Injury Severity Score coding: Data analyst v. emerging m-health technology

Background. The cost of Abbreviated Injury Scale (AIS) coding has limited its utility in areas of the world with the highest incidence of trauma. We hypothesised that emerging mobile health (m-health) technology could offer a cost-effective alternative to the current goldstandard AIS mechanism in a high-volume trauma centre in South Africa.Methods. A prospectively collected sample of consecutive patients admitted following a traumatic injury that required an operation during a 1-month period was selected for the study. AISs and Injury Severity Scores (ISSs) were generated by clinician-entered data using an m-health application (ISS eTHR) as well as by a team of AIS coders at Vancouver General Hospital, Canada (ISS VGH). Rater agreements for ISSs were analysed using Bland-Altman plots with 95% limits of agreement (LoA) and kappa statistics of the ISSs grouped into ordinal categories. Reliability was analysed using a two-way mixed-model intraclass correlation coefficient (ICC). Calibration and discrimination of univariate logistic regression models built to predict in-hospital complications using ISSs coded by the two methods were also compared.Results. Fifty-seven patients were managed operatively during the study period. The mean age of the cohort was 27.2 years (range 14 - 62), and 96.3% were male. The mechanism of injury was penetrating in 93.4% of cases, of which 52.8% were gunshot injuries. The LoA fell within –8.6 - 9.4. The mean ISS difference was 0.4 (95% CI –0.8 - 1.6). The kappa statistic was 0.53. The ICC of the individual ISS was 0.88 (95% CI 0.81 - 0.93) and the categorical ISS was 0.81 (95% CI 0.68 - 0.87). Model performance to predict in-hospital complications using either the ISS eTHR or the ISS VGH was equivalent.Conclusions. ISSs calculated by the eTHR and gold-standard coding were comparable. Emerging m-health technology provides a costeffective alternative for injury severity scoring

Trauma Surveillance in Cape Town, South Africa: An Analysis of 9236 Consecutive Trauma Center Admissions.

PublishedJournal ArticleResearch Support, Non-U.S. Gov'tThis is the final version of the article. Available from American Medical Association via the DOI in this record.IMPORTANCE: Trauma is a leading cause of death and disability worldwide. In many low- and middle-income countries, formal trauma surveillance strategies have not yet been widely implemented. OBJECTIVE: To formalize injury data collection at Groote Schuur Hospital, the chief academic hospital of the University of Cape Town, a level I trauma center, and one of the largest trauma referral hospitals in the world. DESIGN, SETTING, AND PARTICIPANTS: This was a prospective study of all trauma admissions from October 1, 2010, through September 30, 2011, at Groote Schuur Hospital. A standard admission form was developed with multidisciplinary input and was used for both clinical and data abstraction purposes. Analysis of data was performed in 3 parts: demographics of injury, injury risk by location, and access to and maturity of trauma services. Geographic information science was then used to create satellite imaging of injury "hot spots" and to track referral patterns. Finally, the World Health Organization trauma system maturity index was used to evaluate the current breadth of the trauma system in place. MAIN OUTCOMES AND MEASURES: The demographics of trauma patients, the distribution of injury in a large metropolitan catchment, and the patterns of injury referral and patient movement within the trauma system. RESULTS: The minimum 34-point data set captured relevant demographic, geographic, incident, and clinical data for 9236 patients. Data field completion rates were highly variable. An analysis of demographics of injury (age, sex, and mechanism of injury) was performed. Most violence occurred toward males (71.3%) who were younger than 40 years of age (74.6%). We demonstrated high rates of violent interpersonal injury (71.6% of intentional injury) and motor vehicle injury (18.8% of all injuries). There was a strong association between injury and alcohol use, with alcohol implicated in at least 30.1% of trauma admissions. From a systems standpoint, the data suggest a mature pattern of referral consistent with the presence of an inclusive trauma system. CONCLUSIONS AND RELEVANCE: The implementation of injury surveillance at Groote Schuur Hospital improved insights about injury risk based on demographics and neighborhood as well as access to service based on patterns of referral. This information will guide further development of South Africa's already advanced trauma system.This work was supported by the Canadian Institute for Health Research and the Social Sciences and Humanities Research Council

