Outcome prediction for improvement of trauma care

The main aim of this thesis is to evaluate, develop and validate models for predicting fatal and non-fatal outcome after trauma in the Netherlands. The dissertation addresses the following questions: I. How can we improve and use prediction models for fatal outcome after trauma? II. To what extent can we predict non-fatal outcome after trauma

Medical and productivity costs after trauma

BACKGROUND: Well-advised priority setting in prevention and treatment of injuries relies on detailed insight into costs of injury. This study aimed to provide a detailed overview of medical and productivity costs due to injury up to two years post-injury and compare these costs across subgroups for injury severity and age. METHODS: A prospective longitudinal cohort study followed all adult (≥18 years) injury patients admitted to a hospital in Noord-Brabant, the Netherlands. Patients filled out questionnaires 1 week, 1, 3, 6, 12 and 24 months after trauma, including items on health care consumption from the medical consumption questionnaire (iMCQ) and productivity loss from the productivity cost questionnaire (PCQ). Furthermore, injury severity was defined by Injury Severity Score (ISS). Data on diagnostics was retrieved from hospital registries. We calculated medical costs, consisting of in-hospital costs and post-hospital medical costs, and productivity costs due to injury up to two years post-injury. RESULTS: Approximately 50% (N = 4883) of registered patients provided informed consent, and 3785 filled out at least one questionnaire. In total, the average costs per patient were €12,190. In-hospital costs, post-hospital medical costs and productivity costs contributed €4810, €5110 and €5830, respectively. Total costs per patient increased with injury severity, from €7030 in ISS1-3 to €23,750 in ISS16+ and were lowest for age category 18-24y (€7980), highest for age category 85 years and over (€15,580), and fluctuated over age groups in between. CONCLUSION: Both medical costs and productivity costs generally increased with injury severity. Furthermore, productivity costs were found to be a large component of total costs of injury in ISS1-8 and are therefore a potentially interesting area with regard to reducing costs

Performance of the modified TRISS for evaluating trauma care in subpopulations: A cohort study

Introduction: Previous research showed that there is no agreement on a practically applicable model to use in the evaluation of trauma care. A modification of the Trauma and Injury Severity Score (modified TRISS) is used to evaluate trauma care in the Netherlands. The aim of this study w

TARP as immunotherapeutic target in AML expressed in the LSC compartment

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Health care and productivity costs of non-fatal traffic injuries: A comparison of road user types

This study aimed to provide a detailed overview of the health care and productivity costs of non-fatal road traffic injuries by road user type. In a cohort study in the Netherlands, adult injury patients admitted to a hospital as a result of a traffic accident completed questionnaires 1 week and 1, 3, 6, 12 and 24 months after injury, including the iMTA Medical Consumption and Productivity Cost Questionnaire. In-hospital, post-hospital medical costs and productivity costs were calculated up to two years after traffic injury. In total, 1024 patients were included in this study. The mean health care costs per patient were € 8200. The mean productivity costs were € 5900. Being female, older age, with higher injury severity and having multiple comorbidities were associated with higher health care costs. Higher injury severity and being male were associated with higher productivity costs. Pedestrians aged ≥ 65 years had the highest mean health care costs (€ 18,800) and motorcyclists the highest mean productivity costs (€ 9000). Bicycle injuries occurred most often in our sample (n = 554, 54.1%) and accounted for the highest total health care and productivity costs. Considering the high proportion of total costs incurred by bicycle injuries, this is an important area for the prevention of traffic injuries

Whole Grain, Bran, and Germ Intake and Risk of Type 2 Diabetes: A Prospective Cohort Study and Systematic Review

Background: Control of body weight by balancing energy intake and energy expenditure is of major importance for the prevention of type 2 diabetes, but the role of specific dietary factors in the etiology of type 2 diabetes is less well established. We evaluated intakes of whole grain, bran, and germ in relation to risk of type 2 diabetes in prospective cohort studies. Methods and Findings: We followed 161,737 US women of the Nurses' Health Studies (NHSs) I and II, without history of diabetes, cardiovascular disease, or cancer at baseline. The age at baseline was 37–65 y for NHSI and 26–46 y for NHSII. Dietary intakes and potential confounders were assessed with regularly administered questionnaires. We documented 6,486 cases of type 2 diabetes during 12–18 y of follow-up. Other prospective cohort studies on whole grain intake and risk of type 2 diabetes were identified in searches of MEDLINE and EMBASE up to January 2007, and data were independently extracted by two reviewers. The median whole grain intake in the lowest and highest quintile of intake was, respectively, 3.7 and 31.2 g/d for NHSI and 6.2 and 39.9 g/d for NHSII. After adjustment for potential confounders, the relative risks (RRs) for the highest as compared with the lowest quintile of whole grain intake was 0.63 (95% confidence interval [CI] 0.57–0.69) for NHSI and 0.68 (95% CI 0.57–0.81) for NHSII (both: p-value, test for trend <0.001). After further adjustment for body mass index (BMI), these RRs were 0.75 (95% CI 0.68–0.83; p-value, test for trend <0.001) and 0.86 (95% CI 0.72–1.02; p-value, test for trend 0.03) respectively. Associations for bran intake were similar to those for total whole grain intake, whereas no significant association was observed for germ intake after adjustment for bran. Based on pooled data for six cohort studies including 286,125 participants and 10,944 cases of type 2 diabetes, a two-serving-per-day increment in whole grain consumption was associated with a 21% (95% CI 13%–28%) decrease in risk of type 2 diabetes after adjustment for potential confounders and BMI. Conclusions: Whole grain intake is inversely associated with risk of type 2 diabetes, and this association is stronger for bran than for germ. Findings from prospective cohort studies consistently support increasing whole grain consumption for the prevention of type 2 diabetes

