393 research outputs found

    Cervical spine injuries and collar complications in severely injured paediatric trauma patients

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    Study design:A retrospective registry review.Objectives:To determine the incidence of cervical spine (CS) injuries and collar complications in severely injured paediatric trauma patients.Setting:Regional Trauma Centre, Children\u27s Hospital.Methods:A retrospective review of 365 paediatric severe trauma patients (0-17 years), defined as an Injury Severity Score (ISS)≥12, admitted to the paediatric intensive care unit (PICU).Results:Clinically significant CS injuries occurred in 5% (n=18/365) of trauma patients, in 9% (n=13/149) of traumatic brain injury (TBI) patients and in 11% (n=6/56) of in-hospital trauma deaths. CS injuries were suspected before imaging in 33% (n=6/18) of patients based on either motor/sensory impairment or shock. CS injuries were deemed unstable in 61% (n=11/18) of patients. Patients with CS injuries had higher ISS, and longer PICU and hospital stays (P\u3c0.05). CS collar complications occurred in 10% of patients, mainly identified by day 6 and consisting of either erythema or ulcers. Patients with CS collar complications were older and more likely to have TBI, lower Glasgow Coma Scale (GCS) scores, longer PICU and hospital stays, and increased days to CS clearance (P\u3c0.05). Three CS X-rays, together with flexion/extension views, were used most frequently for CS clearance.Conclusion: CS injuries were prevalent in severely injured paediatric trauma patients, particularly in those with TBI and in nonsurvivors. CS collar complications were associated with a lower GCS and longer CS clearance times. Attention to CS collar management protocols and earlier CS clearance with computed tomography/magnetic resonance imaging in obtunded patients might reduce CS collar complications. © 2013 International Spinal Cord Society. All rights reserved

    Cervical spine injuries and collar complications in severely injured paediatric trauma patients

    Get PDF
    Study design:A retrospective registry review.Objectives:To determine the incidence of cervical spine (CS) injuries and collar complications in severely injured paediatric trauma patients.Setting:Regional Trauma Centre, Children\u27s Hospital.Methods:A retrospective review of 365 paediatric severe trauma patients (0-17 years), defined as an Injury Severity Score (ISS)≥12, admitted to the paediatric intensive care unit (PICU).Results:Clinically significant CS injuries occurred in 5% (n=18/365) of trauma patients, in 9% (n=13/149) of traumatic brain injury (TBI) patients and in 11% (n=6/56) of in-hospital trauma deaths. CS injuries were suspected before imaging in 33% (n=6/18) of patients based on either motor/sensory impairment or shock. CS injuries were deemed unstable in 61% (n=11/18) of patients. Patients with CS injuries had higher ISS, and longer PICU and hospital stays (P\u3c0.05). CS collar complications occurred in 10% of patients, mainly identified by day 6 and consisting of either erythema or ulcers. Patients with CS collar complications were older and more likely to have TBI, lower Glasgow Coma Scale (GCS) scores, longer PICU and hospital stays, and increased days to CS clearance (P\u3c0.05). Three CS X-rays, together with flexion/extension views, were used most frequently for CS clearance.Conclusion: CS injuries were prevalent in severely injured paediatric trauma patients, particularly in those with TBI and in nonsurvivors. CS collar complications were associated with a lower GCS and longer CS clearance times. Attention to CS collar management protocols and earlier CS clearance with computed tomography/magnetic resonance imaging in obtunded patients might reduce CS collar complications. © 2013 International Spinal Cord Society. All rights reserved

    Provinciality and the Art World: The Midland Group 1961- 1977

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    This paper takes as its focus the Midland Group Gallery in order to first, make a case for the consideration of the geographies of art galleries. Second, highlight the importance of galleries in the context of cultural geographies of the sixties. Third, discuss the role of provinciality in the operation of art worlds. In so doing it explicates one set of geographies surrounding the gallery – those of the local, regional and international networks that connected to produce art works and art space. It reveals how the interactions between places and practices outside of metropolitan and regional hierarchies provides a more nuanced insight into how art worlds operated during the sixties, a period of growing internationalism of art, and how contested definitions of the provincial played an integral role in this. The paper charts the operations of the Midland Group Gallery and the spaces that it occupied to demonstrate how it was representative of a post-war discourse of provincialism and a corresponding re-evaluation of regional cultural activity

    Modeling species' distributions to improve conservation in semiurban landscapes: Koala case study

