Head Injury-A Neglected Public Health Problem: A Four-Month Prospective Study at Jimma University Specialized Hospital, Ethiopia

Background: Trauma, especially head trauma, is an expanding major public health problem and the leading cause of death of the young and productive part of the world’s population. Research is mainly done in high-income countries where only a small proportion of the worldwide fatalities occur. The intention of this study was to analyze head injury in a setting where most patients in low- and middleincome countries receive treatment, a referral hospital with general but no neurosurgical service like Jimma University Specialized Hospital. The study aims to provide surgeons, hospital managers and health planners working in similar set-ups with baseline information for further investigation and prevention programs intending to reduce the burden of head injury.Methods: All head injury patients presented to Jimma University Specialized Hospital between March and June 2010 were included in this prospective research. Epidemiological, clinical and management data were collected for the study.Results: Out of 52 patients, 47 were males. The median age was 20.0 years (SD=13.3). Fights (n=20, 38.5%) and road traffic accidents (n=19, 36.5%) were the most common causes of head injury. Half of the patients sustained mild and 36.5% sustained severe head injury. The initial GCS had a significant correlation with the outcome. The mortality rate was 21.2%. Of all patients 76.9% were managed conservatively.Conclusion: Prevention of road traffic accidents and improvement of conservative care were identified as major methods to reduce the burden of head injury in a set-up similar to Jimma. Further studies on head injury patients in low-income countries should be done.Keywords: Head injury, Traffic accidents, Violence, Lo

Chronology of the History of Eastern Washington University

This chronology of the history of Eastern Washington University has been compiled by many persons, under the direction of the University Archivist. Intended for use by persons at the university, the chronology was originally created for use by the EWU Centennial Committee in 1981. The university was then planning activities to commemorate the centennial of the opening of the institutions’ predecessor, the Benjamin P. Cheney Academy.--from the Foreword

Building Names at Eastern Washington University

This document provides information about the history of the buildings located on Eastern Washington University\u27s Cheney campus and the buildings\u27 namesakes. The document was created by University Archivist Charles Mutschler and updated by Jay Rea and Steven Bingo in 2019

Local identification of nonlinear and non-Gaussian DSGE models

Diese Arbeit befasst sich mit der lokalen Identifikation von nicht-linearen und nicht-gaussianischen DSGE Modellen. Es werden Strategien entwickelt, um Probleme der Identifizierbarkeit zu erkennen und zu vermeiden. Dabei wird ein umfassender Überblick über vorhandene Methoden für linearisierte DSGE Modelle gegeben und diese um Restriktionen durch höhere Momente, Kumulanten und Polyspektren erweitert. Weiterhin wird in der Arbeit die Identifizierung durch höhere Approximationen begründet. Mithilfe einer abgeschnittenen Zustandsraumdarstellung werden formale Rangkriterien für die lokale Identifizierbarkeit der Parameter von nicht-linearen und nicht-gaussianischen DSGE Modellen hergeleitet. Mit diesen Methoden lässt sich Identifizierbarkeit bereits vor der Schätzung des nicht-linearen Modells überprüfen. Auf diese Weise wird gezeigt, dass alle Parameter des Kim (2003) als auch des An und Schorfheide (2007) Modells mit einer Approximation zweiter Ordnung identifiziert werden können.This thesis adds to the literature on the local identification of nonlinear and non-Gaussian DSGE models. It gives applied researchers a strategy to detect identification problems and means to avoid them in practice. A comprehensive review of existing methods for linearized DSGE models is provided and extended to include restrictions from higher-order moments, cumulants and polyspectra. Another approach, established in this thesis, is to consider higher-order approximations. Formal rank criteria for a local identification of the deep parameters of nonlinear or non-Gaussian DSGE models, using the pruned state-space system are derived. The procedures can be implemented prior to estimating the nonlinear model. In this way, the identifiability of the Kim (2003) and the An and Schorfheide (2007) model are demonstrated, when solved by a second-order approximation.<br

The sequential trauma score - a new instrument for the sequential mortality prediction in major trauma*

