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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.
Guangxi, a province in southwestern China, has the second highest reported number of HIV/AIDS cases in China. This study aimed to develop an accurate and effective model to describe the tendency of HIV and to predict its incidence in Guangxi. HIV incidence data of Guangxi from 2005 to 2016 were obtained from the database of the Chinese Center for Disease Control and Prevention. Long short-term memory (LSTM) neural network models, autoregressive integrated moving average (ARIMA) models, generalised regression neural network (GRNN) models and exponential smoothing (ES) were used to fit the incidence data. Data from 2015 and 2016 were used to validate the most suitable models. The model performances were evaluated by evaluating metrics, including mean square error (MSE), root mean square error, mean absolute error and mean absolute percentage error. The LSTM model had the lowest MSE when the N value (time step) was 12. The most appropriate ARIMA models for incidence in 2015 and 2016 were ARIMA (1, 1, 2) (0, 1, 2)12 and ARIMA (2, 1, 0) (1, 1, 2)12, respectively. The accuracy of GRNN and ES models in forecasting HIV incidence in Guangxi was relatively poor. Four performance metrics of the LSTM model were all lower than the ARIMA, GRNN and ES models. The LSTM model was more effective than other time-series models and is important for the monitoring and control of local HIV epidemics.
This study investigates numerically the performance of applying aerospike nozzle in a hydrogen peroxide mono-propellant propulsion system. A set of governing equations, including continuity, momentum, energy and species conservation equations with extended k-ε turbulence equations, are solved using the finite-volume method. The hydrogen peroxide mono-propellant is assumed to be fully decomposed into water vapor and oxygen after flowing through a catalyst bed before entering the nozzle. The aerospike nozzle is expected to have high performance even in deep throttling cases due to its self-compensating characteristics in a wide range of ambient pressure environments. The results show that the thrust coefficient efficiency (Cf,η) of this work exceeds 90% of the theoretical value with a nozzle pressure ratio (PR) in the range of 20 ~ 45. Many complex gas dynamics phenomena in the aerospike nozzle are found and explained in the paper. In addition, performance of the aerospike nozzle is compared with that of the bell-shape nozzle.
An underwater shock loading experimental device is used to simulate underwater explosion shock waves. The aim of this study is to investigate the influence of flyer momentum on the response of an aluminium plate to this underwater shock loading experimental device. The simulation accuracy can be verified by comparing theoretical data with the simulation and experimental results. Through simulations, an aluminium plate’s deformation and pressure specific impulse can be determined when flyers impact the piston at different velocities but at the same momentum. The aluminium plate's deformation and pressure specific impulse are constant when the flyers had constant momentum because both are directly proportional to the flyer momentum. The results have an important practical value for understanding and using this type of experimental device.
A new approach is proposed to analyze Bremsstrahlung X-rays that are emitted from laser-produced plasmas (LPP) and are measured by a stack type spectrometer. This new method is based on a spectral tomographic reconstruction concept with the variational principle for optimization, without referring to the electron energy distribution of a plasma. This approach is applied to the analysis of some experimental data obtained at a few major laser facilities to demonstrate the applicability of the method. Slope temperatures of X-rays from LPP are determined with a two-temperature model, showing different spectral characteristics of X-rays depending on laser properties used in the experiments.
The ultimate goal of poultry hatching is to increase the hatching rate and to produce healthy hatched birds. In the incubation process, temperature is the most important factor for the egg hatching rate, the growth performance and offspring phenotype. This not only affects the early development of the offspring, but also has a continued influence on the physical characteristics of the birds, such as final body weight and meat quality. This article reviews the importance of incubation temperature on offspring phenotype, sex differentiation, organism immunity and the development of muscle fibre in poultry.
To examine the incidence of asthma in adult patients with major depressive disorder (MDD).
From the National Health Insurance database of Taiwan, we identified 30 169 adult patients who were newly diagnosed with MDD between 2000 and 2010. Individuals without depression were randomly selected four times and frequency matched for sex, age and year of diagnosis. Both cohorts were followed-up for the occurrence of asthma up to the end of 2011. Adjusted hazard ratios (aHRs) of asthma were estimated using the Cox proportional hazards method.
The overall incidence of asthma was 1.91-fold higher in the MDD cohort than in the non-depression cohort (7.55 v. 3.96 per 1000 person-years), with an aHR of 1.66 (95% confidence interval (CI) 1.55–1.78). In both cohorts, the incidence of asthma was higher in patients and controls who were female, aged, with comorbidities and users of aspirin or beta-adrenergic receptor blockers. No significant difference was observed in the occurrence of asthma between patients with MDD treated with selective serotonin reuptake inhibitors (SSRIs) and those treated with non-SSRIs (SSRIs to non-SSRIs aHR = 1.03, 95% CI 0.91–1.17).
Adult patients with MDD are at a higher risk of asthma than those without depression are.
