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In January of 2010, North Carolina (NC) USA implemented state-wide Trauma Triage Destination Plans (TTDPs) to provide standardized guidelines for Emergency Medical Services (EMS) decision making. No study exists to evaluate whether triage behavior has changed for geriatric trauma patients.
The impact of the NC TTDPs was investigated on EMS triage of geriatric trauma patients meeting physiologic criteria of serious injury, primarily based on whether these patients were transported to a trauma center.
This is a retrospective cohort study of geriatric trauma patients transported by EMS from March 1, 2009 through September 30, 2009 (pre-TTDP) and March 1, 2010 through September 30, 2010 (post-TTDP) meeting the following inclusion criteria: (1) age 50 years or older; (2) transported to a hospital by NC EMS; (3) experienced an injury; and (4) meeting one or more of the NC TTDP’s physiologic criteria for trauma (n = 5,345). Data were obtained from the Prehospital Medical Information System (PreMIS). Data collected included proportions of patients transported to a trauma center categorized by specific physiologic criteria, age category, and distance from a trauma center.
The proportion of patients transported to a trauma center pre-TTDP (24.4% [95% CI 22.7%-26.1%]; n = 604) was similar to the proportion post-TTDP (24.4% [95% CI 22.9%-26.0%]; n = 700). For patients meeting specific physiologic triage criteria, the proportions of patients transported to a trauma center were also similar pre- and post-TTDP: systolic blood pressure <90 mmHg (22.5% versus 23.5%); respiratory rate <10 or >29 (23.2% versus 22.6%); and Glascow Coma Scale (GCS) score <13 (26.0% versus 26.4%). Patients aged 80 years or older were less likely to be transported to a trauma center than younger patients in both the pre- and post-TTDP periods.
State-wide implementation of a TTDP had no discernible effect on the proportion of patients 50 years and older transported to a trauma center. Under-triage remained common and became increasingly prevalent among the oldest adults. Research to understand the uptake of guidelines and protocols into EMS practice is critical to improving care for older adults in the prehospital environment.
Concentrations of total organic carbon (TOC), total petroleum hydrocarbons, polycyclic aromatic hydrocarbons (PAHs) and polychlorinated biphenyls (PCBs) were determined in 84 near-surface soils (5–20cm depth) taken from a 255km2 area of Glasgow in the Clyde Basin, UK, during July 2011. Total petroleum hydrocarbon range was 79–2,505mgkg–1 (mean 388mgkg–1; median 272mgkg–1) of which the aromatic fraction was 13–74 % (mean 44 %, median 43 %) and saturates were 28–87 % (mean 56 %, median 57 %). ∑16 PAH varied from 2–653mgkg–1 (mean 32.4mgkg–1; median 12.5mgkg–1) and ∑31 PAH range was 2.47–852mgkg–1 (mean 45.4mgkg–1; median 19.0mgkg–1). ∑PCBtri-hepta range was 2.2–1052μgkg–1 (mean 32.4μgkg–1; median 12.7μgkg–1) and the ∑PCB7 range was 0.3–344μgkg–1 (mean 9.8μgkg–1; median 2.7μgkg–1). The concentration, distribution and source of the persistent organic pollutants were compared with those found in urban soils from other cities and to human health assessment criteria for chronic exposure to chemicals in soil. Total concentrations encountered were generally similar to other urban areas that had a similar industrial history. Benzo[a]pyrene concentrations were assessed against four different land use scenarios (irrespective of current land use) using generic assessment criteria resulting in six of 84 samples exceeding the residential criteria. Isomeric PAH ratios and relative abundance of perylene suggest multiple and environmentally modified pyrogenic PAH sources, inferred to be representative of diffuse pollution. ∑PCB7 concentrations were exceeded in 10 % of sites using the Dutch target value of 20μgkg–1. PCB congener profiles were environmentally attenuated and generally dominated by penta-, hexa- and hepta-chlorinated congeners.
