Care of bullet-related injuries: A cross-sectional study of instructions and prescriptions provided on discharge from the emergency department

INTRODUCTION: There are more than 80,000 emergency department (ED) visits for non-fatal bullet-related injuries (BRI) per year in the United States. Approximately half of these patients are discharged home from the ED. Our objective in this study was to characterize the discharge instructions, prescriptions, and follow-up plans provided to patients discharged from the ED after BRI. METHODS: This was a single-center, cross-sectional study of the first 100 consecutive patients who presented to an urban, academic, Level I trauma center ED with an acute BRI beginning on January 1, 2020. We queried the electronic health record for patient demographics, insurance status, cause of injury, hospital arrival and discharge timestamps, discharge prescriptions, and documented instructions regarding wound care, pain management, and follow-up plans. We analyzed data using descriptive statistics and chi-square tests. RESULTS: During the study period, 100 patients presented to the ED with an acute firearm injury. Patients were predominantly young (median age 29, interquartile range 23-38 years), male (86%), Black (85%), non-Hispanic (98%), and uninsured (70%). We found that 12% of patients did not receive any type of written wound care instruction, while 37% received discharge paperwork that included instructions to take both an NSAID and acetaminophen. Fifty-one percent of patients received an opioid prescription, with a range from 3-42 tablets (median 10 tablets). The proportion of patients receiving an opioid prescription was significantly higher among White patients (77%) than among Black patients (47%). CONCLUSION: There is variability in prescriptions and instructions provided to survivors of bullet injuries upon ED discharge at our institution. Our data indicates that standardized discharge protocols could improve quality of care and equity in the treatment of patients who have survived a BRI. Current variable quality in discharge planning is an entry point for structural racism and disparity

Design of light concentrators for Cherenkov telescope observatories

The Cherenkov Telescope Array (CTA) will be the largest cosmic gamma ray detector ever built in the world. It will be installed at two different sites in the North and South hemispheres and should be operational for about 30 years. In order to cover the desired energy range, the CTA is composed of typically 50-100 collecting telescopes of various sizes (from 6 to 24-m diameters). Most of them are equipped with a focal plane camera consisting of 1500 to 2000 Photomultipliers (PM) equipped with light concentrating optics, whose double function is to maximize the amount of Cherenkov light detected by the photo-sensors, and to block any stray light originating from the terrestrial environment. Two different optical solutions have been designed, respectively based on a Compound Parabolic Concentrator (CPC), and on a purely dioptric concentrating lens. In this communication are described the technical specifications, optical designs and performance of the different solutions envisioned for all these light concentrators. The current status of their prototyping activities is also given

Optimizing projectional radiographic imaging of the abdomen of obese patients: an e-Delphi study

This is the author accepted manuscript. The final version is available from Elsevier via the DOI in this record.Purpose: Obesity is increasing in prevalence globally, with increased demands placed on radiology departments to image obese patients to assist with diagnosis and management. The aim of this study was to determine perceived best practice techniques currently used in clinical practice for projectional radiography of the abdomen for obese patients with the aim to help elucidate areas for future research and education needs in this field. Experimental Design: A two round e-Delphi study was undertaken to establish a consensus within a reference group of expert Australian clinical educator diagnostic radiographers (CEDRs). Initially, a conceptual map of issues regarding imaging obese patients was undertaken by analysing interview transcripts of 12 CEDRs. This informed an online questionnaire design used in Delphi rounds 1 and 2. A consensus threshold was set <75% “agreement/disagreement”, with 15 and 14 CEDRs participating in rounds 1 and 2, respectively. Results: Seven of the 11 statements reach consensus after round 2. Consensus on using a combination of higher peak kilovoltage (kVp) and milliampere-seconds (mAs) to increase radiation exposure increased source-to-image distance and tighter collimation was achieved. There was no consensus regarding patient positioning practices or patient communication strategies. The expert group reported the importance of personal confidence and treating patients as individuals when applying techniques. Conclusion: Diversity of experts' opinions and current practice may be due to the variations in obese patients’ size and presentation. Therefore, there is a need for extensive empirical evidence to underpin practice and education resources for radiographers when imaging obese patients

Beings in their own right? Exploring Children and young people's sibling and twin relationships in the Minority World

This paper examines the contributions that the sociological study of sibship and twinship in the Minority World can make to childhood studies. It argues that, in providing one forum within which to explore children and young people's social relationships, we can add to our understanding of children and young people's interdependence and develop a more nuanced understanding of agency. As emergent subjects, children, young people and adults are in a process of ‘becoming’. However, this does not mean that they can ‘become’ anything they choose to. The notion of negotiated interdependence (Punch 2002) is useful in helping us to grasp the contingent nature of children and young people's agency

