A regional trauma system to optimize the pre-hospital triage of trauma patients.

INTRODUCTION: Pre-hospital triage is a key element in a trauma system that aims to admit patients to the most suitable trauma center, and may decrease intra-hospital mortality. We evaluated the performance of a pre-hospital procedure in a regional trauma system through measurements of the quality of pre-hospital medical assessment and the efficacy of a triage protocol. METHODS: Our regional trauma system included 13 hospitals categorized as Level I, II or III trauma centers according to their technical facilities. Each patient was graded A, B or C by an emergency physician, according to the seriousness of their injuries at presentation on scene. The triage was performed according to this grading and the categorization of centers. This study is a registry analysis of a three-year period (2009 to 2011). RESULTS: Of the 3,428 studied patients, 2,572 were graded using the pre-hospital grading system (Graded group). The pre-hospital gradation was closely related with injury severity score (ISS) and intra-hospital mortality rate. The triage protocol had a sensitivity of 92% (95% confidence interval (CI) 90% to 93%) and a specificity of 41% (95% CI 39% to 44%) to predict adequate admission of patients with ISS more than 15. A total of 856 patients were not graded at the scene (Non-graded group). Undertriage rate was significantly reduced in the Graded group compared with the Non-graded group, with a relative risk of 0.47 (95% CI 0.40 to 0.56) according to the definition of the American College of Surgeons Committee on Trauma (P <0.001). Where adjusted for trauma severity, the expected mortality rate at discharge from hospital was higher than observed mortality, with a difference of +2.0% (95% CI 1.4 to 2.6%; P <0.01). CONCLUSIONS: Implementation of a regional trauma system with a pre-hospital triage procedure was effective in detecting severe trauma patients and in lowering the rate of pre-hospital undertriage. A beneficial effect on outcome of such an organization is suggested

Letter to the Editor : Attitudes among Spanish general dentists in relation to burning mouth syndrome: Results of a national survey

Thouret Jacques-Guillaume, Lapoule Jean-Denis-Louis, Talleyrand Périgord Charles Maurice de, Goupil de Préfeln Guillaume François, Populus Marc Etienne, Cochard Claude Alexis, Muguet de Nanthou François Felix, Merlin (de Douai), Toulongeon Emmanuel-François, vicomte de, Tronchet François Denis. Discussion de l'article 4 du titre II du décret sur les droits féodaux, lors de la séance du 27 février 1790. In: Archives Parlementaires de 1787 à 1860 - Première série (1787-1799) Tome XI - Du 24 décembre 1789 au 1er mars 1790. Paris : Librairie Administrative P. Dupont, 1880. pp. 725-727

Tomodensitométrie corps entier pour le traumatisé grave stable (reste-t-il une place à l'examen clinique ?)

La tomodensitométrie corps entier est réalisée en routine pour une majorité des traumatisés graves stables au niveau régional. La comparaison de cette stratégie à la réalisation de scanners segmentaires décidés sur des points d appels cliniques a cependant été étudiée. La TDM-CE a permis de mettre en évidence une et souvent plusieurs lésions chez la plupart de nos patients, certaines ont motivé une intervention chirurgicale urgente ou un transfert hospitalier. D après nos résultats, l examen clinique du traumatisé grave sans signe de détresse était insuffisamment fiable pour déterminer les scanners nécessaires au niveau du cou, du thorax, de l abdomen et du pelvis. Les scanners réalisés sans point d appel clinique révèlent à ces étages de nombreuses lésions qui n ont pas conduit à des interventions urgentes mais dont l impact thérapeutiques n est vraisemblablement pas négligeable. L examen de l étage crânien nous a paru fiable pour éliminer une lésion. Ainsi le scanner encéphalique pourrait n être réalisé qu en cas de signe clinique, ce qui pourrait permettre une diminution de l irradiation et du coût de prise en charge des patients. Nous n avons pu mettre en évidence de prédicteur fiable d une discordance clinico-scannographique. Cependant, il existait une tendance statistique à l augmentation des lésions passées inaperçues chez les patients alcoolisés devant inciter à la prudence dans cette population. La fréquence des lésions retrouvées et l absence de validité de l examen clinique du traumatisé grave stable nous semblent des arguments en faveur de la réalisation systématique de la TDM-C, crâne mis à part, pour obtenir un bilan lésionnel satisfaisant. Une étude comparative sur une plus large population est requise pour valider ces résultats et mieux apprécier l impact d une telle prise en charge sur le devenir des patients.GRENOBLE1-BU Médecine pharm. (385162101) / SudocSudocFranceF

Etude de la canicule européenne de 2003 avec les données aéroportées MOZAIC

TOULOUSE3-BU Sciences (315552104) / SudocTOULOUSE-Observ. Midi Pyréné (315552299) / SudocSudocFranceF

