Panamerican Trauma Society: The first three decades

Panamerican Trauma Society was born 30 years ago with the mission of improving trauma care in the Americas by exchange of ideas and concepts and expanding knowledge of trauma and acute illness. The authors, immediate-past leaders of the organization, review the evolution of this assembly of diverse cultures and nationalities

Stress Analysis of Bolted, Segmented Cylindrical Shells Exhibiting Flange Mating-Surface Waviness

Bolted, segmented cylindrical shells are a common structural component in many engineering systems especially for aerospace launch vehicles. Segmented shells are often needed due to limitations of manufacturing capabilities or transportation issues related to very long, large-diameter cylindrical shells. These cylindrical shells typically have a flange or ring welded to opposite ends so that shell segments can be mated together and bolted to form a larger structural system. As the diameter of these shells increases, maintaining strict fabrication tolerances for the flanges to be flat and parallel on a welded structure is an extreme challenge. Local fit-up stresses develop in the structure due to flange mating-surface mismatch (flange waviness). These local stresses need to be considered when predicting a critical initial flaw size. Flange waviness is one contributor to the fit-up stress state. The present paper describes the modeling and analysis effort to simulate fit-up stresses due to flange waviness in a typical bolted, segmented cylindrical shell. Results from parametric studies are presented for various flange mating-surface waviness distributions and amplitudes

Fracture Mechanics Analyses of the Slip-Side Joggle Regions of Wing-Leading Edge Panels

The Space Shuttle Orbiter wing comprises of 22 leading edge panels on each side of the wing. These panels are part of the thermal protection system that protects the Orbiter wings from extreme heating that take place on the reentry in to the earth atmosphere. On some panels that experience extreme heating, liberation of silicon carbon (SiC) coating was observed on the slip side regions of the panels. Global structural and local fracture mechanics analyses were performed on these panels as a part of the root cause investigation of this coating liberation anomaly. The wing-leading-edge reinforced carbon-carbon (RCC) panels, Panel 9, T-seal 10, and Panel 10, are shown in Figure 1 and the progression of the stress analysis models is presented in Figure 2. The global structural analyses showed minimal interaction between adjacent panels and the T-seal that bridges the gap between the panels. A bounding uniform temperature is applied to a representative panel and the resulting stress distribution is examined. For this loading condition, the interlaminar normal stresses showed negligible variation in the chord direction and increased values in the vicinity of the slip-side joggle shoulder. As such, a representative span wise slice on the panel can be taken and the cross section can be analyzed using plane strain analysis

Stress Intensity Factors for Part-Through Surface Cracks in Hollow Cylinders

Flaws resulting from improper welding and forging are usually modeled as cracks in flat plates, hollow cylinders or spheres. The stress intensity factor solutions for these crack cases are of great practical interest. This report describes some recent efforts at improving the stress intensity factor solutions for cracks in such geometries with emphasis on hollow cylinders. Specifically, two crack configurations for cylinders are documented. One is that of a surface crack in an axial plane and the other is a part-through thumb-nail crack in a circumferential plane. The case of a part-through surface crack in flat plates is used as a limiting case for very thin cylinders. A combination of the two cases for cylinders is used to derive a relation for the case of a surface crack in a sphere. Solutions were sought which cover the entire range of the geometrical parameters such as cylinder thickness, crack aspect ratio and crack depth. Both the internal and external position of the cracks are considered for cylinders and spheres. The finite element method was employed to obtain the basic solutions. Power-law form of loading was applied in the case of flat plates and axial cracks in cylinders and uniform tension and bending loads were applied in the case of circumferential (thumb-nail) cracks in cylinders. In the case of axial cracks, the results for tensile and bending loads were used as reference solutions in a weight function scheme so that the stress intensity factors could be computed for arbitrary stress gradients in the thickness direction. For circumferential cracks, since the crack front is not straight, the above technique could not be used. Hence for this case, only the tension and bending solutions are available at this time. The stress intensity factors from the finite element method were tabulated so that results for various geometric parameters such as crack depth-to-thickness ratio (a/t), crack aspect ratio (a/c) and internal radius-to-thickness ratio (R/t) or the crack length-to-width ratio (2c/W) could be obtained by interpolation and extrapolation. Such complete tables were then incorporated into the NASA/FLAGRO computer program which is widely used by the aerospace community for fracture mechanics analysis

Ares I-X Upper Stage Simulator Structural Analyses Supporting the NESC Critical Initial Flaw Size Assessment

