Major trauma from suspected child abuse: A profile of the patient pathway

© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. Background Networked organised systems of care for patients with major trauma now exist in many countries, designed around the needs of the majority of patients (90% adults). Non-accidental injury is a significant cause of paediatric major trauma and has a different injury and age profile from accidental injury (AI). This paper compares the prehospital and inhospital phases of the patient pathway for children with suspected abuse, with those accidentally injured. Methods The paediatric database of the national trauma registry of England and Wales, Trauma Audit and Research Network, was interrogated from April 2012 (the launch of the major trauma networks) to June 2015, comparing the patient pathway for cases of suspected child abuse (SCA) with AI. Results In the study population of 7825 children, 7344 (94%) were classified as AI and 481 (6%) as SCA. SCA cases were younger (median 0.4 years vs 7 years for AI), had a higher Injury Severity Score (median 16vs9 for AI), and had nearly three times higher mortality (5.7%vs2.2% for AI). Other differences included presentation to hospital evenly throughout the day and year, arrival by non-ambulance means to hospital (74%) and delayed presentation to hospital from the time of injury (median 8 hours vs 1.8 hours for AI). Despite more severe injuries, these infants were less likely to receive key interventions in a timely manner. Only 20% arrived to a designated paediatric-capable major trauma centre. Secondary transfer to specialist care, if needed, took a median of 21.6 hours from injury(vs 13.8 hours for AI). Conclusion These data show that children with major trauma that is inflicted rather than accidental follow a different pathway through the trauma system. The current model of major trauma care is not a good fit for the way in which child victims of suspected abuse present to healthcare. To achieve better care, awareness of this patient profile needs to increase, and trauma networks should adjust their conventional responses

Evolution of the Schr\"odinger--Newton system for a self--gravitating scalar field

Using numerical techniques, we study the collapse of a scalar field configuration in the Newtonian limit of the spherically symmetric Einstein--Klein--Gordon (EKG) system, which results in the so called Schr\"odinger--Newton (SN) set of equations. We present the numerical code developed to evolve the SN system and topics related, like equilibrium configurations and boundary conditions. Also, we analyze the evolution of different initial configurations and the physical quantities associated to them. In particular, we readdress the issue of the gravitational cooling mechanism for Newtonian systems and find that all systems settle down onto a 0--node equilibrium configuration.Comment: RevTex file, 19 pages, 26 eps figures. Minor changes, matches version to appear in PR

Sport-related major trauma incidence in young people and adults in England and Wales: a national registry-based study

Objectives Data on sport and physical activity (PA) injury risk can guide intervention and prevention efforts. However, there are limited national-level data, and no estimates for England or Wales. This study sought to estimate sport and PA-related major trauma incidence in England and Wales. Methods Nationwide, hospital registry-based cohort study between January 2012 and December 2017. Following Trauma Audit and Research Network Registry Research Committee approval, data were extracted in April 2018 for people ≥16 years of age, admitted following sport or PA-related injury in England and Wales. The population-based Active Lives Survey was used to estimate national sport and PA participation (ie, running, cycling, fitness activities). The cumulative injury incidence rate was estimated for each activity. Injury severity was described by Injury Severity Score (ISS) >15. Results 11 702 trauma incidents occurred (mean age 41.2±16.2 years, 59.0% male), with an ISS >15 for 28.0% of cases, and 1.3% were fatal. The overall annual injury incidence rate was 5.40 injuries per 100 000 participants. The incidence rate was higher in men (6.44 per 100 000) than women (3.34 per 100 000), and for sporting activities (9.88 per 100 000) than cycling (2.81 per 100 000), fitness (0.21 per 100 000) or walking (0.03 per 100 000). The highest annual incidence rate activities were motorsports (532.31 per 100 000), equestrian (235.28 per 100 000) and gliding (190.81 per 100 000). Conclusion Injury incidence was higher in motorsports, equestrian activity and gliding. Targeted prevention in high-risk activities may reduce admissions and their associated burden, facilitating safer sport and PA participation

Denial at the top table: status attributions and implications for marketing

Senior marketing management is seldom represented on the Board of Directors nowadays, reflecting a deteriorating status of the marketing profession. We examine some of the key reasons for marketing’s demise, and discuss how the status of marketing may be restored by demonstrating the value of marketing to the business community. We attribute marketing’s demise to several related key factors: narrow typecasting, marginalisation and limited involvement in product development, questionable marketing curricula, insensitivity toward environmental change, questionable professional standards and roles, and marketing’s apparent lack of accountability to CEOs. Each of these leads to failure to communicate, create, or deliver value within marketing. We argue that a continued inability to deal with marketing’s crisis of representation will further erode the status of the discipline both academically and professionally

