CT Scan Effective Radiation Dose Reduction in Pediatric Trauma Patients

This project attempts to address the problem of excessive radiation exposure via CT imaging for pediatric patients presenting at adult regional trauma centers. To answer this question, we utilized the pediatric trauma registry to conduct a retrospective chart review of consisting of all patients under 14 years of age that received trauma related CT imaging and that were transferred from an adult trauma center to Dayton Children’s Hospital in the time period of January 2019 to December 2019.Cases of unnecessary imaging will be determined by subject matter expert review, based on ACS and Image Gently guidelines. Cases of overexposure to radiation were determined via DLP and effective radiation dose, in conjunction with subject matter expert review. Results showed that 48 pediatrics patients were transferred to Dayton Children’s Hospital from 12 different adult trauma, from January to December 2019. In total, 118 scans were performed on these 48 patients. Of these, 41 scans were identified as an opportunity for improvement. The most common opportunity for improvement was a reduction in unnecessary cervical spine scans. From a patient safety perspective, this project emphasizes the need for increased knowledge of pediatric imaging guidelines at adult trauma centers. Such knowledge includes knowing when a scan can be reformatted from an existing image, as well as an understanding of weight-based pediatric imaging. A follow up project could be to assess for change after implementation of guidelines at the adult trauma centers

West Florida Shelf: A Natural Laboratory for the Study of Ocean Acidification

Declining oceanic pH and carbonate-ion concentrations are well-known consequences of increased atmospheric and surface-ocean partial pressure of carbon dioxide (pCO2). The possible subject of shifts in seawater carbonate chemistry on biocalcification and survival rates of marine organisms provides questions amenable to both experimental and field study (Kleypas and Langdon, 2006). To date, limited quantitative data exist with which to formalize and test hypotheses regarding such impacts, particularly in continental-shelf settings. The continental shelves of Florida provide an ideal natural laboratory in which to test latitudinal (and temperature and depth) shifts in habitat ranges of calcifying organisms. Both the east and west Florida shelves extend from warm temperate to subtropical latitudes; additionally, the west Florida shelf has very little siliciclastic influx to mask the carbonate production. This study utilizes the natural laboratory of the west and southwest Florida shelf (fig 1.1) to examine the transition from foramol (predominately foraminifera and molluscan) carbonate sediments, characteristic of the west-central Florida shelf, to chlorozoan (algal and coral) sediments characteristic of the southwest Florida shelf. The west Florida shelf is a mixed siliciclastic carbonate ramp that to the south transitions to the carbonate-dominated southwest Florida shelf (Enos, 1977; Brooks and others, 2003). The west Florida shelf is a distally steepened carbonate ramp that is ~250 kilometers (km) wide (Read, 1985). It is covered by a veneer of unconsolidated sediment consisting of mainly biogenic carbonate and quartz in the near shore, with subordinate amounts of phosphate. The sediment-distribution pattern is largely a function of proximity to source, with physical processes playing a minor role in distribution. The carbonate sand-and-gravel fraction is produced by organisms within the depositional basin of the west Florida shelf (Brooks and others, 2003). The southwest Florida shelf is a rimmed carbonate margin where organisms produce virtually all of the substrate; it also exhibits a greater sediment thickness as compared to the west Florida shelf (Enos, 1977). Temperature, which is usually associated with latitude, plays a major role in locations of foramol versus chlorozoan assemblages, but other factors beyond latitude influence temperature on the west and southwest Florida shelves. The potential of cooler, deep-water upwelling and transport over the bottom waters of the shelf may have a significant role in the species assemblage at the sediment/water interface and ultimately on location of foramol versus chlorozoan production. Deep water transported onto and over the shelf may also have environmental ramifications beyond temperature by bringing in water of different chemistry

State of the California Current, Spring 2008-2009: cold conditions drive regional differences in coastal production

This report describes the state of the California Surrent system (CCS) between the springs of 2008 and 2009 based on observations taken along the west coast of North America. the dominant forcing on the CCS during this time period were La Nina type conditions that prevailed from the summer of 2007 through early 2009, transitioning to neutral El Nino-Southern Oscillation conditions in the spring of 2009. The Pacific Decadal Oscillation index was negative during this time period and its values had not returned to normal by the spring of 2009. The general effects on the California Current system were stronger than normal southward winds and upselling as well as generally colder that normal SST and shallow nitraclines; however, there were regional differences. Off Baja California sea surface temperatures did not respond to the La Nina conditions; however, concentrations of chorophyll a (Chl a) were significantly above normal, probably due to the anomolously high upwelling off Baja during most of the year. Off southern California there was no clear evidence of increased promary or secondary production, despite observations that previous La Nina conditions affected mixed layer depth, temperatures, nutrients, and nitracline depths. In both central and northern California and Oregon, stronger than normal upwelling increased primary production and prevented potential spawning of sardine north of San Francisco. In central California the midwater fish community resembled that of recent cool years, and cover by kelp was much reduced along the coast. Off Oregon there was evidence of increased abundance of boreal copepods, although the neritic boreal species did not appear to extend as far south as central California. Current predictions are for cooler conditions to change to El Nino conditions by the end of 2009; these are expected to last through the Northern Hemisphere winter of 2009-10