Studies of the end-Permian mass extinction have suggested a variety of patterns from a single catastrophic event to multiple phases. But most of these analyses have been based on fossil distributions from single localities. Although single sections may simplify the interpretation of species diversity, they are susceptible to bias from stratigraphic incompleteness and facies control of preservation. Here we use a data set of 1450 species from 18 fossiliferous sections in different paleoenvironmental settings across South China and the northern peri-Gondwanan region, and integrate it with high-precision geochronologic data to evaluate the rapidity of the largest Phanerozoic mass extinction. To reduce the Signor-Lipps effect, we applied constrained optimization (CONOP) to search for an optimal sequence of first and last occurrence datums for all species and generate a composite biodiversity pattern based on multiple sections. This analysis indicates that an abrupt extinction of 62% of species took place within 200 Kyr. The onset of the sudden extinction is around 252.3 Ma, just below Bed 25 at the Meishan section. Taxon turnover and diversification rates suggest a deterioration of the living conditions nearly 1.2 Myr before the sudden extinction. The magnitude of the extinction was such that there was no immediate biotic recovery. Prior suggestions of highly variable, multi-phased extinction patterns reflect the impact of the Signor-Lipps effect and facies-dependent occurrences, and are not supported following appropriate statistical treatment of this larger data set.
Dysregulation of the striatum and altered corticostriatal connectivity have been associated with psychotic disorders. Social anhedonia has been identified as a predictor for the development of schizophrenia spectrum disorders. The aim of the present study was to examine corticostriatal functional connectivity in individuals with high social anhedonia.
Twenty-one participants with high social anhedonia score and 30 with low social anhedonia score measured by the Chinese version of the Revised Social Anhedonia Scale were recruited from university undergraduates (age 17–21 years) to undergo resting-state functional MRI scans. Six subdivisions of the striatum in each hemisphere were defined as seeds. Voxel-wise functional connectivity analyses were conducted between each seed and the whole brain voxels, followed by repeated-measures ANOVA for the group effect.
Participants with high social anhedonia showed hyper-connectivity between the ventral striatum and the anterior cingulate cortex and the insula, and between the dorsal striatum and the motor cortex. Hypo-connectivity in participants with high social anhedonia was also observed between the ventral striatum and the posterior cingulate cortex. Partial correlation analyses further showed that the functional connectivity between the ventral striatum and the prefrontal cortex was associated with pleasure experience and emotional suppression.
Our findings suggest that altered corticostriatal connectivity can be found in participants with high levels of social anhedonia. Since social anhedonia has been considered a predictor for schizophrenia spectrum disorders, our results may provide novel evidence on the early changes in brain functional connectivity in at-risk individuals.
Titanium oxide photoelectrodes have been used for water splitting for a few decades, but have low solar-to-hydrogen efficiencies. Perovskite halides (e.g., CH3NH3PbI3) have recently emerged as an efficient light absorber system. We try to combine the two materials to create new photoelectrodes to achieve a higher efficiency for hydrogen production. The photoelectrodes are investigated for water-splitting hydrogen production under Xe light irradiation by photoelectrochemical (PEC) reaction. Since perovskite halides are favorable light harvesters under UV and visible light irradiation, the composite films of titania and perovskite halide would achieve efficient water splitting. The hydrogen production rate using the composite films is higher than that using anatase TiO2 electrode. However, the composite films are not stable in water under light irradiation and the perovskite halide gradually decomposes into lead halide.
The interferon-inducible transmembrane protein 3 (IFITM3), as one of the key genes involved in the interferon pathway, is critical for defending the host against influenza virus, and the rs12252 T>C variant in IFITM3 might be associated with susceptibility to severe influenza. Owing to contradictory and inconclusive results, we performed a meta-analysis to assess the association between rs12252 T>C polymorphism and severe influenza risk. A comprehensive literature search up to 1 August 2014 was conducted in EMBASE, Pubmed, Web of Science, VIP, Wanfang and CNKI databases. Four eligible studies with a total of 445 influenza patients and 3396 controls were included in this meta-analysis. Overall, our results demonstrated a significant association between the IFITM3 rs12252 T>C polymorphism and influenza risk [C vs. T: odds ratio (OR) 1·68, 95% confidence interval (CI) 1·32–2·13; CC vs. CT+TT: OR 2·38, 95% CI 1·52–3·73; CC+CT vs. TT: OR 1·62, 95% CI 1·18–2·22]. Stratification by ethnicity indicated that the variant C allele was associated with an 88% increased risk of influenza in Asians (C vs. T: OR 1·88, 95% CI 1·34–2·62). Moreover, subjects carrying the variant C allele had an increased risk of developing severe illness upon influenza infection (C vs. T: OR 2·70, 95% CI 1·86–3·94). However, no significant association was observed in patients with mild infection (C vs. T: OR 1·26, 95% CI 0·93–1·71). Our meta-analysis suggests that IFITM3 rs12252 T>C polymorphism is significantly associated with increased risk of severe influenza but not with the chance of initial virus infection.
