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Racial and ethnic groups in the USA differ in the prevalence of posttraumatic stress disorder (PTSD). Recent research however has not observed consistent racial/ethnic differences in posttraumatic stress in the early aftermath of trauma, suggesting that such differences in chronic PTSD rates may be related to differences in recovery over time.
As part of the multisite, longitudinal AURORA study, we investigated racial/ethnic differences in PTSD and related outcomes within 3 months after trauma. Participants (n = 930) were recruited from emergency departments across the USA and provided periodic (2 weeks, 8 weeks, and 3 months after trauma) self-report assessments of PTSD, depression, dissociation, anxiety, and resilience. Linear models were completed to investigate racial/ethnic differences in posttraumatic dysfunction with subsequent follow-up models assessing potential effects of prior life stressors.
Racial/ethnic groups did not differ in symptoms over time; however, Black participants showed reduced posttraumatic depression and anxiety symptoms overall compared to Hispanic participants and White participants. Racial/ethnic differences were not attenuated after accounting for differences in sociodemographic factors. However, racial/ethnic differences in depression and anxiety were no longer significant after accounting for greater prior trauma exposure and childhood emotional abuse in White participants.
The present findings suggest prior differences in previous trauma exposure partially mediate the observed racial/ethnic differences in posttraumatic depression and anxiety symptoms following a recent trauma. Our findings further demonstrate that racial/ethnic groups show similar rates of symptom recovery over time. Future work utilizing longer time-scale data is needed to elucidate potential racial/ethnic differences in long-term symptom trajectories.
This article reports on a new project to investigate the activities of early Homo sapiens in the area of the Chotts ‘megalake’ in southern Tunisia. Excavations in 2015 and 2019 at Oued el Akarit revealed one of a number of Middle Stone Age (MSA) horizons near the top of a long sequence of Upper Pleistocene deposits. The site identified as Oued el Akarit (Sondage 8) consists of lithic artefacts, bone fragments of large ungulates and pieces of ostrich eggshell. Many of the objects are burnt. Excavation of about nine square metres revealed that these were associated with a lightly trampled and combusted occupation surface. Amongst the identified artefacts were Levallois flakes some of which could be refitted, thereby indicating the generally undisturbed nature of the occupation. The lithic finds also included side scrapers and other tools diagnostic of the MSA but significantly no bifacial or tanged tools. OSL (Optically Stimulated Luminescence) dating of the sediments and AMS (Accelerator Mass Spectrometry) radiocarbon dating of ostrich eggshell have produced uncalibrated age determinations in the range 37,000–40,000 years ago, one of the youngest ages for MSA sites in the region. This is the first example of a securely dated later MSA occupation in a riparian environment in south-eastern Tunisia.
This is the first report on the association between trauma exposure and depression from the Advancing Understanding of RecOvery afteR traumA(AURORA) multisite longitudinal study of adverse post-traumatic neuropsychiatric sequelae (APNS) among participants seeking emergency department (ED) treatment in the aftermath of a traumatic life experience.
We focus on participants presenting at EDs after a motor vehicle collision (MVC), which characterizes most AURORA participants, and examine associations of participant socio-demographics and MVC characteristics with 8-week depression as mediated through peritraumatic symptoms and 2-week depression.
Eight-week depression prevalence was relatively high (27.8%) and associated with several MVC characteristics (being passenger v. driver; injuries to other people). Peritraumatic distress was associated with 2-week but not 8-week depression. Most of these associations held when controlling for peritraumatic symptoms and, to a lesser degree, depressive symptoms at 2-weeks post-trauma.
These observations, coupled with substantial variation in the relative strength of the mediating pathways across predictors, raises the possibility of diverse and potentially complex underlying biological and psychological processes that remain to be elucidated in more in-depth analyses of the rich and evolving AURORA database to find new targets for intervention and new tools for risk-based stratification following trauma exposure.
Coronavirus disease 2019 (COVID-19) has migrated to regions that were initially spared, and it is likely that different populations are currently at risk for illness. Herein, we present our observations of the change in characteristics and resource use of COVID-19 patients over time in a national system of community hospitals to help inform those managing surge planning, operational management, and future policy decisions.
To determine risk factors for mortality among COVID-19 patients admitted to a system of community hospitals in the United States.
Retrospective analysis of patient data collected from the routine care of COVID-19 patients.
System of >180 acute-care facilities in the United States.
All admitted patients with positive identification of COVID-19 and a documented discharge as of May 12, 2020.
Determination of demographic characteristics, vital signs at admission, patient comorbidities and recorded discharge disposition in this population to construct a logistic regression estimating the odds of mortality, particular for those patients characterized as not being critically ill at admission.