Surface sediments from a 160-km stretch of the River Clyde, Scotland, were analysed for persistent organic pollutants to investigate distribution, source and environmental effect. Glasgow's urban tributaries polyaromatic hydrocarbons (PAH) ranged from 2.3 to 4226mgkg–1, total petroleum hydrocarbons (TPH) 72 to 37879mgkg–1 and polychlorinated biphenyls (PCB) 3 to 809μgkg–1, which were more polluted than the upper River Clyde PAH that ranged from 0.1 to 42mgkg–1, TPH 3 to 260mgkg–1 and PCB 2 to 147μgkg–1. Intermediate values of the inner Clyde estuary PAH ranging from 0.6 to 30mgkg–1, and PCB ranging from 5 to 130μgkg–1, were attributed to point sources and sediment transfer from the urban tributaries. Comparison with sediment quality criteria suggested possible adverse effects on aquatic biota. PAH isomeric ratios confirmed a pyrolytic source throughout the Clyde and benzo[a]pyrene/benzo[g,h,i]perylene ratios >0.6 confirmed that upper, urban and estuarine domains all to a lesser or greater extent accumulated PAH from traffic emissions. The degree of chlorination determined from PCB homologues differed in each of the three domains, suggesting variable source or that the process aerobic/anaerobic degradation varied in each of the three domains. The anthropogenic impact of the city of Glasgow can be quantified in that the urban tributary sediment mean values were 60 (PAH), 33 (TPH) and 11 (PCB) times higher than the rural upper Clyde counterpart.
Surface sediments (n=85) from a 160-km river-estuarine transect of the Clyde, UK, were analysed for total mercury (Hg), saturated hydrocarbons and unresolved complex mixtures (UCMs) of hydrocarbons. Results show that sediment-Hg concentration ranges from 0.01 to 1.38mgkg–1 (mean 0.20mgkg–1) and a spatial trend in Hg-content low–high–low–high, from freshwater source, to Glasgow, to estuary, is evident. In summary, sediment-Hg content is low in the upper Clyde (mean of 0.05Hg mgkg–1), whereas sediments from the Clyde in urbanised Glasgow have higher Hg concentrations (0.04 to 1.26mgkg–1; mean 0.45mgkg–1), and the inner estuary sediments contain less Hg (mean 0.06mgkg–1). The highest mean sediment Hg (0.65mgkg–1) found in the outer estuary is attributed to historical anthropogenic activities. A significant positive Spearman correlation between Hg and total organic carbon is observed throughout the river estuary (0.86; P<0.001). Comparison with Marine Scotland guidelines suggests that no sites exceed the 1.5mgkg–1 criterion (Action Level 2); 22 fall between 0.25 and 1.5mgkg–1 dry wt. (Action Level 1) and 63 are of no immediate concern (<0.25mgkg–1 dry wt.). Saturated (n-alkane) hydrocarbons in the upper Clyde are of natural terrestrial origin. By contrast, the urbanised Glasgow reaches and outer estuary are characterised by pronounced and potentially toxic UCM concentrations in sediments (380–914mg/kg and 103–247mgkg–1, respectively), suggesting anthropogenic inputs such as biodegraded crude oil, sewage discharge and/or urban run-off.
The fifth in a 5-part series on the clinical and translational sciences educational pipeline, this paper focuses on strategies for developing leadership capacity among senior faculty and administrators responsible for clinical and translational science (CTS) research. Although progression in academic rank recognizes scientific excellence in research or scholarship, neither disciplinary training nor experience alone prepare senior faculty for the leadership challenges they inevitably face. Yet these faculty are increasingly responsible for multidisciplinary teams working within complex organizations with unclear or conflicting incentives that demand innovation. In academic health centers with Clinical and Translational Science Awards (CTSAs), investing in leadership often includes career development support in the CTSA education and training pillar programs. Only a few CTSAs have taken an intentional approach to developing senior leadership capacity, however, and still fewer have focused specifically on building such capacity for current CTS leaders within the context of a growing emphasis on team science. This manuscript explains the need for senior leadership training and describes an established example of such a program, the year-long Leadership for Innovative Team Science program for senior CTS researchers at the University of Colorado. The development of the program over time, topical elements, and participant perspectives are provided.