Instrumentation on commercial aircraft for monitoring the atmospheric composition on a global scale: the IAGOS system, technical overview of ozone and carbon monoxide measurements

This article presents the In-service Aircraft of a Global Observing System (IAGOS) developed for operations on commercial long-range Airbus aircraft (A330/A340) for monitoring the atmospheric composition. IAGOS is the continuation of the former Measurement of OZone and water vapour on Airbus In-service airCraft (MOZAIC) programme (1994–2014) with five aircraft operated by European airlines over 20 yr. MOZAIC has provided unique scientific database used worldwide by the scientific community. In continuation of MOZAIC, IAGOS aims to equip a fleet up to 20 aircraft around the world and for operations over decades. IAGOS started in July 2011 with the first instruments installed aboard a Lufthansa A340-300, and a total of six aircraft are already in operation. We present the technical aircraft system concept, with basic instruments for O3, CO, water vapour and clouds; and optional instruments for measuring either NOy, NOx, aerosols or CO2/CH4. In this article, we focus on the O3 and CO instrumentation while other measurements are or will be described in specific papers. O3 and CO are measured by optimised but well-known methods such as UV absorption and IR correlation, respectively. We describe the data processing/validation and the data quality control for O3 and CO. Using the first two overlapping years of MOZAIC/IAGOS, we conclude that IAGOS can be considered as the continuation of MOZAIC with the same data quality of O3 and CO measurements

Suite de la discussion du projet de décret sur les jurés, lors de la séance du 11 janvier 1791

Thouret Jacques-Guillaume, Boutteville-Dumetz Louis, Tronchet François Denis, Maury Jean Siffrein, abbé, Lavie Marc Antoine. Suite de la discussion du projet de décret sur les jurés, lors de la séance du 11 janvier 1791. In: Archives Parlementaires de 1787 à 1860 - Première série (1787-1799) Tome XXII - Du 3 janvier au 5 février 1791. Paris : Librairie Administrative P. Dupont, 1885. pp. 128-135

Suite de la discussion du projet de décret sur les jurés, lors de la séance du 11 janvier 1791

Thouret Jacques Guillaume, Bouteville-Dumetz Gislain-Louis, Tronchet François Denis, Maury Jean Siffrein, Lavie Marc David. Suite de la discussion du projet de décret sur les jurés, lors de la séance du 11 janvier 1791. In: Archives Parlementaires de 1787 à 1860 - Première série (1787-1799) Tome XXII - Du 3 janvier au 5 février 1791. Paris : Librairie Administrative P. Dupont, 1885. pp. 128-135

Influence of altitude on ozone levels and variability in the lower troposphere: a ground-based study for western Europe over the period 2001-2004

International audienceThe PAES (French acronym for synoptic scale atmospheric pollution) network focuses on the chemical composition (ozone, CO, NOx/y and aerosols) of the lower troposphere (0-3000 m). Its high-altitude surface stations located in different mountainous areas in France complete the low-altitude rural MERA stations (the French contribution to the european program EMEP, European Monitoring and Evaluation Program). They are representative of pollution at the scale of the French territory because they are away from any major source of pollution. This study deals with ozone observations between 2001 and 2004 at 11 stations from PAES and MERA, in addition to 16 elevated stations located in mountainous areas of Switzerland, Germany, Austria, Italy and Spain. The set of stations covers a range of altitudes between 115 and 3550 m. The comparison between recent ozone mixing ratios with those of the last decade found in the literature for two high-elevation sites (Pic du Midi, 2877 m and Jungfraujoch, 3580 m) leads to a trend that has slowed down compared to old trends but remains positive. This could be attribuable to the reduction of ozone precursors at European scale, that however do not compensate an ozone increase at the global scale. Averaged levels of ozone increase with elevation in good agreement with data provided by the airborne observation system MOZAIC (Measurement of OZone and water vapour by Airbus In-service airCraft), showing a highly stratified ozone field in the lower troposphere, with a transition at about 1000 m asl between a sharp gradient (30 ppb/km) below but a gentler gradient (3 ppb/km) above. Ozone variability also reveals a clear transition between boundary-layer and free-tropospheric regimes at the same altitude. Below, diurnal photochemistry accounts for about the third of the variability in summer, but less than 20% above - and at all levels in winter - where ozone variability is mostly due to day-to-day changes (linked to weather conditions or synoptic transport). Monthly-mean ozone mixing-ratios show at all levels a minimum in winter and the classical summer broad maximum in spring and summer - which is actually the superposition of the tropospheric spring maximum (April-May) and regional pollution episodes linked to persistent anticyclonic conditions that may occur from June to September. To complement this classical result it is shown that summer maxima are associated with considerably more variability than the spring maximum. This ensemble of findings support the relevance of mountain station networks such as PAES for the long-term observation of free-tropospheric ozone over Europe