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    Models of species' distributions are commonly used to inform landscape and conservation planning. In urban and semiurban landscapes, the distributions of species are determined by a combination of natural habitat and anthropogenic impacts. Understanding the spatial influence of these two processes is crucial for making spatially explicit decisions about conservation actions. We present a logistic regression model for the distribution of koalas (Phascolarctos cinereus) in a semiurban landscape in eastern Australia that explicitly separates the effect of natural habitat quality and anthropogenic impacts on koala distributions. We achieved this by comparing the predicted distributions from the model with what the predicted distributions would have been if anthropogenic variables were at their mean values. Similar approaches have relied on making predictions assuming anthropogenic variables are zero, which will be unreliable if the training data set does not include anthropogenic variables close to zero. Our approach is novel because it can be applied to landscapes where anthropogenic variables are never close to zero. Our model showed that, averaged across the study area, natural habitat was the main determinant of koala presence. At a local scale, however, anthropogenic impacts could be more important, with consequent implications for conservation planning. We demonstrated that this modeling approach, combined with the visual presentation of predictions as a map, provides important information for making decisions on how different conservation actions should be spatially allocated. This method is particularly useful for areas where wildlife and human populations exist in close proximity

    Review debate: we need human rights not nationalism 'lite': globalization and British solidarity

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    The article explores the relationship of multiculturalism to social solidarity. The multicultural nature of Britain is accepted as a welcome reality but certain problems in relation to the development of multiculturalism in Britain are acknowledged. Various approaches to buttress or replace multiculturalism are reviewed. These are: a strengthened and/or reconstituted nationalism (`Britishness'); human rights; and social equality. The issue of citizenship recurs throughout. It is argued that a combined emphasis on human rights and greater social equality offer a better basis than nationalism for strengthening solidarity in Britain, especially in the longer term. Sociological theory offers a fruitful if strangely neglected starting point for understanding social solidarity. I draw critically on Durkheim and Marx to obtain some objective perspective on this controversial matter. Copyright 2007 SAGE Publications. All rights reserved. Not for commercial use or unauthorized distribution

    Estimates of Methane Release From Gas Seeps at the Southern Hikurangi Margin, New Zealand

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    The highest concentration of cold seep sites worldwide has been observed along convergent margins, where fluid migration through sedimentary sequences is enhanced by tectonic deformation and dewatering of marine sediments. In these regions, gas seeps support thriving chemosynthetic ecosystems increasing productivity and biodiversity along the margin. In this paper, we combine seismic reflection, multibeam and split-beam hydroacoustic data to identify, map and characterize five known sites of active gas seepage. The study area, on the southern Hikurangi Margin off the North Island of Aotearoa/New Zealand, is a well-established gas hydrate province and has widespread evidence for methane seepage. The combination of seismic and hydroacoustic data enable us to investigate the geological structures underlying the seep sites, the origin of the gas in the subsurface and the associated distribution of gas flares emanating from the seabed. Using multi-frequency split-beam echosounder (EK60) data we constrain the volume of gas released at the targeted seep sites that lie between 1,110 and 2,060 m deep. We estimate the total deep-water seeps in the study area emission between 8.66 and 27.21 × 10 6 kg of methane gas per year. Moreover, we extrpolate methane fluxes for the whole Hikurangi Margin based on an existing gas seep database, that range between 2.77 × 10 8 and 9.32 × 10 8 kg of methane released each year. These estimates can result in a potential decrease of regional pH of 0.015–0.166 relative to the background value of 7.962. This study provides the most quantitative assessment to date of total methane release on the Hikurangi Margin. The results have implications for understanding what drives variation in seafloor biological communities and ocean biogeochemistry in subduction margin cold seep sites

    Real patient learning integrated in a preclinical block musculoskeletal disorders. Does it make a difference?

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    Although musculoskeletal disorders are the most common reason for general practitioner visits, training did not keep pace. Implementation of learning from patients with rheumatologic disorders linked together with the teaching of theoretical knowledge in the preclinical medical education might be an important step forward in the improvement of quality of care for these patients. The Leiden Medical School curriculum has implemented two non-obligatory real patient learning (RPL) practicals integrated within the preclinical block musculoskeletal disorders. This study investigates the educational effectiveness of the practicals, the expectations students have of RPL, and students’ satisfaction. Participants’ grades on the end-of-block test served as the test results of the educational effectiveness of the practicals and were compared with those of the non-participants. Qualitative data was collected by means of questionnaires generated by focus groups. The participants in practicals scored significantly higher at the end-of-block test. The expected effects of the contact with real patients concerned positive effects on cognition and skills. ‘Contextualizing of the theory’, ‘better memorizing of clinical pictures’, and ‘understanding of the impact of the disease’ were the most frequently mentioned effects of the practicals. Overall, the participants were (very) enthusiastic about this educational format. The RPL practicals integrated within a preclinical block musculoskeletal disorders are a valuable addition to the Leiden medical curriculum. This relatively limited intervention exhibits a strong effect on students’ performance in tests. Future research should be directed towards the long-term effects of this intervention
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