Nitrogen-deficient fibrous crop residues are widely used as basal diets in less developed countries, particularly in dry seasons when alternative foods are often in short supply. One approach to improving animal performance on crop residue based diets is to include a supplement of improved quality food to provide fermentable protein and energy. There are no established in vitro methods for investigating interactions between foods but the in vitro gas production method shows promise in this regard (Prasad et al., 1994). This paper describes the interactions observed in vitro; an accompanying paper (Murray et al., 1998) describes in vivo responses to supplementation and relationships between in vitro and in vivo data.
Ruminants in many less developed countries may consume poor quality roughages such as straws, stovers and senescent native pasture as a major part of their diet, particularly during the dry season when high-quality forages are in short supply. The majority of these roughages are high in fibre, low in protein and the intake of digestible nutrients often is not enough to meet maintenance requirements. Intake and digestibility of poor-quality roughages may be increased by supplementation. The response to supplementation can be attributed to an increase in the supply of nitrogen and/or readily fermentable carbohydrate, resulting in an increase in rumen cellulolytic micro-organisms and therefore enhanced fibre degradation.
As in most presidential election years, Latin America is not significant in the campaign issues presently under discussion, nor is it likely to become so before November 1992. This article focuses, therefore, not so much upon which issues might, or even should, be emphasized by the Democratic Party during the campaign, as upon what might be the design of a Latin American policy by a new Democratic administration in January 1993. Start, then, by assuming a Democratic victory in November.
It would be reasonable to predict that Latin America will get more attention, of a different nature and on a more consistent basis, than it has during the Reagan-Bush years. The Democrats have had the affiliation of the greater number of this country's Latin Americanists, and their weight will be felt. They will want, demand, and probably get, some serious input.
A foundation diet, an intermediate blend and a summit diet were formulated with different levels of soyabean meal, casein and crystalline amino acids to compare ‘slow’ and ‘rapid’ protein diets. The diets were offered to male Ross 308 chicks from 7 to 28 d post-hatch and assessed parameters included growth performance, nutrient utilisation, apparent digestibility coefficients and disappearance rates of starch and protein (N) in four small intestinal segments. Digestibility coefficients and disappearance rates of sixteen amino acids in three small intestinal segments and amino acid concentrations in plasma from portal and systemic circulations from the foundation and summit diets were determined. The dietary transition significantly accelerated protein (N) disappearance rates in the distal jejunum and ileum. The transition from foundation to summit diets significantly increased starch digestibility coefficients in the ileum and disappearance rates in all four small intestinal segments. These starch responses were associated with significant enhancements in nutrient utilisation. The dietary transition linearly increased digestibility coefficients and disappearance rates of amino acids in the majority of cases. The summit diet increased plasma concentrations of five amino acids but decreased those of four amino acids relative to the foundation diet to significant extents. Plasma concentrations of free amino acids were higher in the portal than systemic circulations. Rapid protein disappearance rates advantaged poultry performance and influenced post-enteral availability of amino acids. If the underlying mechanisms are to be identified, further research into the impact of protein digestive dynamics on broiler performance is required but appears justified.
Methane formation in the rumen represents a substantial loss of energy to the animal and is also a major source of greenhouse gas emissions from agriculture. Methanogenesis is the main means of disposal of hydrogen during rumen fermentation. The formation of propionate represents an alternative route of hydrogen disposal, providing sufficient propionate precursors are available. Theoretically, adding propionate precursors should stimulate propionate production and decrease methane production. In the present experiment, the effects of two potential precursors of propionate, fumarate and acrylate, on rumen fermentation and methane production were investigated in a rumen simulating fermentor.
