Impact of Trauma System Structure on Injury Outcomes : A Systematic Review and Meta-Analysis

The effectiveness of trauma systems in decreasing injury mortality and morbidity has been well demonstrated. However, little is known about which components contribute to their effectiveness. We aimed to systematically review the evidence of the impact of trauma system components on clinically important injury outcomes. We searched MEDLINE, EMBASE, Cochrane CENTRAL, and BIOSIS/Web of Knowledge, gray literature and trauma association Web sites to identify studies evaluating the association between at least one trauma system component and injury outcome. We calculated pooled effect estimates using inverse-variance random-effects models. We evaluated quality of evidence using GRADE criteria. We screened 15,974 records, retaining 41 studies for qualitative synthesis and 19 for meta-analysis. Two recommended trauma system components were associated with reduced odds of mortality: inclusive design (odds ratio [OR] = 0.72 [0.65-0.80]) and helicopter transport (OR = 0.70 [0.55-0.88]). Pre-Hospital Advanced Trauma Life Support was associated with a significant reduction in hospital days (mean difference [MD] = 5.7 [4.4-7.0]) but a nonsignificant reduction in mortality (OR = 0.78 [0.44-1.39]). Population density of surgeons was associated with a nonsignificant decrease in mortality (MD = 0.58 [-0.22 to 1.39]). Trauma system maturity was associated with a significant reduction in mortality (OR = 0.76 [0.68-0.85]). Quality of evidence was low or very low for mortality and healthcare utilization. This review offers low-quality evidence for the effectiveness of an inclusive design and trauma system maturity and very-low-quality evidence for helicopter transport in reducing injury mortality. Further research should evaluate other recommended components of trauma systems and non-fatal outcomes and explore the impact of system component interactions.Peer reviewe

Impact of Trauma System Structure on Injury Outcomes : A Systematic Review and Meta-Analysis

The effectiveness of trauma systems in decreasing injury mortality and morbidity has been well demonstrated. However, little is known about which components contribute to their effectiveness. We aimed to systematically review the evidence of the impact of trauma system components on clinically important injury outcomes. We searched MEDLINE, EMBASE, Cochrane CENTRAL, and BIOSIS/Web of Knowledge, gray literature and trauma association Web sites to identify studies evaluating the association between at least one trauma system component and injury outcome. We calculated pooled effect estimates using inverse-variance random-effects models. We evaluated quality of evidence using GRADE criteria. We screened 15,974 records, retaining 41 studies for qualitative synthesis and 19 for meta-analysis. Two recommended trauma system components were associated with reduced odds of mortality: inclusive design (odds ratio [OR] = 0.72 [0.65-0.80]) and helicopter transport (OR = 0.70 [0.55-0.88]). Pre-Hospital Advanced Trauma Life Support was associated with a significant reduction in hospital days (mean difference [MD] = 5.7 [4.4-7.0]) but a nonsignificant reduction in mortality (OR = 0.78 [0.44-1.39]). Population density of surgeons was associated with a nonsignificant decrease in mortality (MD = 0.58 [-0.22 to 1.39]). Trauma system maturity was associated with a significant reduction in mortality (OR = 0.76 [0.68-0.85]). Quality of evidence was low or very low for mortality and healthcare utilization. This review offers low-quality evidence for the effectiveness of an inclusive design and trauma system maturity and very-low-quality evidence for helicopter transport in reducing injury mortality. Further research should evaluate other recommended components of trauma systems and non-fatal outcomes and explore the impact of system component interactions.Peer reviewe

Beyond the conflict: religion in the public sphere and deliberative democracy

Traditionally, liberals have confined religion to the sphere of the ‘private’ or ‘non-political’. However, recent debates over the use of religious symbols in public spaces, state financing of faith schools, and tax relief for religious organisations suggest that this distinction is not particularly useful in easing the tension between liberal ideas of equality among citizens and freedom of religion. This article deals with one aspect of this debate, which concerns whether members of religious communities should receive exemptions from regulations that place a distinctively heavy burden on them. For supporters of exemptions, protection for diverse practices and religious beliefs justifies such a special treatment. For others, this is a form of positive discrimination incompatible with equal citizenship. Drawing on Habermas’ understanding of churches as ‘communities of interpretation’ this article explores possible alternative solutions to both the ‘rule-andexemption’ approach and the ‘neutralist’ approach. Our proposal rests on the idea of mutual learning between secular and religious perspectives. On this interpretation, what is required is, firstly, generation and maintenance of public spaces in which there could be discussion and dialogue about particular cases, and, secondly, evaluation of whether the basic conditions of moral discourse are present in these spaces. Thus deliberation becomes a touchstone for the building of a shared democratic etho

