2,729 research outputs found
Outcomes and costs of penetrating trauma injury in England and Wales
The official published version of the article can be found at the link below.Background: Penetrating trauma injury is generally associated with higher short-term mortality than blunt trauma, and results in substantial societal costs given the young age of those typically injured. Little information exists on the patient and treatment characteristics for penetrating trauma in England and Wales, and the acute outcomes and costs of care have not been documented and analysed in detail.Methods: Using the Trauma Audit Research Network (TARN) database, we examined patient records for persons aged 18+ years hospitalised for penetrating trauma injury between January 2000 and December 2005. Patients were stratified by injury severity score (ISS).Results: 1365 patients were identified; 16% with ISS 1-8, 50% ISS 9-15, 15% ISS 16-24, 16% ISS 25-34, and 4% with ISS 35-75. The median age was 30 years and 91% of patients were men. Over 90% of the injuries occurred in alleged assaults. Stabbings were the most common cause of injury (73%), followed by shootings (19%). Forty-seven percent were admitted to critical care for a median length of stay of 2 days; median total hospital length of stay was 7 days. Sixty-nine percent of patients underwent at least one surgical procedure. Eight percent of the patients died before discharge, with a mean time to death of 1.6 days (S.D. 4.0). Mortality ranged from 0% among patients with ISS 1-8 to 55% in patients with ISS > 34. The mean hospital cost per patient was 7983 pound, ranging from 6035 pound in patients with ISS 9-15 to El 6,438 among patients with ISS > 34. Costs varied significantly by ISS, hospital mortality, cause and body region of injury.Conclusion: The acute treatment costs of penetrating trauma injury in England and Wales vary by patient, injury and treatment characteristics. Measures designed toreduce the incidence and severity of penetrating trauma may result in significant hospital cost savings. (C) 2008 Elsevier Ltd. All rights reserved.This study was funded by Novo Nordisk A/S
Outcomes and costs of blunt trauma in England and Wales
Background Trauma represents an important public health
concern in the United Kingdom, yet the acute costs of blunt
trauma injury have not been documented and analysed in detail.
Knowledge of the overall costs of trauma care, and the drivers
of these costs, is a prerequisite for a cost-conscious approach
to improvement in standards of trauma care, including evaluation
of the cost-effectiveness of new healthcare technologies.
Methods Using the Trauma Audit Research Network database,
we examined patient records for persons aged 18 years and
older hospitalised for blunt trauma between January 2000 and
December 2005. Patients were stratified by the Injury Severity
Score (ISS).
Results A total of 35,564 patients were identified; 60% with an
ISS of 0 to 9, 17% with an ISS of 10 to 16, 12% with an ISS of
17 to 25, and 11% with an ISS of 26 to 75. The median age was
46 years and 63% of patients were men. Falls were the most
common cause of injury (50%), followed by road traffic
collisions (33%). Twenty-nine percent of patients were admitted
to critical care for a median length of stay of 4 days. The median
total hospital length of stay was 9 days, and 69% of patients
underwent at least one surgical procedure. Seven percent of the
patients died before discharge, with the highest proportion of
deaths among those in the ISS 26–75 group (32%). The mean
hospital cost per person was £9,530 (± 11,872). Costs varied
significantly by Glasgow Coma Score, ISS, age, cause of injury,
type of injury, hospital mortality, grade and specialty of doctor
seen in the accident and emergency department, and year of
admission.
Conclusion The acute treatment costs of blunt trauma in
England and Wales vary significantly by injury severity and
survival, and public health initiatives that aim to reduce both the
incidence and severity of blunt trauma are likely to produce
significant savings in acute trauma care. The largest component
of acute hospital cost is determined by the length of stay, and
measures designed to reduce length of admissions are likely to
be the most effective in reducing the costs of blunt trauma care
Problems in cow evaluation and current use of cow index report of a working group on cow evaluation
International audienc
Characterising half a degree difference: a review of methods for identifying regional climate responses to global warming targets
The Paris Agreement long term global temperature goal refers to two global warming levels: well below 2°C and 1.5°C above preindustrial. Regional climate signals at specific global warming levels, and especially the differences between 1.5°C and 2°C, are not well constrained, however. In particular, methodological challenges related to the assessment of such differences have received limited attention. This paper reviews alternative approaches for identifying regional climate signals associated with global temperature limits, and evaluates the extent to which they constitute a sound basis for impacts analysis. Four methods are outlined, including comparing data from different greenhouse gas scenarios, sub-selecting climate models based on global temperature response, pattern scaling, and extracting anomalies at the time of each global temperature increment. These methods have rarely been applied to compare 2°C with 1.5°C, but some demonstrate potential avenues for useful research. Nevertheless, there are methodological challenges associated with the use of existing climate model experiments, which are generally designed to model responses to different levels of greenhouse gas forcing, rather than to model climate responses to a specific level of forcing that targets a given level of global temperature change. Novel approaches may be required to address policy questions, in particular: to differentiate between half degree warming increments while accounting for different sources of uncertainty; to examine mechanisms of regional climate change including the potential for nonlinear responses; and to explore the relevance of time-lagged processes in the climate system and declining emissions, and the resulting sensitivity to alternative mitigation pathways
One-loop Quantum Gravity in Schwarzschild Spacetime
The quantum theory of linearized perturbations of the gravitational field of
a Schwarzschild black hole is presented. The fundamental operators are seen to
be the perturbed Weyl scalars and associated with the
Newman-Penrose description of the classical theory. Formulae are obtained for
the expectation values of the modulus squared of these operators in the
Boulware, Unruh and Hartle-Hawking quantum states. Differences between the
renormalized expectation values of both and
in the three quantum states are evaluated
numerically.Comment: 39 pages, 11 Postscript figures, using revte
Selected reactive oxygen species and antioxidant enzymes in common bean after Pseudomonas syringae pv. phaseolicola and Botrytis cinerea infection
Phaseolus vulgaris cv. Korona plants were
inoculated with the bacteria Pseudomonas syringae pv.