A Multicenter Prospective Analysis of Pediatric Trauma Activation Criteria Routinely Used in Addition to the Six Criteria of the American College of Surgeons

BACKGROUND The American College of Surgeons has defined six minimum activation criteria (ACS-6) for the highest level of trauma activations at trauma centers. The verification criteria also allow for the inclusion of additional criteria at the institution’s discretion. The purpose of this prospective multicenter study was to evaluate the ACS-6 as well as commonly used activation criteria to evaluate overtriage and undertriage rates for pediatric trauma team activation. METHODS Data were prospectively collected at nine pediatric trauma centers to examine 29 commonly used activation criteria. Patients meeting any of these criteria were evaluated for the use of high-level trauma resuscitation resources according to an expert consensus list. Patients requiring a resource but not meeting any activation criteria were included to evaluate undertriage rates. RESULTS During the 1-year study, a total of 656 patients were enrolled with a mean age of 8 years, a median Injury Severity Score of 14, and mortality of 11%. Using all criteria, 55% of patients would have been overtriaged and 9% would have been undertriaged. If only the ACS-6 were used, 24% of patients would have been overtriaged and 16% would have been undertriaged. Among activation criteria with more than 10 patients, those most predictive of using a high-level resource were a gunshot wound to the abdomen (92%), blood given before arrival (83%), traumatic arrest (83%), tachycardia/poor perfusion (83%), and age-appropriate hypotension (77%). The addition of tachycardia/poor perfusion and pretrauma center resuscitation with greater than 40 mL/kg results in eight criteria with an overtriage of 39% and an undertriage of 10.5%. CONCLUSION The ACS-6 provides a reliable overtriage or undertriage rate for pediatric patients. The inclusion of two additional criteria can further improve these rates while maintianing a simplified triage list for children. LEVEL OF EVIDENCE Therapeutic study, level III

A NOAA Fisheries science perspective on the conditions during and after COVID-19: challenges, observations, and some possible solutions, or why the future is upon us

Many fisheries and marine science organizations are working to determine how to meet their missions in the midst of the COVID-19 outbreak. As such, it seems prudent to exchange ideas, share knowledge, and initiate a discussion among us. As the scientific leadership team for NOAA Fisheries, we wanted to offer some perspectives. Others are also evaluating the impacts of COVID-19 but from the perspective of addressing tactical, day-to-day concerns of restarting operations for various marine and fisheries-oriented organizations. Thus, it seemed appropriate to us to explore the potential challenges posed by COVID-19 and to purposefully ascertain whether there are strategic opportunities for improving how we conduct our operations. We need to find ways to mitigate the effects of COVID-19 on our mission and also to glean information from our responses while in the midst of the crisis. We offer some recommendations to that end and offer these thoughts not as having solved every problem, but to learn from each other, compare across organizations, and engage in dialogue within our discipline to advance much-needed changes.The accepted manuscript in pdf format is listed with the files at the bottom of this page. The presentation of the authors' names and (or) special characters in the title of the manuscript may differ slightly between what is listed on this page and what is listed in the pdf file of the accepted manuscript; that in the pdf file of the accepted manuscript is what was submitted by the author

Why preen others? Predictors of allopreening in parrots and corvids and comparisons to grooming in great apes

Allogrooming in primates serves not only a hygienic function, but also plays a crucial role in maintaining strong affiliative bonds between group members, which in turn, underpin the emergence of cooperative behavior. In contrast, although allopreening occurs in many avian species, we know little about its social functions. Our study addresses this issue by investigating allopreening in a broad comparative data set including six corvid and nine parrot species. We assessed whether rates of allopreening initiations, proportion of time spent allopreening, and the number of grooming partners in captive group‐housed birds were comparable to patterns observed in captive chimpanzees and bonobos. While parrots and corvids were found to have similar rates of social grooming to bonobos and chimpanzees, Pan species dedicated significantly more time to social grooming. Animals in larger groups had more grooming partners, but when controlling for the number of potential partners, birds tended to have fewer grooming interaction partners than Pan species. We then investigated whether allopreening in parrots and corvids was predicted by behavioral markers of affiliative social bonds (close physical proximity, active feeding, and low levels of agonistic behavior). Results revealed that providing allopreening to a partner was significantly predicted by often being in close proximity, but not engagement in active feeding or agonistic behavior. We examined the region allopreened in a subset of species and found that preening a partner's head was predicted by both close physical proximity and active feeding, while body allopreening was only predicted by close physical proximity. Head preening may confer more hygienic benefits to recipients, and thus, may be more selectively provided to valued partners. Results support the hypothesis that allopreening in corvids and parrots helps maintain social bonds with an individual's most important social partners, showing some similarities to allogrooming in primates