Injury Severity Score coding: Data analyst v. emerging m-health technology

Background. The cost of Abbreviated Injury Scale (AIS) coding has limited its utility in areas of the world with the highest incidence of trauma. We hypothesised that emerging mobile health (m-health) technology could offer a cost-effective alternative to the current gold-standard AIS mechanism in a high-volume trauma centre in South Africa.Methods. A prospectively collected sample of consecutive patients admitted following a traumatic injury that required an operation during a 1-month period was selected for the study. AISs and Injury Severity Scores (ISSs) were generated by clinician-entered data using an m-health application (ISS eTHR) as well as by a team of AIS coders at Vancouver General Hospital, Canada (ISS VGH). Rater agreements for ISSs were analysed using Bland-Altman plots with 95% limits of agreement (LoA) and kappa statistics of the ISSs grouped into ordinal categories. Reliability was analysed using a two-way mixed-model intraclass correlation coefficient (ICC). Calibration and discrimination of univariate logistic regression models built to predict in-hospital complications using ISSs coded by the two methods were also compared.Results. Fifty-seven patients were managed operatively during the study period. The mean age of the cohort was 27.2 years (range 14 - 62), and 96.3% were male. The mechanism of injury was penetrating in 93.4% of cases, of which 52.8% were gunshot injuries. The LoA fell within –8.6 - 9.4. The mean ISS difference was 0.4 (95% CI –0.8 - 1.6). The kappa statistic was 0.53. The ICC of the individual ISS was 0.88 (95% CI 0.81 - 0.93) and the categorical ISS was 0.81 (95% CI 0.68 - 0.87). Model performance to predict in-hospital complications using either the ISS eTHR or the ISS VGH was equivalent.Conclusions. ISSs calculated by the eTHR and gold-standard coding were comparable. Emerging m-health technology provides a cost-effective alternative for injury severity scoring.

Effects of annealing treatment prior to cold rolling on delayed fracture properties in ferrite-austenite duplex lightweight steels

Tensile properties of recently developed automotive high-strength steels containing about 10 wt pct of Mn and Al are superior to other conventional steels, but the active commercialization has been postponed because they are often subjected to cracking during formation or to the delayed fracture after formation. Here, the delayed fracture behavior of a ferrite-austenite duplex lightweight steel whose microstructure was modified by a batch annealing treatment at 1023 K (750 A degrees C) prior to cold rolling was examined by HCl immersion tests of cup specimens, and was compared with that of an unmodified steel. After the batch annealing, band structures were almost decomposed as strong textures of {100}aOE (c) 011 > alpha-fibers and {111}aOE (c) 112 > gamma-fibers were considerably dissolved, while ferrite grains were refined. The steel cup specimen having this modified microstructure was not cracked when immersed in an HCl solution for 18 days, whereas the specimen having unmodified microstructure underwent the delayed fracture within 1 day. This time delayed fracture was more critically affected by difference in deformation characteristics such as martensitic transformation and deformation inhomogeneity induced from concentration of residual stress or plastic strain, rather than the difference in initial microstructures. The present work gives a promise for automotive applications requiring excellent mechanical and delayed fracture properties as well as reduced specific weight.ope

Heteromeric TRPV4/TRPC1 channels mediate calcium-sensing receptor-induced relaxations and nitric oxide production in mesenteric arteries: Comparative study using wild-type and TRPC1−/- mice

We have previously provided pharmacological evidence that stimulation of calcium-sensing receptors (CaSR) induces endothelium-dependent relaxations of rabbit mesenteric arteries through activation of heteromeric TRPV4/TRPC1 channels and nitric oxide (NO) production. The present study further investigates the role of heteromeric TRPV4/TRPC1 channels in these CaSR-induced vascular responses by comparing responses in mesenteric arteries from wild-type (WT) and TRPC1-/- mice. In WT mice, stimulation of CaSR induced endothelium-dependent relaxations of pre-contracted tone and NO generation in endothelial cells (ECs), which were inhibited by the TRPV4 channel blocker RN1734 and the TRPC1 blocking antibody T1E3. In addition, TRPV4 and TRPC1 proteins were colocalised at, or close to, the plasma membrane of endothelial cells (ECs) from WT mice. In contrast, in TRPC1-/- mice, CaSR-mediated vasorelaxations and NO generation were greatly reduced, unaffected by T1E3, but blocked by RN1734. In addition, the TRPV4 agonist GSK1016790A (GSK) induced endothelium-dependent vasorelaxations which were blocked by RN1734 and T1E3 in WT mice, but only by RN1734 in TRPC1-/- mice. Moreover, GSK activated cation channel activity with a 6pS conductance in WT ECs but with a 52 pS conductance in TRPC1-/- ECs. These results indicate that stimulation of CaSR activates heteromeric TRPV4/TRPC1 channels and NO production in ECs, which are responsible for endothelium-dependent vasorelaxations. This study also suggests that heteromeric TRPV4-TRPC1 channels may form the predominant TRPV4-containing channels in mouse mesenteric artery ECs. Together, our data further implicates CaSR-induced pathways and heteromeric TRPV4/TRPC1 channels in the regulation of vascular tone