In total, 6,180 COVID-19+ patients were identified as of May 12, 2020. Most COVID-19+ patients (4,808, 77.8%) were admitted directly to a medical-surgical unit with no documented critical care or mechanical ventilation within 8 hours of admission. After adjusting for demographic characteristics, comorbidities, and vital signs at admission in this subgroup, the largest driver of the odds of mortality was patient age (OR, 1.07; 95% CI, 1.06–1.08; P < .001). Decreased oxygen saturation at admission was associated with increased odds of mortality (OR, 1.09; 95% CI, 1.06–1.12; P < .001) as was diabetes (OR, 1.57; 95% CI, 1.21–2.03; P < .001).
The identification of factors observable at admission that are associated with mortality in COVID-19 patients who are initially admitted to non-critical care units may help care providers, hospital epidemiologists, and hospital safety experts better plan for the care of these patients.
Background: Trauma care represents a complex patient journey, requiring multi-disciplinary coordinated care. Team members are human, and as such, how they feel about their colleagues and their work affects performance. The challenge for health service leaders is enabling culture that supports high levels of collaboration, cooperation and coordination across diverse groups. Aim Statement: We aimed to define and set the agenda for improvement of the relational aspects of trauma care at a large tertiary care hospital. Measures & Design: We conducted a mixed-methods collaborative ethnography using the Relational Coordination survey – an established tool to analyze the relational dimensions of multidisciplinary teamwork – participant observation, interviews, and narrative surveys. Findings were presented to clinicians in working groups for further interpretation and to facilitate co-creation of targeted interventions designed to improve team relationships and performance. Evaluation/Results: We engaged a complex multidisciplinary network of ~500 care providers dispersed across seven core interdependent clinical disciplines. Initial findings highlighted the importance of relationships in trauma care and opportunities to improve. Narrative survey and ethnographic findings further highlighted the centrality of a translational simulation program in contributing positively to team culture and relational ties. A range of 16 interventions – focusing on structural, process and relational dimensions – were co-created with participants and are now being implemented and evaluated by various trauma care providers. Discussion/Impact: Through engagement of clinicians spanning organizational boundaries, relational aspects of care can be measured and directly targeted in a collaborative quality improvement process. We encourage health care leaders to consider relationship-based quality improvement strategies, including translational simulation and relational coordination processes, in their efforts to improve care for patients with complex, interdependent journeys.
Individuals with major mental illnesses (MMI) die significantly younger than the general population. Rates of Cardiovascular morbidity and mortality have fallen in the general population, due to effective primary prevention through the use of accurate cardiovascular risk assessment algorithms. This reduction has not occurred in individuals with MMI and there is evidence that the mortality gap is widening.
To determine the cardiometabolic risk profile and cardiovascular risk score in patients with schizophrenia compared to controls.
1,977 individuals with schizophrenia or related psychoses were compared to 215,165 controls. Cardiometabolic risk factors including cholesterol, BMI, systolic blood pressure, smoking status and diabetes were compared. Mean age and sex adjusted 10 year cardiovascular risk prediction scores were generated and compared using the Joint British Societies Score (JBS2).
Rates of diabetes, smoking and obesity were significantly higher in both men and women with schizophrenia compared to controls. In men with schizophrenia mean JBS2 score was lower than controls (10.2% vs. 10.9%). Rates of individuals at high risk of cardiovascular disease (JBS2 >20%) were lower in men with schizophrenia (28.4% vs. 39.3%). In women with schizophrenia mean JBS2 scores were higher (8.3% vs. 7.9%) and the rate of individuals at high risk of cardiovascular disease was higher than in controls (13.4% vs. 11.8%).
Despite high rates of cardiometabolic risk factors in men and women with schizophrenia across all age groups, cardiovascular risk algorithms may not adequately predict increased 10 year cardiovascular risk in men.
The Glasgow area has a combination of highly variable superficial deposits and a legacy of heavy industry, quarrying and mining. These factors create complex foundation and hydrological conditions, influencing the movement of contaminants through the subsurface and giving rise locally to unstable ground conditions. Digital geological three-dimensional models developed by the British Geological Survey are helping to resolve the complex geology underlying Glasgow, providing a key tool for planning and environmental management. The models, covering an area of 3200km2 to a depth of 1.2km, include glacial and post-glacial deposits and the underlying, faulted Carboniferous igneous and sedimentary rocks. Control data, including 95,000 boreholes, digital mine plans and published geological maps, were used in model development. Digital outputs from the models include maps of depth to key horizons, such as rockhead or depth to mine workings. The models have formed the basis for the development of site-scale high-resolution geological models and provide input data for a wide range of other applications from groundwater modelling to stochastic lithological modelling.
