Missed injuries in trauma patients: A literature review

<p>Abstract</p> <p>Background</p> <p>Overlooked injuries and delayed diagnoses are still common problems in the treatment of polytrauma patients. Therefore, ongoing documentation describing the incidence rates of missed injuries, clinically significant missed injuries, contributing factors and outcome is necessary to improve the quality of trauma care. This review summarizes the available literature on missed injuries, focusing on overlooked muscoloskeletal injuries.</p> <p>Methods</p> <p>Manuscripts dealing with missed injuries after trauma were reviewed. The following search modules were selected in PubMed: Missed injuries, Delayed diagnoses, Trauma, Musculoskeletal injuires. Three time periods were differentiated: (n = 2, 1980–1990), (n = 6, 1990–2000), and (n = 9, 2000-Present).</p> <p>Results</p> <p>We found a wide spread distribution of missed injuries and delayed diagnoses incidence rates (1.3% to 39%). Approximately 15 to 22.3% of patients with missed injuries had clinically significant missed injuries. Furthermore, we observed a decrease of missed pelvic and hip injuries within the last decade.</p> <p>Conclusion</p> <p>The lack of standardized studies using comparable definitions for missed injuries and clinically significant missed injuries call for further investigations, which are necessary to produce more reliable data. Furthermore, improvements in diagnostic techniques (e.g. the use of multi-slice CT) may lead to a decreased incidence of missed pelvic injuries. Finally, the standardized tertiary trauma survey is vitally important in the detection of clinically significant missed injuries and should be included in trauma care.</p

Pregnancy-related pelvic girdle pain: an update

A large number of scientists from a wide range of medical and surgical disciplines have reported on the existence and characteristics of the clinical syndrome of pelvic girdle pain during or after pregnancy. This syndrome refers to a musculoskeletal type of persistent pain localised at the anterior and/or posterior aspect of the pelvic ring. The pain may radiate across the hip joint and the thigh bones. The symptoms may begin either during the first trimester of pregnancy, at labour or even during the postpartum period. The physiological processes characterising this clinical entity remain obscure. In this review, the definition and epidemiology, as well as a proposed diagnostic algorithm and treatment options, are presented. Ongoing research is desirable to establish clear management strategies that are based on the pathophysiologic mechanisms responsible for the escalation of the syndrome's symptoms to a fraction of the population of pregnant women

Pan-cancer analysis of whole genomes

Cancer is driven by genetic change, and the advent of massively parallel sequencing has enabled systematic documentation of this variation at the whole-genome scale(1-3). Here we report the integrative analysis of 2,658 whole-cancer genomes and their matching normal tissues across 38 tumour types from the Pan-Cancer Analysis of Whole Genomes (PCAWG) Consortium of the International Cancer Genome Consortium (ICGC) and The Cancer Genome Atlas (TCGA). We describe the generation of the PCAWG resource, facilitated by international data sharing using compute clouds. On average, cancer genomes contained 4-5 driver mutations when combining coding and non-coding genomic elements; however, in around 5% of cases no drivers were identified, suggesting that cancer driver discovery is not yet complete. Chromothripsis, in which many clustered structural variants arise in a single catastrophic event, is frequently an early event in tumour evolution; in acral melanoma, for example, these events precede most somatic point mutations and affect several cancer-associated genes simultaneously. Cancers with abnormal telomere maintenance often originate from tissues with low replicative activity and show several mechanisms of preventing telomere attrition to critical levels. Common and rare germline variants affect patterns of somatic mutation, including point mutations, structural variants and somatic retrotransposition. A collection of papers from the PCAWG Consortium describes non-coding mutations that drive cancer beyond those in the TERT promoter(4); identifies new signatures of mutational processes that cause base substitutions, small insertions and deletions and structural variation(5,6); analyses timings and patterns of tumour evolution(7); describes the diverse transcriptional consequences of somatic mutation on splicing, expression levels, fusion genes and promoter activity(8,9); and evaluates a range of more-specialized features of cancer genomes(8,10-18).Peer reviewe

The impact of voltage independent carriers on implied voltage measurements on silicon devices