Heteromeric TRPV4/TRPC1 channels mediate calcium-sensing receptor-induced nitric oxide production and vasorelaxation in rabbit mesenteric arteries

Stimulation of calcium-sensing receptors (CaSR) by increasing the external calcium concentration (Ca2 +]o) induces endothelium-dependent vasorelaxation through nitric oxide (NO) production and activation of intermediate Ca2 +-activated K+ currents (IKCa) channels in rabbit mesenteric arteries. The present study investigates the potential role of heteromeric TRPV4-TRPC1 channels in mediating these CaSR-induced vascular responses. Immunocytochemical and proximity ligation assays showed that TRPV4 and TRPC1 proteins were expressed and co-localised at the plasma membrane of freshly isolated endothelial cells (ECs). In wire myography studies, increasing [Ca2 +]o between 1 and 6 mM induced concentration-dependent relaxations of methoxamine (MO)-induced pre-contracted tone, which were inhibited by the TRPV4 antagonists RN1734 and HC067047, and the externally-acting TRPC1 blocking antibody T1E3. In addition, CaSR-evoked NO production in ECs measured using the fluorescent NO indicator DAF-FM was reduced by RN1734 and T1E3. In contrast, [Ca2 +]o-evoked perforated-patch IKCa currents in ECs were unaffected by RN1734 and T1E3. The TRPV4 agonist GSK1016790A (GSK) induced endothelium-dependent relaxation of MO-evoked pre-contracted tone and increased NO production, which were inhibited by the NO synthase inhibitor L-NAME, RN1734 and T1E3. GSK activated 6pS cation channel activity in cell-attached patches from ECs which was blocked by RN1734 and T1E3. These findings indicate that heteromeric TRPV4-TRPC1 channels mediate CaSR-induced vasorelaxation through NO production but not IKCa channel activation in rabbit mesenteric arteries. This further implicates CaSR-induced pathways and heteromeric TRPV4-TRPC1 channels in regulating vascular tone

Kisspeptin enhances brain responses to olfactory and visual cues of attraction in men

Successful reproduction is a fundamental physiological process which relies on the integration of sensory cues of attraction with appropriate emotions and behaviors and the reproductive axis. However, the factors responsible for this integration remain largely unexplored. Using functional neuroimaging, hormonal and psychometric analyses, we demonstrate that the reproductive hormone kisspeptin enhances brain activity in response to olfactory and visual cues of attraction in men. Furthermore, the brain regions enhanced by kisspeptin correspond to areas within the olfactory and limbic systems that govern sexual behavior and perception of beauty as well as overlapping with its endogenous expression pattern. Of key functional and behavioral significance, we observed that kisspeptin was most effective in men with lower sexual quality of life scores. As such, our results reveal a previously undescribed attraction pathway in humans activated by kisspeptin, and identify kisspeptin signaling as a new therapeutic target for related reproductive and psychosexual disorders