<p>Abstract</p> <p>Background</p> <p>There are several well established scores for the assessment of the prognosis of major trauma patients that all have in common that they can be calculated at the earliest during intensive care unit stay. We intended to develop a sequential trauma score (STS) that allows prognosis at several early stages based on the information that is available at a particular time.</p> <p>Study design</p> <p>In a retrospective, multicenter study using data derived from the Trauma Registry of the German Trauma Society (2002-2006), we identified the most relevant prognostic factors from the patients basic data (P), prehospital phase (A), early (B1), and late (B2) trauma room phase. Univariate and logistic regression models as well as score quality criteria and the explanatory power have been calculated.</p> <p>Results</p> <p>A total of 2,354 patients with complete data were identified. From the patients basic data (P), logistic regression showed that age was a significant predictor of survival (AUC_{model p}, area under the curve = 0.63). Logistic regression of the prehospital data (A) showed that blood pressure, pulse rate, Glasgow coma scale (GCS), and anisocoria were significant predictors (AUC_{model A}= 0.76; AUC_{model P + A}= 0.82). Logistic regression of the early trauma room phase (B1) showed that peripheral oxygen saturation, GCS, anisocoria, base excess, and thromboplastin time to be significant predictors of survival (AUC_{model B1}= 0.78; AUC_{model P +A + B1}= 0.85). Multivariate analysis of the late trauma room phase (B2) detected cardiac massage, abbreviated injury score (AIS) of the head ≥ 3, the maximum AIS, the need for transfusion or massive blood transfusion, to be the most important predictors (AUCmodel B2 = 0.84; AUCfinal model P + A + B1 + B2 = 0.90). The explanatory power - a tool for the assessment of the relative impact of each segment to mortality - is 25% for P, 7% for A, 17% for B1 and 51% for B2. A spreadsheet for the easy calculation of the sequential trauma score is available at: <url>http://www.sequential-trauma-score.com</url></p> <p>Conclusions</p> <p>This score is the first sequential, dynamic score to provide a prognosis for patients with blunt major trauma at several points in time. With every additional piece of information the precision increases. The medical team has a simple, useful tool to identify patients at high risk and to predict the prognosis of an individual patient with major trauma very early, quickly and precisely.</p

Concentration Kinetics of Serum MMP-9 and TIMP-1 after Blunt Multiple Injuries in the Early Posttraumatic Period

Metalloproteinases are secreted in response to a variety of inflammatory mediators and inhibited by tissue inhibitors of matrixmetalloproteinases (TIMPs). Two members of these families, MMP-9 and TIMP-1, were differentially expressed depending on clinical parameters in a previous genomewide mRNA analysis. The aim of this paper was now to evaluate the posttraumatic serum levels and the time course of both proteins depending on distinct clinical parameters. 60 multiple traumatized patients (ISS > 16) were included. Blood samples were drawn on admission and 6 h, 12 h, 24 h, 48 h, and 72 h after trauma. Serum levels were quantified by ELISA. MMP-9 levels significantly decreased in the early posttraumatic period (P < 0.05) whereas TIMP-1 levels significantly increased in all patients (P < 0.05). MMP-9 and TIMP-1 serum concentration kinetics became manifest in an inversely proportional balance. Furthermore, MMP-9 presented a stronger decrease in patients with severe trauma and non-survivors in contrast to minor traumatized patients (ISS ≤ 33) and survivors, initially after trauma

Natural history, clinical pattern, and surgical considerations of pneumatosis intestinalis