The Isgur-Wise function in a relativistic model for qQˉq\bar Q system

We use the Dirac equation with a ``(asymptotically free) Coulomb + (Lorentz scalar) linear '' potential to estimate the light quark wavefunction for $q\bar Q$ mesons in the limit $m_Q\to \infty$. We use these wavefunctions to calculate the Isgur-Wise function $\xi (v.v^\prime )$ for orbital and radial ground states in the phenomenologically interesting range $1\leq v.v^ \prime \leq 4$. We find a simple expression for the zero-recoil slope, $\xi^ \prime (1) =-1/2- \epsilon^2 /3$, where $\epsilon$ is the energy eigenvalue of the light quark, which can be identified with the $\bar\Lambda$ parameter of the Heavy Quark Effective Theory. This result implies an upper bound of $-1/2$ for the slope $\xi^\prime (1)$. Also, because for a very light quark $q (q=u, d)$ the size $\sqrt {}$ of the meson is determined mainly by the ``confining'' term in the potential $(\gamma_\circ \sigma r)$, the shape of $\xi_{u,d}(v.v^\prime )$ is seen to be mostly sensitive to the dimensionless ratio $\bar \Lambda_{u,d}^2/\sigma$. We present results for the ranges of parameters $150 MeV <\bar \Lambda_{u,d} <600 MeV$ $(\bar\Lambda_s \approx \bar\Lambda_{u,d}+100 MeV)$, $0.14 {GeV}^2 \leq \sigma \leq 0.25 {GeV}^2$ and light quark masses $m_u, m_d \approx 0, m_s=175 MeV$ and compare to existing experimental data and other theoretical estimates. Fits to the data give: ${\bar\Lambda_{u,d}}^2/\sigma =4.8\pm 1.7$, $-\xi^\prime_{u,d}(1)=2.4\pm 0.7$ and $\vert V_{cb} \vert \sqrt {\frac {\tau_B}{1.48 ps}}=0.050\pm 0.008$ [ARGUS '93]; ${\bar\Lambda_{u,d}}^2/\sigma = 3.4\pm 1.8$, $-\xi^\prime_{u,d}(1)=1.8\pm 0.7$ and $\vert V_{cb} \vert \sqrt { \frac {\tau_B}{1.48 ps}}=0.043\pm 0.008$ [CLEO '93]; ${\bar\Lambda_{u,d}}^2/Comment: 22 pages, Latex, 4 figures (not included) available by fax or via email upon reques

Learning from text-based close call data

A key feature of big data is the variety of data sources that are available; which include not just numerical data but also image or video data or even free text. The GB railways collects a large volume of free text data daily from railway workers describing close call hazard reports: instances where an accident could have – but did not – occur. These close call reports contain valuable safety information which could be useful in managing safety on the railway, but which can be lost in the very large volume of data – much larger than is viable for a human analyst to read. This paper describes the application of rudimentary natural language processing (NLP) techniques to uncover safety information from close calls. The analysis has proven that basic information extraction is possible using the rudimentary techniques, but has also identified some limitations that arise using only basic techniques. Using these findings further research in this area intends to look at how the techniques that have been proven to date can be improved with the use of more advanced NLP techniques coupled with machine-learning

Resummation of Running Coupling Effects in Semileptonic B Meson Decays and Extraction of ∣Vcb∣|V_{cb}|

We present a determination of $|V_{cb}|$ from semileptonic B decays that includes resummation of supposedly large perturbative corrections, originating from the running of the strong coupling. We argue that the low value of the BLM scale found previously for inclusive decays is a manifestation of the renormalon divergence of the perturbative series starting already in third order. A reliable determination of $|V_{cb}|$ from inclusive decays is possible if one either uses a short-distance b quark mass or eliminates all unphysical mass parameters in terms of measured observables, such that all infra-red contributions of order $1/m_b$ cancel explicitly. We find that using the $\overline{\rm MS}$ running mass significantly reduces the perturbative coefficients already in low orders. For a semileptonic branching ratio of $10.9\%$ we obtain $|V_{cb}|(\tau_B/1.50\,{\rm ps})^{1/2}= 0.041\pm 0.002$ from inclusive decays, in good agreement with the value extracted from exclusive decays.Comment: 37 pages + 4 figures, final version accepted for publication in Phys. Rev.

FICTION-TSA analysis of the B-cell compartment in myeloma shows no significant expansion of myeloma precursor cells

Faith E. Davies, Andrew C. Rawstron, Guy Pratt, Sheila O'Connor, Lela Su'ut, David Blythe, James Fenton, David Claydon, J. Anthony Child, Andrew S. Jack & Gareth J. Morga

Early exercise in blunt chest wall trauma: protocol for a mixed-methods, multicentre, parallel randomised controlled trial (ELECT2 trial)

Introduction: Chronic pain and disability are now well-recognised long-term complications of blunt chest wall trauma. Limited research exists regarding therapeutic interventions that can be used to address these complications. A recent feasibility study was completed testing the methods of a definitive trial. This protocol describes the proposed definitive trial, the aim of which is to investigate the impact of an early exercise programme on chronic pain and disability in patients with blunt chest wall trauma. Methods/analysis: This mixed-methods, multicentre, parallel randomised controlled trial will run in four hospitals in Wales and one in England over 12-month recruitment period. Patients will be randomised to either the control group (routine physiotherapy input) or the intervention group (routine physiotherapy input plus a simple exercise programme completed individually by the patient). Baseline measurements including completion of two surveys (Brief Pain Inventory and EuroQol 5-dimensions, 5-Levels) will be obtained on initial assessment. These measures and a client services receipt inventory will be repeated at 3-month postinjury. Analysis of outcomes will focus on rate and severity of chronic pain and disability, cost-effectiveness and acceptability of the programme by patients and clinicians. Qualitative feedback regarding acceptability will be obtained through patient and clinician focus groups. Ethics/dissemination: London Riverside Research Ethics Committee (Reference number: 21/LO/0782) and the Health Research Authority granted approval for the trial in December 2021. Patient recruitment will commence in February 2022. Planned dissemination is through publication in a peer-reviewed Emergency Medicine Journal, presentation at appropriate conferences and to stakeholders at professional meetings. Trial registration number: ISRCTN65829737; Pre-results