Andricus csokai Melika & Tavakoli 2008, new species

Andricus csokai Melika & Tavakoli, new species Figs 51–67 Type material. HOLOTYPE female: IRAN, Kermanshah, Gahvareh and Javanrod, X-XII.2005. Q. infectoria. leg. M. Tavakoli. Lor 149. PARATYPES: 39 females with the same labels as the holotype. The holotype and 5 female paratypes in HNHM; 5 female paratypes in RIFR; 24 female paratypes in SPL; 5 female paratypes in NHML. Etymology. In recognition of the continuing contribution of Dr. György Csóka (Forest Research Institute, Hungary) to research on oak gallwasps. Diagnosis. Most closely resembles Andricus quercusradicis (Fabricius) in which POL 1.5 times as long as OOL; OOL 1.4 times as long as the length of the lateral ocellus and 1.4 times as long as LOL; placodeal sensilla on F3–F12; the median mesoscutal line in a form of a small but distinct triangle; the mesoscutellum delicately coriaceous, posteriorly rounded and medially incised; scutellar foveae are well-delimited around; the mesopleuron including speculum, uniformly delicately coriaceous to alutaceous; the upper half of the mesopleural triangle nearly smooth, ventrally delicately coriaceous with some weak wrinkles and dense setae; lateral propodeal carinae subparallel, broader anteriorly, slightly curved outwards in the most posterior part; the central propodeal area with few delicate irregular wrinkles; metasomal tergite 2 without micropunctures; the prominent part of the ventral spine of the hypopygium 4.5–5.0 times as long as broad while in A. csokai, new species, POL 2.3 times as long as OOL; OOL only slightly longer than the length of the lateral ocellus and equal to LOL; placodeal sensilla on F4–F12; the median mesoscutal line extending to 1/4 of the mesoscutum length; the mesoscutellum rugose, posteriorly is rounded and not incised centrally; scutellar foveae posteriorly delimited by the rugulose sculpture only; the mesopleuron with some delicate longitudinal interrupted striae, while the speculum is reticulate, with distinct punctures; the mesopleural triangle uniformly shining, alutaceous; lateral propodeal carinae subparallel, uniformly broad, slightly curved inwards in the middle; the central propodeal area delicately uniformly coriaceous; metasomal tergite 2 with micropunctures in the posterior 1/3 of the tergite; the prominent part of the ventral spine of the hypopygium at least 6.0 times as long as broad. Description. ASEXUAL FEMALE (holotype). Body predominantly dark reddish brown, with some extensive dark patches. Head posteriorly, between antennal toruli, central triangular area below median ocellus, central elevated area of lower face, clypeus and narrow stripes of malar space along attachment of mandibles always black; mandibles and antennae reddish brown; compound eyes and ocelli silvery or light brown. Scutum between anterior parallel lines and along parapsidal lines black; scutellar fovea, axillar complex, mesopleuron (entirely or only speculum), mesosoma ventrally, metascutellum and central propodeal area black. Legs uniformly reddish brown, slightly lighter than body. Metasoma reddish brown, except metasomal tergite 2, which dorsally always black. Wings with distinct brown veins. Body with relatively dense white setae. Head coriaceous, with relatively sparse short white setae, more dense on lower face; 2.2 times as broad as long from above; 1.3 times as broad as high in front view and as broad as mesosoma. Gena delicately coriaceous, broadened behind eye, well-visible in front view behind eye, slightly narrower than cross diameter of eye, measuring behind eye. Malar space delicately coriaceous, 0.45 times as long as height of eye, with delicate striae radiating from clypeus and extending to half of its length. POL 2.3 times as long as OOL; OOL slightly longer than length of lateral ocellus and equal to LOL. Transfacial distance slightly longer than height of eye and 1.3 times as long as height of lower face (distance between antennal rim and ventral margin of clypeus); diameter of antennal torulus 2.4 times as large as distance between them; distance between torulus and eye margin equal to diameter of torulus. Inner margins of eyes slightly divirging ventrally. Lower face coriaceous, with very slightly elevated delicately coriaceous median area, without striae radiating from clypeus, with dense white setae. Clypeus coriaceous, impressed along sides and elevated centrally, slightly broader than high, with distinct anterior tentorial pits, deeply impressed along distinct epistomal sulcus, clypeo-pleurostomal line distinct, ventrally widely emarginated and only very slightly incised medially. Frons, especially the black triangular area below median ocellus reticulate, with