The structural analyses described in the present report were performed in support of the NASA Engineering and Safety Center (NESC) Critical Initial Flaw Size (CIFS) assessment for the ARES I-X Upper Stage Simulator (USS) common shell segment. The structural analysis effort for the NESC assessment had three thrusts: shell buckling analyses, detailed stress analyses of the single-bolt joint test; and stress analyses of two-segment 10 degree-wedge models for the peak axial tensile running load. Elasto-plastic, large-deformation simulations were performed. Stress analysis results indicated that the stress levels were well below the material yield stress for the bounding axial tensile design load. This report also summarizes the analyses and results from parametric studies on modeling the shell-to-gusset weld, flange-surface mismatch, bolt preload, and washer-bearing-surface modeling. These analyses models were used to generate the stress levels specified for the fatigue crack growth assessment using the design load with a factor of safety

DVT Surveillance Program in the ICU: Analysis of Cost-Effectiveness

Background Venous Thrombo-embolism (VTE – Deep venous thrombosis (DVT) and/or pulmonary embolism (PE) – in traumatized patients causes significant morbidity and mortality. The current study evaluates the effectiveness of DVT surveillance in reducing PE, and performs a cost-effectiveness analysis. Methods All traumatized patients admitted to the adult ICU underwent twice weekly DVT surveillance by bilateral lower extremity venous Duplex examination (48-month surveillance period – SP). The rates of DVT and PE were recorded and compared to the rates observed in the 36-month pre-surveillance period (PSP). All patients in both periods received mechanical and pharmacologic prophylaxis unless contraindicated. Total costs – diagnostic, therapeutic and surveillance – for both periods were recorded and the incremental cost for each Quality Adjusted Life Year (QALY) gained was calculated. Results 4234 patients were eligible (PSP – 1422 and SP – 2812). Rate of DVT in SP (2.8%) was significantly higher than in PSP (1.3%) – p Conclusions Surveillance of traumatized ICU patients increases DVT detection and reduces PE incidence. Costs in terms of QALY gained compares favorably with other interventions accepted by society

Implementation of J-A Methodology Elastic-Plastic Crack Instability Analysis Capability into the WARP-3D Code

Characterization of the near crack-tip stress/strain fields is the foundation of fracture mechanics. The description of the near tip stress field and the prediction of when fracture occurs is well established for brittle materials that exhibit linear elastic behavior. However, in ductile materials or conditions that violate linear elastic assumptions (Aluminum alloys, Al 2024-T3, Al 2024- T351 etc.), the elastic-plastic crack-tip stress fields are characterized by the Hutchison-Rice-Rosengren (HRR) field. The J-integral is commonly used to characterize amplitude of the HRR field under elastic-plastic conditions. The J-integral has been demonstrated for crack-tip fields that are under high constraint conditions (i.e., small-scale plasticity where the J-dominance is maintained). However, as the external load increases, yielding changes from small- to largescale plasticity and usually a loss of constraint (i.e., reduction in the triaxial stress field along the crack front). The loss of constraint leads to the deviation of the crack-tip stress fields from that given by the HRR field. Hence, the J-dominance will be gradually lost and additional parameter(s) are required to quantify the crack-tip stress fields and predict fracture behavior. The assessment objectives were to: 1) implement a two-parameter (i.e., J-A) fracture criterion into an elastic-plastic three-dimensional (3D) finite element analysis (FEA), 2) validate the implementation by comparison with the A parameter from literature data, 3) conduct material characterization tests to quantify the material behavior and provide fracture data for validation of the J-A fracture criteria, and (4) perform evaluations to establish if the J-A criteria can be used to predict fracture in a ductile metallic material (e.g., aluminum alloys). The A parameter in these criteria is the second parameter in a three-term elastic-plastic asymptotic expansion of the neartip stress behavior. A series of extensive FEAs were performed using WARP3D software package to obtain solutions for the A parameter for different specimen configurations. The methodology needed for the estimation of the A parameter in the asymptotic expansion was developed and implemented using Matlab. A user material (UMAT) routine was used to model the material stress-strain response using a Ramberg-Osgood power law with a hardening exponent (n) and a material coefficient (alpha). This UMAT routine was successfully implemented in WARP3D software and validated through comparison with the experimental data. Three configurations were extracted from published results: 1) center cracked plate (CCP), 2) single edge-cracked plate (SECP), and 3) double edge-cracked plate (DECP). These configurations and four other configurations (three-hole tension (THT)), three-point bend (3PTB), three-hole compact tension (3PCT), and compact tension (CT)) were analyzed to verify the methodology that was developed and implemented into WARP3D. Solutions of the A parameter were obtained for remote tension loading conditions that started with small-scale yielding and continued into the large-scale plasticity regime. The results indicate that the methodology developed can be used to calculate the elastic-plastic J-A parameters for test specimens with a range of crack geometries, material strain hardening behaviors, and loading conditions. The J-A parameters were implemented as fracture criteria and used to predict the test results. For comparison, other fracture criteria were used to predict the same test results. Major findings include: The A constraint parameter A varies with specimen type and applied load thus accurate determination is crucial in predicting the failure load, and the A parameter is asymptotic as the failure load is approached, making an accurate determination difficult (i.e., small differences in the A parameter can cause large variations in failure load) for materials exhibiting elastic-plastic behavior. The failure predictions from J-A methodology were more accurate than the traditionally used KC and J methods, and have comparable scatter to that observed when using the crack-tip opening angle (CTOA) method. However, the J-A methodology requires considerable effort (expertise level and labor) to implement and to evaluate the A parameter for different specimen types and materials, or to apply this methodology to part-through crack (e.g., 3D problems) structural applications