phaseolicola (Psp), necrotrophic fungus Botrytis cinerea
(Bc) or with both pathogens sequentially. The aim of the
experiment was to determine how plants cope with multiple
infection with pathogens having different attack strategy.
Possible suppression of the non-specific infection with
the necrotrophic fungus Bc by earlier Psp inoculation was
examined. Concentration of reactive oxygen species
(ROS), such as superoxide anion (O2
-) and H2O2 and
activities of antioxidant enzymes such as superoxide dismutase
(SOD), catalase (CAT) and peroxidase (POD) were
determined 6, 12, 24 and 48 h after inoculation. The
measurements were done for ROS cytosolic fraction and
enzymatic cytosolic or apoplastic fraction. Infection with
Psp caused significant increase in ROS levels since the
beginning of experiment. Activity of the apoplastic
enzymes also increased remarkably at the beginning of
experiment in contrast to the cytosolic ones. Cytosolic
SOD and guaiacol peroxidase (GPOD) activities achieved
the maximum values 48 h after treatment. Additional forms
of the examined enzymes after specific Psp infection were
identified; however, they were not present after single Bc
inoculation. Subsequent Bc infection resulted only in
changes of H2O2 and SOD that occurred to be especially
important during plant–pathogen interaction. Cultivar Korona
of common bean is considered to be resistant to Psp and mobilises its system upon infection with these bacteria.
We put forward a hypothesis that the extent of defence
reaction was so great that subsequent infection did not
trigger significant additional response
DISK–WIND CONNECTION DURING THE HEARTBEATS OF GRS 1915+105
Disk and wind signatures are seen in the soft state of Galactic black holes, while the jet is seen in the hard state. Here we study the disk–wind connection in the ρ class of variability in GRS 1915+105 using a joint NuSTAR–Chandra observation. The source shows 50 s limit cycle oscillations. By including new information provided by the reflection spectrum and using phase-resolved spectroscopy, we find that the change in the inner disk inferred from the blackbody emission is not matched by reflection measurements. The latter is almost constant, independent of the continuum model. The two radii are comparable only if the disk temperature color correction factor changes, an effect that could be due to the changing opacity of the disk caused by changes in metal abundances. The disk inclination is similar to that inferred from the jet axis, and oscillates by ~10°. The simultaneous Chandra data show the presence of two wind components with velocities between 500 and 5000 km s⁻¹, and possibly two more with velocities reaching 20,000 km s⁻¹ (~0.06 c). The column densities are ~5 × 10²² cm⁻². An upper limit to the wind response time of 2 s is measured, implying a launch radius of <6 × 10¹° cm. The changes in wind velocity and absorbed flux require the geometry of the wind to change during the oscillations, constraining the wind to be launched from a distance of 290–1300 r _g from the black hole. Both data sets support fundamental model predictions in which a bulge originates in the inner disk and moves outward as the instability progresses.This work made use of data from the NuSTAR mission, a project led by the California Institute of Technology, managed by the Jet Propulsion Laboratory, and funded by the National Aeronautics and Space Administration. This work is also based on observations made by the Chandra X-ray Observatory
A Model to Define an eHealth Technological Ecosystem for Caregivers
The ageing of world population has a direct impact on the health and care systems, as it means an increase in the number of people needing care which leads to higher care costs and the need for more resources. In this context, informal caregivers play an important role as they enable dependent persons to stay at home and thus reduce care costs. However, long-term continuous care provision has also an impact in the physical and mental health of the caregivers. Moreover, geographical barriers make it difficult for caregivers to accessing psychoeducation as a way to alleviate their problems. To support caregivers in their needs and provide specialized training, technology plays a fundamental role. The present work provides the theoretical basis for the development of a technological ecosystem focused on learning and knowledge management processes to develop and enhance the caregiving competences of formal and informal caregivers, both at home and in care environments. In particular, a platform-specific model to
support the definition of the ecosystem based on Open Source software components is presented, along with a Business Model Canvas to define the business structure as part of the human elements of the technological ecosystem
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