distinct large punctures; vertex with some distinct punctures, interocellar area with some strong rugae; occiput uniformly delicately coriaceous. Antenna with 12 flagellomeres, slightly longer than head+mesosoma; pedicel 1.6 times as long as broad; F1 2.0 times as long as pedicel and only very slightly longer than F2, F2 1.3 times as long as F3; F4–F6 nearly equal in length, slightly shorter than F3; F7 and subsequent flagellomeres much shorter, nearly equal in length, F12 1.8 times as long as F11, placodeal sensilla on F4–F12. Mesosoma convex, slightly longer than high in lateral view, with relatively dense white setae. Pronotum delicately coriaceous, with some delicate wrinkles along antero-lateral edge only, with dense white setae, especially along anterior edge. Mesoscutum reticulate, punctures are dense, distance between punctures less than the diameter of a puncture. Notauli complete, well-impressed in all length, converging and not broadened posteriorly; median mesoscutal line extending to 1/4 of mesoscutum length; anterior parallel and parapsidal lines extending to 1/2 of mesoscutum length. Mesoscutellum coriaceous, posteriorly rounded and centrally not incised, 1.7 times shorter than mesoscutum, rounded, nearly as long as broad or slightly longer, slightly overhanging metanotum. Scutellar foveae transversely ovate, posteriorly delimited by rugulose sculpture, smooth, shining, without setae; separated by a distinct, delicately coriaceous central carina. Mesopleuron with some delicate longitudinal interrupted striae; speculum reticulate, with distinct punctures; mesopleural triangle uniformly shiny, alutaceous. Metapleural sulcus reaching mesopleuron slightly above the half of its height, lower part of metapleuron, delimited by metapleural sulcus shiny, smooth; preaxilla delicately coriaceous; axillula ovate, shining, coriaceous, with very dense white setae; subaxillular bar coriaceous, shining, in the most posterior end 2.0 times higher than height of metanotal trough; ventral bar of metanotal trough shiny, at least 2.0 times narrower than height of metanotal trough measuring above propodeal spiracle. Metascutellum uniformly delicately coriaceous, nearly as high as height of smooth, shiny delicately longitudinally wrinkled ventral impressed area; metanotal trough coriaceous, shiny, with relatively sparse white setae. Lateral propodeal carinae subparallel, uniformly broad, slightly curved inwards in the middle; central propodeal area delicately coriaceous, without setae; lateral propodeal area delicately uniformly coriaceous, with dense white setae; nucha short, with irregular wrinkles. Tarsal claws with distinct basal lobe. Forewing much longer than body, with distinct brown veins, margin with cilia; radial cell 3.7 times as long as broad, areolet distinct, Rs+M extending to 2/3 of distance between areolet and basalis. Metasoma nearly as long as head+mesosoma, higher than long in lateral view; metasomal tergite 2 with large patch of dense white setae antero-laterally, with micropunctures in the posterior 1/3, subsequent tergites and hypopygium without setae, with dense micropunctures; prominent part of ventral spine of hypopygium short, 6.0 times as long as broad, with few short white setae, apical setae short, not extending beyond apex of spine. Body length 4.1–4.8 mm. Gall (Figs 62–67). Galls are on roots which are close to the surface or on branches at ground level and up to 15–35 cm below the ground surface. Often found on the roots of fallen trees with many regrowth shoots. Commonly in groups. Varying in size from a walnut to an onion; thick walled; usually globular, multilocular, 2.5–5.0 cm in diameter. Initially fleshy, soon becomes woody. When young the gall is light brown or reddish, darkening (brownish) with age, after wasps emerged, the old gall turns black. Biology. Only the asexual generation is known from galls on Quercus infectoria Olivier. Rare species. The gall becomes apparent at the beginning of summer; adult wasps emerge at the beginning of November. Lack of information on the phylogenetic placement of this species precludes prediction of a likely host for the sexual generation. Distribution. Iran, known from Kermanshah province only (Gahvareh and Javanrod).Published as part of Tavakoli, M., Melika, G., Sadeghi, S. E., Pénzes, Z., Assareh, M. A., Atkinson, R., Bechtold, M., Mikó, I., Zargaran, M. R., Aligolizade, D., Barimani, H., Bihari, P., Pirozi, F., Fülöp, D., Somogyi, K., Challis, R., Preuss, S., Nicholls, J. & Stone, G. N., 2008, New species of oak gallwaps from Iran (Hymenoptera: Cynipidae: Cynipini), pp. 1-64 in Zootaxa 1699 (1) on pages 10-12, DOI: 10.11646/zootaxa.1699.1.1, http://zenodo.org/record/510717