Epidemiology formed the basis of ‘the Barker hypothesis’, the concept of ‘developmental programming’ and today’s discipline of the Developmental Origins of Health and Disease (DOHaD). Animal experimentation provided proof of the underlying concepts, and continues to generate knowledge of underlying mechanisms. Interventions in humans, based on DOHaD principles, will be informed by experiments in animals. As knowledge in this discipline has accumulated, from studies of humans and other animals, the complexity of interactions between genome, environment and epigenetics, has been revealed. The vast nature of programming stimuli and breadth of effects is becoming known. As a result of our accumulating knowledge we now appreciate the impact of many variables that contribute to programmed outcomes. To guide further animal research in this field, the Australia and New Zealand DOHaD society (ANZ DOHaD) Animals Models of DOHaD Research Working Group convened at the 2nd Annual ANZ DOHaD Congress in Melbourne, Australia in April 2015. This review summarizes the contributions of animal research to the understanding of DOHaD, and makes recommendations for the design and conduct of animal experiments to maximize relevance, reproducibility and translation of knowledge into improving health and well-being.
It is well established that people with irritable bowel syndrome (IBS) have higher levels of anxiety and depression compared with controls. However, the role of these as risk factors is less clearly established. The aims of this systematic review were to investigate: (1) whether anxiety and/or depression predict IBS onset; (2) the size of the relative risk (RR) of anxiety versus depression in IBS onset. Subgroup analyses explored if methodological factors affected the overall findings.
Prospective cohort or case–control studies were included if they: (1) focused on the development of IBS in population-based or gastroenteritis cohorts; (2) explored the effects of anxiety and/or depression at baseline as predictors of IBS onset at a future point. In all, 11 studies were included of which eight recruited participants with a gastrointestinal infection. Meta-analyses were conducted.
The risk of developing IBS was double for anxiety cases at baseline compared with those who were not [RR 2.38, 95% confidence interval (CI) 1.58–3.60]. Similar results were found for depression (RR 2.06, 95% CI 1.44–2.96). Anxiety and depression seemed to play a stronger role in IBS onset in individuals with a gastrointestinal infection although this could be attributed to other differences in methodology, such as use of diagnostic interviews rather than self-report.
The findings suggest that self-reported anxiety and depression provide a twofold risk for IBS onset. There is less support for the role of anxiety or depressive disorder diagnosed using clinical interview. These findings may have implications for the development of interventions focused on IBS prevention and treatment.
Hippocampal volume reductions in major depression have been frequently reported. However, evidence for functional abnormalities in the same region in depression has been less clear. We investigated hippocampal function in depression using functional magnetic resonance imaging (fMRI) and neuropsychological tasks tapping spatial memory function, with complementing measures of hippocampal volume and resting blood flow to aid interpretation.
A total of 20 patients with major depressive disorder (MDD) and a matched group of 20 healthy individuals participated. Participants underwent multimodal magnetic resonance imaging (MRI): fMRI during a spatial memory task, and structural MRI and resting blood flow measurements of the hippocampal region using arterial spin labelling. An offline battery of neuropsychological tests, including several measures of spatial memory, was also completed.
The fMRI analysis showed significant group differences in bilateral anterior regions of the hippocampus. While control participants showed task-dependent differences in blood oxygen level-dependent (BOLD) signal, depressed patients did not. No group differences were detected with regard to hippocampal volume or resting blood flow. Patients showed reduced performance in several offline neuropsychological measures. All group differences were independent of differences in hippocampal volume and hippocampal blood flow.
Functional abnormalities of the hippocampus can be observed in patients with MDD even when the volume and resting perfusion in the same region appear normal. This suggests that changes in hippocampal function can be observed independently of structural abnormalities of the hippocampus in depression.
Reliability and degradation processes in broad-area InGaAs-AlGaAs strained quantum well (QW) lasers are under intensive investigation because these lasers are the key components for fiber lasers and amplifiers that have found both industrial and military applications in recent years. Unlike single-mode lasers that were developed for high reliability telecom applications, broad-area lasers were mainly targeted for applications that require less stringent reliability of the lasers until recently. Especially, the lack of field reliability data is a concern for satellite communication systems where high reliability is required of lasers for long-term duration. For our present study, we addressed this concern by performing long-term life-tests of broad-area InGaAs-AlGaAs strained QW lasers and also by studying mechanisms that are responsible for catastrophic degradation of the lasers.