The electrical performance a solar cell is determined from direct measurements of the current voltage relationship, while the so-called implied current-voltage measurements are often performed to estimate the performance of partially processed samples. Implied current voltage measurements are commonly obtained from quasi steady state photoconductance and quasi steady state photoluminescence measurements, where the implied voltage is inferred from the average excess carrier density. As will be shown here, this approach can be problematic due to the presence of excess carriers that do not contribute to the terminal voltage. These carriers are referred to as voltage independent carriers, a concept that is not widely known or generally accepted. This paper provides the theoretical background for the distinction of voltage dependent and voltage independent carriers. It is shown that the relative impact of voltage independent carriers on implied voltage data depends strongly on device parameters and on the illumination wavelength. Practical limits are provided for these parameters for which the voltage independent carriers can be neglected and for which an implied voltage thus accurately reflects the junction voltage

2018 IEEE 7th World Conference on Photovoltaic Energy Conversion, WCPEC 2018 - A Joint Conference of 45th IEEE PVSC, 28th PVSEC and 34th EU PVSEC

This paper reports on a low temperature, simple, surface passivation technique using onlychemicals commonly found in laboratories that results in a chemically safe and relatively stable surface. The technique has been applied to a bare silicon wafer, resulting in a chemical-free hydrogenterminated surface. Surface recombination velocities on 1 Ohmcm (100) oriented silicon down to 25 cm/s were achieved and remained below 50 cm/s for 30 minutes, confirming the temporal stability of the surface. This temporary surface passivation facilitates the measurement of wafer's bulk lifetime, an important parameter in photovoltaic devices. Being a low temperature process, thermal activation or deactivation of grown-in defects is avoided, increasing confidence in measured bulk lifetimes. By etching the sample in semiconductor grade chemicals commonly used for solar cell processing, the introduction of new impurities to the sample surface is also avoided. The surface is left clean and dry, making it safe and compatible with standard characterization equipment allowing for reliable in-line monitoring of lifetimes in solarcell processing flows without the need for construction of dedicated equipment for immersionmeasurements

Relative External Quantum Efficiency of Crystalline Silicon Wafers from Photoluminescence

The external quantum efficiency is routinely measured to determine the carrier collection probability of solar cells as a function of illumination wavelength. The common method used to perform these measurements requires a fully metalized device such that the short circuit current can be measured under monochromatic illumination. This paper demonstrates the extraction of relative external quantum efficiency data from open circuit photoluminescence measurements in a contactless fashion. Good agreement is observed between the photoluminescence-based technique and traditional external quantum efficiency data for illumination wavelengths in the range 400 to 625 nm. Deviations are observed for longer illumination wavelengths and their origin is discussed

Addressing limitations of photoluminescence based external quantum efficiency measurements

The spectral response of photoluminescence is a contactless method that provides a measurement of the relative external quantum efficiency of silicon solar cells and wafers. This method is accurate only if the measured luminescence originates from the radiative recombination of voltage dependent carriers. This paper investigates the impact of luminescence from voltage independent carriers in heavily diffused regions and other spurious sources of luminescence, such as luminescence from dielectric layers. A method, based on partial shading, is then demonstrated to record luminescence from only the voltage dependent carriers. This method is shown to provide accurate relative external quantum efficiency on cells and partially processed wafers. The relevance of the dependence of the measured data on the angular distribution of the incident light is demonstrated in this context, which explains errors in previously published data

2018 IEEE 7th World Conference on Photovoltaic Energy Conversion, WCPEC 2018 - A Joint Conference of 45th IEEE PVSC, 28th PVSEC and 34th EU PVSEC

Luminescence inspection of modules is currently being adopted as a standard practice in the photovoltaic industry. This paper presents a comparison of electroluminescence and photoluminescence imaging on industrial crystalline silicon modules, employed with a line scan system. We find that specific defects appear differently in the two techniques due to the difference in excitation method. Line scan photoluminescence images enable differentiation of series resistance defects from recombination defects and can identify the presence of encapsulant discolouration. Line scan electroluminescence images allow defects that prevent majority carrier transport to be evaluated. The use of both techniques enables robust defect characterisation