HBV genotypes have specific geographical distributions and can serve as epidemiological markers. Accumulated data have shown that the major HBV genotypes in China are B and C. Here, the HBV genotypes were examined from 6817 blood samples, which were collected from patients with chronic HBV infection in Fujian Province during 2006–2013; genotype B was identified in 3384 patients (49·6%), while genotype C was identified in 3430 patients (50·3%). The percentage of patients infected with genotype C gradually increased with age from 39·5% (patients aged <20 years) to 63·9% (patients aged >50 years), reaching a peak of 67·3% in the 45–50 years age group. These results clearly demonstrate that the genotype distribution of HBV in Fujian Province has significantly changed in recent years with almost equal numbers of genotype B and genotype C infections existing in the entire patient population, while higher incidence of genotype C infection exists in older patients, but genotype B is no longer dominant in the Fujian area as previously reported.
A comparison was made of 6H-SiC surfaces etched with H2, C2H4/H2, and HCl/H2, and the resulting crystal quality of epitaxial GaN films deposited on these substrates. To remove the many fine scratches and to smooth the rough surfaces typical of commercial SiC substrates, the Si-face 6H-SiC substrates were etched in H2, C2H4/H2, and HCl/H2 at 145 °C. GaN was subsequently deposited on these etched surfaces after first depositing a low temperature GaN buffer layer via metalorganic chemical vapor deposition (MOCVD). The surface morphologies after etching and after GaN deposition were characterized by atomic force microscopy and Normaski differential interference contrast microscopy, while the crystal quality of the GaN films was assessed by double crystal x-ray rocking curves and x-ray topography. 6H-SiC substrate surfaces were improved in terms of the removal of scratches and the reduction of surface roughness, and both surface morphology and crystal quality of the subsequently deposited GaN films were enhanced. However, the dislocation density was not decreased by the surface etching. The best GaN film was produced by etching the substrate in pure H2 for 40 minutes before growth. Recommendations for the optimum substrate treatment are made.
The transmission of haemorrhagic fever with renal syndrome (HFRS) is deeply influenced by the reservoir and hantavirus prevalence rate. In this study, a surveillance on human HFRS cases, relative rodent abundance, and hantavirus infection prevalence was conducted in Shaanxi province, China, during 1984–2012. A generalized linear model with Poisson-distributed residuals and a log link was used to quantify the relationship between reservoir, virus and HFRS cases. The result indicated that there was a significant association of HFRS incidence with relative rodent density and the prevalence rate. This research provides evidence that the changes of infection prevalence in the reservoir could lead directly to the emergence of a new epidemic. It was concluded that the measurement of a number of these variables could be used in disease surveillance to give useful advance warning of potential disease epidemics.
Using first-principles full-field electromagnetic simulations, we demonstrate that near-perfect above-band-gap solar absorption can be achieved in nanostructured, ultra-thin-film iron oxide photoanodes for photoelectrochemical (PEC) water splitting. In our designed core-shell nanocone structures, all regions of hematite (α-iron oxide) are away from the interface between hematite and water by a minimum distance of less than the hole diffusion length in hematite, which is assumed to be no greater than 20nm. The optical absorption in our structure corresponds to a photocurrent density of 12.5mA/cm2 if one assumes an air mass 1.5 solar spectrum and a unity absorbed photon-to-current efficiency (APCE) for all wavelengths in that spectrum. Our photon management strategy eliminates the trade-off between optical absorption and carrier collection as commonly found in conventional designs of PEC cells, and variants of the strategy are generally applicable to other material systems.
Fast-electron beam stopping mechanisms in media ranging from solid to warm dense matter have been investigated experimentally and numerically. Laser-driven fast electrons have been transported through solid Al targets and shock-compressed Al and plastic foam targets. Their propagation has been diagnosed via rear-side optical self-emission and Kα X-rays from tracer layers. Comparison between measurements and simulations shows that the transition from collision-dominated to resistive field-dominated energy loss occurs for a fast-electron current density ~5 × 1011 A cm−2. The respective increases in the stopping power with target density and resistivity have been detected in each regime. Self-guided propagation over 200μm has been observed in radially compressed targets due to ~1kT magnetic fields generated by resistivity gradients at the converging shock front.
Native defects in Si-doped, Zn-doped and undoped GaAs grown by horizontal Bridgman (HB) method and molecular beam epitaxiy (MBE) were studied by a monoenergetic positron beam. Positron lifetime spectra and Doppler broadening profiles were also measured by using energetic positrons. It was found that monovacancies were usually found in Si-doped HB-GaAs, however, divacancies were created in a specimen with low impurity concentration. For Zn-doped HB-GaAs, interstitial clusters were found to be major type of defects. The high concentration of monovacancies and of divacancies coexist in heavily Si-doped MBE-GaAs. These vacancy-complexes were found to act to reduce the concentration of free carriers.