Reflection of neutrons from an optical grating

Specular and off-specular neutron intensities were measured at grazing incidence from an optical grating. Thee periodicity of the grating was determined from the locations of the intensity peaks in the off-specular data. An analysis of the widths of the off-specular intensity peaks showed that the effect of the coherence length of the neutron beam on the determination of a surface length scale {approximately}30 {mu}m was negligible compared to that of the instrument resolution. Although the structure of an optical grating used in this paper is simple, it has served to illustrate the simple relationship between the off-specular data structure and the real-space properties. For more general rough systems, a practical theoretical model will be needed to relate the off-specular data to the real-space roughness structure so that the diffusive data can be analyzed. Owing to the intrinsic complexity of diffuse scattering, the development of such a theoretical model will be a significant technical challenge, and its solution will constitute a major breakthrough in the development of the diffuse reflectivity technique for rough surface/interface characterization

Reduction of Tantalum Pentoxide with Aluminium and Calcium: Thermodynamic Modelling and Scale Skilled Tests

High reactivity of powdered aluminium together with its relatively low price are the main reasons for the application of this metal as a reducing agent for the reduction of oxides and fluorides of rare and rare earth metals by the aluminothermal method. This technology is widely used in the production of master alloys for ferrous metallurgy. The "out-of-furnace" process (i.e. without external heat access) is the prevailing technology for metallic niobium production worldwide. However, aluminothermal reduction for industrial production of metallic tantalum has been limited because of the high required temperature, over 2800 °C. In this paper the results of simultaneous reduction of tantalum(V) and iron(III) oxides by calcium-aluminothermal "out-of-furnace" process are presented. Powdered aluminium and metallic calcium were used as reductants. The pickup of tantalum at smeltings with the mass of raw materials over 1 kg reached 94%. The metal was obtained in the form of compact ingot; separation of metallic and slag phases was excellent. Crushed melt underwent refining remelting in an electron beam furnace. For thermodynamic studies and optimization of the aluminothermal reduction processes of Ta2O5 and Fe2O3 in the temperature range of 1000-3000°C a licensed computer simulation program "HSC Chemistry 6.1, 2007", elaborated by the company Outotec Oy, was applied

Prognostic factors for recovery of health status after injury: a prospective multicentre cohort study

Objectives To determine prognostic factors for health status and recovery patterns during the first 2 years after injury in the clinical trauma population. Design A prospective longitudinal cohort study. Setting Ten participating hospitals in Brabant, the Netherlands. Participants Injured adult patients admitted to a hospital between August 2015 and November 2016 were followed: 4883 (50%) patients participated. Main outcome measures Primary outcome was health status, measured with the EuroQol-5-dimensions-3-levels (EQ-5D), including a cognition item and the EuroQol Visual Analogue Scale. Health status was collected at 1 week, 1, 3, 6, 12 and 24 months after injury. Potential prognostic factors were based on literature and clinical experience (eg, age, sex, pre-injury frailty (Groningen Frailty Index), pre-injury EQ-5D). Results Health status increased mainly during the first 6 months after injury with a mean EQ-5D utility score at 1 week of 0.49 and 0.79 at 24 months. The dimensions mobility, pain/discomfort and usual activities improved up to 2 years after injury. Lower pre-injury health status, frailty and longer length of stay at the hospital were important prognostic factors for poor recovery. Spine injury, lower and upper extremity injury showed to be prognostic factors for problems after injury. Traumatic brain injury was a prognostic factor for cognitive problems. Conclusion This study contributes to the increase in knowledge of health recovery after injury. It could be a starting point to develop prediction models for specific injury classifications and implementation of personalised medicine.Development and application of statistical models for medical scientific researchAnalysis and support of clinical decision makin