<p>Abstract</p> <p>Objective</p> <p>Pneumatosis intestinalis has been increasingly detected in recent years with the more frequent use of computed tomography for abdominal imaging of the intestine. The underlying causes of the gas found during radiographic studies of the bowel wall can vary widely and different hypotheses regarding its pathophysiology have been postulated. Pneumatosis intestinalis often represents a benign condition and should not be considered an argument for surgery. However, it can also require life-threatening surgery in some cases, and this can be a difficult decision in some patients.</p> <p>Methods</p> <p>The spectrum of pneumatosis intestinalis is discussed here based on various computed tomographic and surgical findings in patients who presented at our University Medical Centre in 2003-2008. We have also systematically reviewed the literature to establish the current understanding of its aetiology and pathophysiology, and the possible clinical conditions associated with pneumatosis intestinalis and their management.</p> <p>Results</p> <p>Pneumatosis intestinalis is a primary radiographic finding. After its diagnosis, its specific pathogenesis should be ascertained because the appropriate therapy is related to the underlying cause of pneumatosis intestinalis, and this is sometimes difficult to define. Surgical treatment should be considered urgent in symptomatic patients presenting with an acute abdomen, signs of ischemia, or bowel obstruction. In asymptomatic patients with otherwise inconspicuous findings, the underlying disease should be treated first, rather than urgent exploratory surgery considered. Extensive and comprehensive information on the pathophysiology and clinical findings of pneumatosis intestinalis is provided here and is incorporated into a treatment algorithm.</p> <p>Conclusions</p> <p>The information presented here allows a better understanding of the radiographic diagnosis and underlying aetiology of pneumatosis intestinalis, and may facilitate the decision-making process in this context, thus providing fast and adequate therapy to particular patients.</p

Zugkraftmessungen beim knöchernen Segmenttransport – in vivo Untersuchungen am Menschen

Bone transport applying the principle of distraction osteogenesis makes it possible to reconstruct long bone defects caused by trauma or resection of bone tumors. The method employing a central cable, developed in Munich, is especially suitable for such applications. The main bone fragments are stabilized by an external fixateur, and bone transport is effected with a single central cable fixed to the tip of the segment, and driven by an external, programmable motor. In 15 patients the tractive forces during the entire bone transport were measured with a strain gauge incorporated within the cable. On the basis of the force profiles characteristics normal bone transport (forces between 150 - 250 N) can be distinguished from a critical transport (forces &gt; 250 N) with the risk of premature consolidation. There is some evidence that at a very high level of force, just before premature consolidation a very effective form of bone transport with good bone neoformation can be achieved. Transport systems employing a central cable allow this special form of distraction osteogenesis, since there is continuous force monitoring, and there is the option of employing the traction force as a control factor in a loop

Duration and predictors of emergency surgical operations - basis for medical management of mass casualty incidents

<p>Abstract</p> <p>Background</p> <p>Hospitals have a critically important role in the management of mass causality incidents (MCI), yet there is little information to assist emergency planners. A significantly limiting factor of a hospital's capability to treat those affected is its surgical capacity. We therefore intended to provide data about the duration and predictors of life saving operations.</p> <p>Methods</p> <p>The data of 20,815 predominantly blunt trauma patients recorded in the Trauma Registry of the German-Trauma-Society was retrospectively analyzed to calculate the duration of life-saving operations as well as their predictors. Inclusion criteria were an ISS ≥ 16 and the performance of relevant ICPM-coded procedures within 6 h of admission.</p> <p>Results</p> <p>From 1,228 patients fulfilling the inclusion criteria 1,793 operations could be identified as life-saving operations. Acute injuries to the abdomen accounted for 54.1% followed by head injuries (26.3%), pelvic injuries (11.5%), thoracic injuries (5.0%) and major amputations (3.1%). The mean cut to suture time was 130 min (IQR 65-165 min). Logistic regression revealed 8 variables associated with an emergency operation: AIS of abdomen ≥ 3 (OR 4,00), ISS ≥ 35 (OR 2,94), hemoglobin level ≤ 8 mg/dL (OR 1,40), pulse rate on hospital admission < 40 or > 120/min (OR 1,39), blood pressure on hospital admission < 90 mmHg (OR 1,35), prehospital infusion volume ≥ 2000 ml (OR 1,34), GCS ≤ 8 (OR 1,32) and anisocoria (OR 1,28) on-scene.</p> <p>Conclusions</p> <p>The mean operation time of 130 min calculated for emergency life-saving surgical operations provides a realistic guideline for the prospective treatment capacity which can be estimated and projected into an actual incident admission capacity. Knowledge of predictive factors for life-saving emergency operations helps to identify those patients that need most urgent operative treatment in case of blunt MCI.</p