Between overt and covert research: concealment and disclosure in an ethnographic study of commercial hospitality

This article examines the ways in which problems of concealment emerged in an ethnographic study of a suburban bar and considers how disclosure of the research aims, the recruitment of informants, and elicitation of information was negotiated throughout the fieldwork. The case study demonstrates how the social context and the relationships with specific informants determined overtness or covertness in the research. It is argued that the existing literature on covert research and covert methods provides an inappropriate frame of reference with which to understand concealment in fieldwork. The article illustrates why concealment is sometimes necessary, and often unavoidable, and concludes that the criticisms leveled against covert methods should not stop the fieldworker from engaging in research that involves covertness

Ethical issues in the use of in-depth interviews: literature review and discussion

This paper reports a literature review on the topic of ethical issues in in-depth interviews. The review returned three types of article: general discussion, issues in particular studies, and studies of interview-based research ethics. Whilst many of the issues discussed in these articles are generic to research ethics, such as confidentiality, they often had particular manifestations in this type of research. For example, privacy was a significant problem as interviews sometimes probe unexpected areas. For similar reasons, it is difficult to give full information of the nature of a particular interview at the outset, hence informed consent is problematic. Where a pair is interviewed (such as carer and cared-for) there are major difficulties in maintaining confidentiality and protecting privacy. The potential for interviews to harm participants emotionally is noted in some papers, although this is often set against potential therapeutic benefit. As well as these generic issues, there are some ethical issues fairly specific to in-depth interviews. The problem of dual role is noted in many papers. It can take many forms: an interviewer might be nurse and researcher, scientist and counsellor, or reporter and evangelist. There are other specific issues such as taking sides in an interview, and protecting vulnerable groups. Little specific study of the ethics of in-depth interviews has taken place. However, that which has shows some important findings. For example, one study shows participants are not averse to discussing painful issues provided they feel the study is worthwhile. Some papers make recommendations for researchers. One such is that they should consider using a model of continuous (or process) consent rather than viewing consent as occurring once, at signature, prior to the interview. However, there is a need for further study of this area, both philosophical and empirical

The CAT Imaging Telescope for Very-High-Energy Gamma-Ray Astronomy

The CAT (Cherenkov Array at Themis) imaging telescope, equipped with a very-high-definition camera (546 fast phototubes with 0.12 degrees spacing surrounded by 54 larger tubes in two guard rings) started operation in Autumn 1996 on the site of the former solar plant Themis (France). Using the atmospheric Cherenkov technique, it detects and identifies very high energy gamma-rays in the range 250 GeV to a few tens of TeV. The instrument, which has detected three sources (Crab nebula, Mrk 421 and Mrk 501), is described in detail.Comment: 24 pages, 15 figures. submitted to Elsevier Preprin

Spectrum and Variability of Mrk501 as observed by the CAT Imaging Telescope

The CAT Imaging Telescope has observed the BL Lac object Markarian 501 between March and August 1997. We report here on the variability over this time including several large flares. We present also preliminary spectra for all these data, for the low emission state, and for the largest flare.Comment: 4 pages, 4 figures, Late

Observation of the Crab Nebula Gamma-Ray Emission Above 220 Gev by the Cat Cherenkov Imaging Telescope

The CAT imaging telescope, recently built on the site of the former solar plant Themis (French Pyrenees), observed gamma-rays from the Crab nebula from October 1996 to March 1997. This steady source, often considered as the standard candle of very-high-energy gamma-ray astronomy, is used as a test-beam to probe the performances of the new telescope, particularly its energy threshold (220 GeV at 20 degrees zenith angle) and the stability of its response. Due to the fine-grain camera, an accurate analysis of the longitudinal profiles of shower images is performed, yielding the source position in two dimensions for each individual shower.Comment: 5 pages, 3 figures, Tex, contribution to 25th ICRC Durba

Detection of Vhe Gamma-Rays from MRK 501 with the Cat Imaging Telescope

The CAT imaging telescope on the site on the former solar plant Themis has been observing gamma-rays from Mrk501 above 220 GeV in March and April 1997. This source is shown to be highly variable and the light curve is presented. The detected gamma-ray rate for the most intense flare is in excess of 10 per minute.Comment: 5 pages, 4 figures, Tex, contribution to 25th ICRC Durba