Fracture Mechanics Analyses of Reinforced Carbon-Carbon Wing-Leading-Edge Panels

Fracture mechanics analyses of subsurface defects within the joggle regions of the Space Shuttle wing-leading-edge RCC panels are performed. A 2D plane strain idealized joggle finite element model is developed to study the fracture behavior of the panels for three distinct loading conditions - lift-off and ascent, on-orbit, and entry. For lift-off and ascent, an estimated bounding aerodynamic pressure load is used for the analyses, while for on-orbit and entry, thermo-mechanical analyses are performed using the extreme cold and hot temperatures experienced by the panels. In addition, a best estimate for the material stress-free temperature is used in the thermo-mechanical analyses. In the finite element models, the substrate and coating are modeled separately as two distinct materials. Subsurface defects are introduced at the coating-substrate interface and within the substrate. The objective of the fracture mechanics analyses is to evaluate the defect driving forces, which are characterized by the strain energy release rates, and determine if defects can become unstable for each of the loading conditions

External Tank (ET) Bipod Fitting Bolted Attachment Locking Insert Performance

Following STS-107, the External Tank (ET) Project implemented corrective actions and configuration changes at the ET bipod fitting. Among the corrective actions, the existing bolt lock wire which provided resistance to potential bolt rotation was removed. The lock wire removal was because of concerns with creating voids during foam application and potential for lock wire to become debris. The bolts had been previously lubricated to facilitate assembly but, because of elimination of the lock wire, the ET Project wanted to enable the locking feature of the insert. Thus, the lubrication was removed from bolt threads and instead applied to the washer under the bolt head. Lubrication is necessary to maximize joint pre-load while remaining within the bolt torque specification. The locking feature is implemented by thread crimping in at four places in the insert. As the bolt is torqued into the insert the bolt threads its way past the crimped parts of the insert. This provides the locking of the bolt, as torque is required to loosen the joint after clamping

History of the Innovation of Damage Control for Management of Trauma Patients: 1902-2016

Objective: To review the history of the innovation of damage control (DC) for management of trauma patients. Background: DC is an important development in trauma care that provides a valuable case study in surgical innovation. Methods: We searched bibliographic databases (1950-2015), conference abstracts (2009-2013), Web sites, textbooks, and bibliographies for articles relating to trauma DC. The innovation of DC was then classified according to the Innovation, Development, Exploration, Assessment, and Long-term study model of surgical innovation. Results: The innovation\u27\u27 of DC originated from the use of therapeutic liver packing, a practice that had previously been abandoned after World War II because of adverse events. It then developed\u27\u27 into abbreviated laparotomy using rapid conservative operative techniques.\u27\u27 Subsequent exploration\u27\u27 resulted in the application of DC to increasingly complex abdominal injuries and thoracic, peripheral vascular, and orthopedic injuries. Increasing use of DC laparotomy was followed by growing reports of postinjury abdominal compartment syndrome and prophylactic use of the open abdomen to prevent intra-abdominal hypertension after DC laparotomy. By the year 2000, DC surgery had been widely adopted and was recommended for use in surgical journals, textbooks, and teaching courses ( assessment\u27\u27 stage of innovation). Long-term study\u27\u27 of DC is raising questions about whether the procedure should be used more selectively in the context of improving resuscitation practices. Conclusions: The history of the innovation of DC illustrates how a previously abandoned surgical technique was adapted and readopted in response to an increased understanding of trauma patient physiology and changing injury patterns and trauma resuscitation practices