LUS in patients with acute heart failure (AHF), compared to expert interpretation. Methods: This was a prospective, multicenter observational study conducted at two urban academic institutions. Learners novice to LUS completed a 30-min training session on lung image acquisition which included lecture and hands-on patient scanning. Learners independently acquired images on patients with suspected AHF. Automatic B-line quantification was obtained offline after completion of the study. Machine AI counted the maximum number of B-lines visualized during a clip. The criterion standard for B-line counts was semi-quantitative analysis by a blinded point-of-care LUS expert reviewer. Image quality was blindly determined by an expert reviewer. A second expert reviewer blindly determined B-line counts and image quality. Intraclass correlation was used to determine agreement between machine AI and expert, and expert to expert. Results: Fifty-one novice learners completed 87 scans on 29 patients. We analyzed data from 611 lung zones. The overall intraclass correlation for agreement between novice learner images post-processed with AI technology and expert review was 0.56 (confidence interval [CI] 0.51-0.62), and 0.82 (CI 0.73-0.91) between experts. Median image quality was 4 (on a 5-point scale), and correlation between experts for quality assessment was 0.65 (CI 0.48-0.82). Conclusion: After a short training session, novice learners were able to obtain high-quality images. When the AI deep learning algorithm was applied to those images, it quantified B-lines with moderate-to-fair correlation as compared to semi-quantitative analysis by expert review. This data shows promise, but further development is needed before widespread clinical use

Climate change impact on streamflow in a tropical basin of Ghana, West Africa

Study region Pra River Basin, Ghana, West Africa. Study focus In this study, variations of the future streamflow in the Pra River Basin (PRB), are projected using the Soil and Water Analysis Tool (SWAT) model with bias-corrected climate data from regional climate models (RCMs) for the near 21 st century (2010–2039), the mid 21 st century (2040–2069), and the end of the 21 st century (2070–2099), under two Representative Concentration Pathways (RCP4.5 and RCP8.5). Weighting, scaling and ranking techniques were applied to the data from each of the seventeen climate stations to select the climate models that best reproduced the observation dataset. New hydrological insights for the region The results from the calibration and validation (R2 and NSE > 0.75, and PBIAS within ±10 %), revealed good simulation of the PRB hydrology from the SWAT model. Annually, streamflow in the near and the mid-21st century is projected to increase within 4 % and 12 % while a reduction was projected at the end of the 21 st century with the RCP4.5 emission scenario. The simulation results from the RCP8.5 scenario showed increase streamflow throughout the 21 st century applying the best performing models. Monthly streamflow variations varied between -15 % and 23 % for RCP4.5, and -24 % to 24 % for RCP8.5. Generally, increasing streamflow was highest in the RCP4.5 emission scenario. In view of the model outcomes, the PRB is expected to experience upsurge in streamflow by the near and the mid of the 21 st century. This would require proper planning by applying cost-effective adaptative water management strategies to provide for the probable influence of climate change on the future water resources of the basin

The Collective Action Problem: Within-Group Cooperation and Between-Group Competition in a Repeated Rent-Seeking Game

This paper analyzes the ability of group members to cooperate in rent-seeking activities in a context of between-group competition. For this purpose, we develop an infinitely repeated rent-seeking game between two groups of different size. We first investigate Nash reversion strategies to support cooperative behavior in a given group before analyzing double-edge trigger strategies which have the property that cheating on the cooperative agreement in a given group is followed by non-cooperation in this group and cooperation in the rival group. The main conclusion is that the set of parameters for which cooperation can be sustained within the larger group as a subgame perfect outcome is as large as that for which cooperation can be sustained in the smaller group. Hence, in contrast with Olson’s (1965) celebrated thesis but in accordance with many informal and formal observations, the larger group is as effective as the smaller group in furthering its interest

Population-Based Rates of Revision of Primary Total Hip Arthroplasty: A Systematic Review

Background: Most research on failure leading to revision total hip arthroplasty (THA) is reported from single centers. We searched PubMed between January 2000 and August 2010 to identify population- or community-based studies evaluating ten-year revision risks. We report ten-year revision risk using the Kaplan-Meier method, stratifying by age and fixation technique. Results: Thirteen papers met the inclusion criteria. Cemented prostheses had Kaplan-Meier estimates of revision-free implant survival of ten years ranging from 88 % to 95%; uncemented prostheses had Kaplan-Meier estimates from 80 % to 85%. Estimates ranged from 72 % to 86 % in patients less than 60 years old and from 90 to 96 % in older patients. Conclusion: Data reported from national registries suggest revision risks of 5 to 20 % ten years following primary THA. Revision risks are lower in older THA recipients. Uncemented implants may have higher ten-year rates of revision, regardless of age