Cell Adhesion Molecules, Leukocyte Trafficking, and Strategies to Reduce Leukocyte Infiltration

Leukocyte-endothelial cell interactions are mediated by various cell adhesion molecules. These interactions are important for leukocyte extravasation and trafficking in all domestic animal species. An initial slowing of leukocytes on the vascular endothelium is mediated by selectins. This event is followed by (1) activation of β2 integrins after leukocyte exposure to cytokines and proinflammatory mediators, (2) adherence of leukocyte β2 integrins to vascular endothelial ligands (eg, intercellular adhesion molecule-1 [ICAM-1]), (3) extravasation of leukocytes into tissues through tight junctions of endothelial cells mediated by platelet and endothelial cell adhesion molecule-1 (PECAM-1), and (4) perivascular migration through the extracellular matrix via β1 integrins. Inhibiting excessive leukocyte egress and subsequent free radical-mediated damage caused by leukocyte components may attenuate or eliminate tissue damage. Several methods have been used to modify leukocyte infiltration in various animal models. These methods include nonspecific inhibition of pro-inflammatory mediators and adhesion molecules by nonsteroidal anti-inflammatory drugs (NSAIDs) and glucocorticoids, inhibition of cytokines and cytokine receptors, and inhibition of specific types of cell adhesion molecules, with inhibitors such as peptides and antibodies to β2integrins, and inhibitors of selectins, ICAMs, and vascular cell adhesion molecule-1 (VCAM-1). By understanding the cellular and molecular events in leukocyte-endothelial cell interactions, therapeutic strategies are being developed in several animal models and diseases in domestic animal species. Such therapies may have clinical benefit in the future to overcome tissue damage induced by excessive leukocyte infiltration

Irish physical force republicanism in Britain, 1919-1923

THESIS 9100This thesis studies the activities of Irish republicans - mainly the Irish Republican Army (IRA) - in Britain from the outbreak of the war of independence in 1919 to the end of the civil war in 1923. It is based on my reading of primary and secondary sources. The primary sources employed can be divided into two main types: those dating from the period under study and the recollections of veterans in later life. At University College Dublin Archives, 1 consulted the collections of Eamon de Valera, Sighle Humphries, Terence MacSwiney, Richard Mulcahy, Ernie O\u27Malley and Maurice ?Moss\u27 Twomey, all of which contain contemporaneous records detailing republican activities in Britain, as well as the transcripts of interviews with veterans decades later

THE DESIGN AND BUILD OF A PORTABLE DEVICE TO MEASURE OCULAR MICROTREMOR (OMT)

ABSTRACT This paper describes the successful design and build of a portable device to record open and closed eye Ocular Microtremor (OMT) signals using an eye contacting piezoelectric crystal. INTRODUCTION The eyes of all normal subjects undergo a continuous, low-amplitude, high frequency, physiological tremor called ocular microtremor (OMT). The tremor occurs at a frequency between 20 and 150 Hz and is of the order of 1µm. It was first described in 1934 by Alder and Fliegelman [1] as one of three fixational eye movements. The first investigation of OMT as a neurological phenomenon was carried out by Shakanovic

Comparison of the Pharmacological Effects of Paricalcitol and Doxercalciferol on the Factors Involved in Mineral Homeostasis

Vitamin D receptor agonists (VDRAs) directly suppress parathyroid hormone (PTH) mRNA expression. Different VDRAs are known to have differential effects on serum calcium (Ca), which may also affect serum PTH levels since serum Ca regulates PTH secretion mediated by the Ca-sensing receptor (CaSR). In this study, we compared the effects of paricalcitol and doxercalciferol on regulating serum Ca and PTH, and also the expression of PTH, VDR, and CaSR mRNA. The 5/6 nephrectomized (NX) Sprague-Dawley rats on a normal or hyperphosphatemia-inducing diet were treated with vehicle, paricalcitol, or doxercalciferol for two weeks. Both drugs at the tested doses (0.042–0.33 g/kg) suppressed PTH mRNA expression and serum PTH effectively in the 5/6 NX rats, but paricalcitol was less potent in raising serum Ca than doxercalciferol. In pig parathyroid cells, paricalcitol and the active form of doxercalciferol induced VDR translocation from the cytoplasm into the nucleus, suppressed PTH mRNA expression and inhibited cell proliferation in a similar manner, although paricalcitol induced the expression of CaSR mRNA more effectively. The multiple effects of VDRAs on modulating serum Ca, parathyroid cell proliferation, and the expression of CaSR and PTH mRNA reflect the complex involvement of the vitamin D axis in regulating the mineral homeostasis system