Introduction: Point of care ultrasound (US) is a key adjunct in the management of trauma patients, in the form of the extended focused assessment with sonography in trauma (E-FAST) scan. This study assessed the impact of adding an edus2 ultrasound simulator on the diagnostic capabilities of resident and attending physicians participating in simulated trauma scenarios. Methods: 12 residents and 20 attending physicians participated in 114 trauma simulations utilizing a Laerdal 3G mannequin. Participants generated a ranked differential diagnosis list after a standard assessment, and again after completing a simulated US scan for each scenario. We compared reports to determine if US improved diagnostic performance over a physical exam alone. Standard statistical tests (χ2 and Student t tests) were performed. The research team was independent of the edus2 designers. Results: Primary diagnosis improved significantly from 53 (46%) to 97 (85%) correct diagnoses with the addition of simulated US (χ2=37.7, 1df; p=<0.0001). Of the 61 scenarios where an incorrect top ranked diagnosis was given, 51 (84%) improved following US. Participants were assigned a score from 1 to 5 based on where the correct diagnosis was ranked, with a 5 indicating a correct primary diagnosis. Median scores significantly increased from 3.8 (IQR 3, 4.9) to 5 (IQR 4.7, 5; W=219, p<0.0001).Participants were significantly more confident in their diagnoses after using the US simulator, as shown by the increase in their mean confidence in the correct diagnosis from 53.1% (SD 22.8) to 83.5% (SD 19.1; t=9.0; p<0.0001)Additionally, participants significantly narrowed their differential diagnosis lists from an initial medium count of 3.5 (IQR 2.9, 4.4) possible diagnoses to 2.4 (IQR 1.9, 3; W=-378, p<0.0001) following US. The performance of residents was compared to that of attending physicians for each of the above analyses. No differences in performance were detected. Conclusion: This study showed that the addition of ultrasound to simulated trauma scenarios improved the diagnostic capabilities of resident and attending physicians. Specifically, participants improved in diagnostic accuracy, diagnostic confidence, and diagnostic precision. Additionally, we have shown that the edus2 simulator can be integrated into high fidelity simulation in a way that improves diagnostic performance.
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.
During the Skylab period from June 1973 to January 1974 approximately 1500 type III metre-wave radio bursts or burst groups were reported (Solar Geophysical Data Prompt Reports). The longitudinal distribution of these type III bursts closely resembles that of sunspots and of the coronal transients observed above 2 R⊙ by the white-light coronagraph on Skylab. White light ejection transients appear as large loop or blob-like structures which carry material outward from the Sun and rearrange the corona. In front of the main, bright structures there are weak enhancements of brightness, termed forerunners (Jackson and Hildner 1978; Jackson 1978). In this paper we enquire into whether or not type III bursts are in any way related to the onset of solar mass ejections indicated by coronal transients.
Studies of coronal transients observed in white-light (Gosling et al., 1976) have shown that fast-moving events (≤ 400 km s-1) are closely associated with flares and with type II and IV radio bursts while slow-moving events are not. We now report the first detection of the radio counterpart of a slow-moving transient. The event of 1974 January 21 is shown to be visible on maps of the quiet Sun made at a frequency of 80 MHz.
When I began my studies of solar radio astronomy, Dr J. L. Pawsey, who then led the radio astronomy group in the Division of Radiophysics, CSIRO, explained to me that the internal structure of the Sun was ‘well understood’, thanks to a lack of conflicting observational data, but that for the observable layers of the Sun, the photosphere, chromosphere and corona, a great many mysteries remained. I am sure that he would have been amused by the recent discovery that there are not enough neutrons coming from the core of the Sun. I shall devote most of my talk to matters about which we are fairly certain, but often I will only be able to give part of the story because the details have not yet emerged from the wealth of solar mysteries.
This communication describes techniques, new to radio astronomy, which permit the analysis of electrical signals at radio-frequencies by optical methods.
Two applications will be described: the first is to a spectrograph which gives the instantaneous power spectrum of a single broad-band electrical signal; the second is to the analysis of the signals from a number of aerials of an array in order to form a simultaneous image of the brightness distribution of the region of the sky under observation.
The Culgoora radioheliograph was designed in the early 1960s and commissioned in 1967. Since then there have been dramatic increases in the speed and versatility of digital integrated-circuit devices, and also a marked fall in their cost. It is now possible to replace the original signal processing electronics with equipment, based on modern digital technology, which will significantly enhance the performance of this radio telescope for solar and cosmic radio observations at metre wavelengths.
With a number of important exceptions associated with transitory flare activity, most persistent sources of solar radio emission observed to date with the 80 MHz Culgoora radioheliograph have been stable in position over periods of tens of minutes or hours even though they fluctuated greatly in intensity. During several hours on 1968 November 11, however, we observed some interesting activity which showed frequent changes in the position of a source.
On 1973 March 22 a radio event was observed above the east limb of the Sun with the Culgoora radioheliograph operating at both 80 and 160 MHz. The first stage of this event, a type I storm closely associated with a rising prominence, offers a new insight into the nature of this phenomenon. This storm was followed immediately by a moving type IV burst – the first burst of this kind for which two-dimensional observations are available at two frequencies. The relation between these two stages may help explain the ‘missing hour’ in observations of another moving type IV burst known as ‘Westward Ho’.
For many years we have had evidence from solar radio bursts of violent mass motions in the solar corona: type II bursts reveal the passage of shock waves through the solar corona, and moving type IV bursts show that plasma and magnetic field travel to great distances without any sign of slowing down.