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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.
Many reported CuIn1-xGaxSe2 (CIGS) thin films for high-efficiency solar cells have been prepared via a two-stage process that consists of a high-vacuum film deposition step followed by selenization with excess H2Se gas or Se vapor. Removing toxic gas and high-vacuum requirements from this process would greatly simplify it and make it less hazardous. We report the formation of CuIn1-xGaxSe2 (x = 0, 0.25, 0.50, 0.75, 1.0) thin films achieved by rapid thermal annealing of spray-deposited CuIn1-xGaxS2 and Se in the absence of an additional selenium source. To prepare the Se layer, commercial Se powder was dissolved by refluxing in ethylenediamine/2,2-dimethylimidizolidine. After cooling to room temperature, this mixture was combined with 2-propanol and the resulting colloidal Se suspension was sprayed by airbrush onto a heated glass substrate. The resulting film was coated with nanocrystalline CuIn1-xGaxS2 via spray deposition of a toluene-based “nanoink” suspension. The two-layer sample was annealed at 550 oC in an argon atmosphere for 60 minutes to form the final CIGS product. Scanning electron microscopy images reveal that film grains are 200-300 nm in diameter and comparable to sizes of the reactant CuIn1-xGaxS2 nanoparticles. XRD patterns are consistent with the chalcopyrite unit cell and calculated lattice parameters and A1 phonon frequencies change nearly linearly between those for CuInSe2 and CuGaSe2.
Market economies are notoriously difficult to identify in the archeological record. This is particularly true in the subtropical Maya lowlands of Mexico, Guatemala, and Belize because most utilitarian items and consumables were made of highly perishable materials. We explore the hypothesis that ancient marketplaces can be identified through analysis of chemical residues in soils from open and easily accessible spaces in and about ancient Maya cities. We compared soil chemical signatures from a credible ancient marketplace location in the specialized trade center of Chunchucmil, Yucatan, Mexico to those from a modern marketplace at Antigua, Guatemala. We found extraordinarily high concentrations of phosphorus and zinc in the soil of Chunchucmil's proposed marketplace and the same high concentrations correlate well with food preparation and vegetable sales areas at the modern marketplace. These methods hold promise in resolving the vexing question of how large ancient Maya urban populations were sustained.
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