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Cardiac trauma is a critical injury, with penetrating cardiothoracic injury accounting for up to a third of traumatic deaths.1–4 These injuries often involve the heart or great vessels and include traumatic insertion of a foreign body, including invasive iatrogenic injury.1–8 Blunt cardiac trauma occurs in a wide range of patients, with 8–71% of patients with cardiothoracic trauma demonstrating signs of cardiac injury.1,2,8 Blunt cardiac injury encompasses all types of injury associated with blunt thoracic trauma to the heart.8–13 Up to 20% of deaths from motor vehicle collisions (MVCs) are due to this type of injury. Patients with thoracic great vessel injury due to penetrating injury have a high mortality rate (over 90% die at the scene),14,15 and blunt injury to the thoracic vessels is commonly due to motor vehicle accident.12,13,16,17 These injuries can result in chest, upper abdominal, back, arm/shoulder, or lower neck pain, as well as hemodynamic instability, nausea/vomiting, and shortness of breath.
Head trauma is a significant cause of death around the world, especially in patients 1–45 years old.1–5 Close to 80% of patients are managed in the emergency department (ED).1.2 Head injury not only causes initial primary injury, but it is associated with several secondary injuries.1–5
Hemorrhage is a leading cause of death in trauma, following head injury. Shock is defined by inadequate tissue perfusion with hemodynamic instability and organ dysfunction.1–10 In trauma, the most common cause of shock is due to acute hemorrhage. Advanced Trauma Life Support (ATLS) describes four classes of hemorrhage,1 but these are not relevant to real world practice, due to different injury types (blunt vs. penetrating), age (due to blunted physiologic responses in the elderly), comorbidities, and medication use (beta blockade reduces the chance of tachycardia in response to decreased blood pressure).6–14 Bradycardia may also be seen in hemorrhage, due to several causes including vagal stimulation and failure to mount a tachycardic response.13,14
According to the United States Eye Injury Registry, eye injury is the leading cause of monocular blindness, and there are approximately 2.4 million eye injuries occurring annually in the US, resulting in 500,000 years of lost eyesight annually.1 These injuries occur more often in males (>70%), and 95% of occupational injuries occur in males.2,3 This chapter will describe the approach to the patient with eye trauma in the emergency department (ED), including how to perform a detailed history and physical examination related to eye injuries, as well as covering the traumatic presentations in Table 9.1.
Extensively revised and updated, this second edition provides, in an A-Z format, an analysis of the most important generalizations that have been made on the unidirectional change of grammatical forms and constructions. Based on the analysis of more than 1,000 languages, it reconstructs over 500 processes of grammatical change in the languages of the world, including East Asian languages such as Chinese, Korean and Japanese. Readers are provided with the tools to discover how lexical and grammatical meanings can be related to one another in a principled way, how such issues as polysemy, heterosemy, and transcategoriality are dealt with, and why certain linguistic forms have simultaneous lexical and grammatical functions. Definitions of lexical concepts are provided with examples from a broad variety of languages, and references to key relevant research literature. Linguists and other scholars will gain a better understanding of languages on a worldwide scale.
Trauma is a leading cause of death and disability around the world, and the leading cause of death in those aged under forty-five years. Conditions such as airway obstruction, hemorrhage, pneumothorax, tamponade, bowel rupture, vascular injury, and pelvic fracture can cause death if not appropriately diagnosed and managed. This essential book provides emergency physicians with an easy-to-use reference and source for traumatic injury evaluation and management in the Emergency Department. It covers approaches to common, life-threatening, and traumatic diseases in the Emergency Department, for use on shift and as a reference for further learning. Each chapter includes a succinct overview of common traumatic injuries, with evaluation and management pearls and pitfalls. Highly illustrated with images from one of the busiest trauma centers in the US, and featuring expert contributions from a diverse set of attending physicians, this is an essential text for all emergency medicine practitioners.
To determine whether school-level participation in the federal Community Eligibility Provision (CEP), which provides free school lunch to all students, is associated with school meal participation rates. Participation in school meals is important for decreasing food insecurity and improving child health and well-being.
Quasi-experimental evaluation using negative binomial regression to predict meal count rates per student-year overall and by reimbursement level adjusted for proportion eligible for free and reduced-price lunch (FR eligibility) and operating days.
Schools (grades kindergarten to 12th) participating in the National School Lunch Program (NSLP) in Maryland and Pennsylvania, USA, from the 2013–2015 (n 1762) and 2016–2017 (n 2379) school years.
Administrative, school-level data on school lunch counts and student enrolment.
CEP was associated with a non-significant 6 % higher total NSLP meal count adjusting for FR eligibility, enrolment and operating days (rate ratio = 1·06, 95 % CI 0·98, 1·14). After controlling for participation rates in the year prior to CEP implementation, the programme was associated with a significant 8 % increase in meal counts (rate ratio = 1·08, 95 % CI 1·03, 1·12). In both analyses, CEP was associated with lower FR meal participation and substantial increases in paid meal participation.
School-level implementation of CEP is associated with increases in total school meal participation. Current funding structures may prevent broader adoption of the programme by schools with fewer students eligible for FR meals.
The psycholinguistic rationale proposed for TBLT varies somewhat, but is usually an amalgam of cognitive-interactionist and usage-based theories (see, e.g., Long, 2015a, pp. 30–62; Robinson, 2007, 2015; Skehan, 1998, 2015) developed with language learning as the explanandum. When students are adults, whose capacity for purely incidental learning, especially instance learning, is weaker than in young children, a variety of devices is required to enhance incidental learning and thereby speed up the process. The enhancements seek to help learners either detect or notice new items in the input by increasing their perceptual saliency and by drawing learners’ attention to needed lexis and collocations and grammatical patterns, especially when non-salient forms and form–function or form–meaning relationships are concerned. However, most of the attention-drawing procedures are deployed in response to learner performance, not in advance, as in synthetic approaches.