scholarly journals Protection for Thorax Injury Severity in 90° Lateral Collision

1996 ◽  
Vol 3 (5) ◽  
pp. 337-351 ◽  
Author(s):  
Dimitrios Kallieris ◽  
Frank Boggasch ◽  
Rainer Mattern
Keyword(s):  
Injury Severity ◽  
Rigid Wall ◽  
Front Passenger ◽  
Side Impacts ◽  
Injury Criteria ◽  
Human Cadavers ◽  
Biomechanical Responses ◽  
Series Of Experiments ◽  
Age Range ◽  
The Impact

The thoracic trauma index (TTI) and the viscous criterion (VC) are injury criteria intended for the prediction of torso injury severity. The criteria were assessed in two series of experiments: 90° (lateral) car to car collisions and controlled left trunk impacts against either a rigid or padded wall. Forty-two belt restrained human cadavers in the age range 18–65 years, located in the near-side front passenger seat, were used. The impact velocity was between 40 and 60 km/h. Left and right side impacts were simulated using standard or modified car side structures. With the second series of experiments, the left side of each subject was impacted under one of two different test conditions: 24 km/h rigid wall or 32 km/h padded wall. The thorax deformation was evaluated through the double integration of the accelerated difference at the fourth and eight ribs, near and far side. Deformation maxima of 6–138 mm (mean 69 mm), VC values of 0.3–4.7 m/s (mean 1.6 m/s), and TTI values of 85–252 (mean 63) occurred. Torso abbreviated injury severity (AIS) values were between 0 and 5. Statistical analyses showed a stronger influence of age on injury severity than the injury criteria or biomechanical responses in the two series of experiments. The TTI showed the highest correlation with thoracic AIS and the number of rib fractures, while VC was the better predictor of abdominal AIS. The results are discussed critically and the strength and robustness of the injury criteria analyzed.

scholarly journals Nonoperative management of splenic injury in closely monitored patients with reduced consciousness is safe and feasible

2019 ◽  
Vol 27 (1) ◽  
Author(s):  
Michel Teuben ◽  
Roy Spijkerman ◽  
Taco Blokhuis ◽  
Roman Pfeifer ◽  
Henrik Teuber ◽  
...  
Keyword(s):  
Mental Status ◽  
Injury Severity ◽  
Splenic Injury ◽  
Nonoperative Management ◽  
Splenic Trauma ◽  
Blunt Splenic Injury ◽  
Icu Stay ◽  
Severity Scores ◽  
Gcs Score ◽  
The Impact

Abstract Background Treatment of blunt splenic injury has changed over the past decades. Nonoperative management (NOM) is the treatment of choice. Adequate patient selection is a prerequisite for successful NOM. Impaired mental status is considered as a relative contra indication for NOM. However, the impact of altered consciousness in well-equipped trauma institutes is unclear. We hypothesized that impaired mental status does not affect outcome in patients with splenic trauma. Methods Our prospectively composed trauma database was used and adult patients with blunt splenic injury were included during a 14-year time period. Treatment guidelines remained unaltered over time. Patients were grouped based on the presence (Group GCS: < 14) or absence (Group GCS: 14–15) of impaired mental status. Outcome was compared. Results A total of 161 patients were included, of whom 82 were selected for NOM. 36% of patients had a GCS-score < 14 (N = 20). The median GCS-score in patients with reduced consciousness was 9 (range 6–12). Groups were comparable except for significantly higher injury severity scores in the impaired mental status group (19 vs. 17, p = 0.007). Length of stay (28 vs. 9 days, p < 0.001) and ICU-stay (8 vs. 0 days, p = 0.005) were longer in patients with decreased GCS-scores. Failure of NOM, total splenectomy rates, complications and mortality did not differ between both study groups. Conclusion This study shows that NOM for blunt splenic trauma is a viable treatment modality in well-equipped institutions, regardless of the patients mental status. However, the presence of neurologic impairment is associated with prolonged ICU-stay and hospitalization. We recommend, in institutions with adequate monitoring facilities, to attempt nonoperative management for blunt splenic injury, in all hemodynamically stable patients without hollow organ injuries, also in the case of reduced consciousness.

scholarly journals Simultaneous Casualty Admissions—Do they Affect Treatment in the Receiving Trauma Center?

2021 ◽  
Author(s):  
Michel Paul Johan Teuben ◽  
Carsten Mand ◽  
Laura Moosdorf ◽  
Kai Sprengel ◽  
Alba Shehu ◽  
...  
Keyword(s):  
Injury Severity ◽  
Damage Control ◽  
Ct Scanning ◽  
Mortality Rates ◽  
Trauma Centers ◽  
Simultaneous Treatment ◽  
Diagnostic Pathway ◽  
Injured Patients ◽  
The Impact ◽  
Mean Time

Abstract Background Simultaneous trauma admissions expose medical professionals to increased workload. The impact of simultaneous trauma admissions on hospital allocation, therapy, and outcome is currently unclear. We hypothesized that multiple admission-scenarios impact the diagnostic pathway and outcome. Methods The TraumaRegister DGU® was utilized. Patients admitted between 2002–2015 with an ISS ≥ 9, treated with ATLS®- algorithms were included. Group ´IND´ included individual admissions, two individuals that were admitted within 60 min of each other were selected for group ´MULT´. Patients admitted within 10 min were considered as simultaneous (´SIM´) admissions. We compared patient and trauma characteristics, treatment, and outcomes between both groups. Results 132,382 admissions were included, and 4,462/3.4% MULTiple admissions were found. The SIM-group contained 1,686/1.3% patients. The overall median injury severity score was 17 and a mean age of 48 years was found. MULT patients were more frequently admitted to level-one trauma centers (68%) than individual trauma admissions were (58%, p < 0.001). Mean time to CT-scanning (24 vs. 26/28 min) was longer in MULT / SIM patients compared to individual admissions. No differences in utilization of damage control principles were seen. Moreover, mortality rates did not differ between the groups (13.1% in regular admissions and 11.4%/10,6% in MULT/SIM patients). Conclusion This study demonstrates that simultaneous treatment of injured patients is rare. Individuals treated in parallel with other patients were more often admitted to level-one trauma centers compared with individual patients. Although diagnostics take longer, treatment principles and mortality are equal in individual admissions and simultaneously admitted patients. More studies are required to optimize health care under these conditions.

scholarly journals ‘You see the empty bed which means it’s either a transplant or a death’: a qualitative study exploring the impact of death in the haemodialysis community

BMJ Open ◽  
2021 ◽  
Vol 11 (6) ◽  
pp. e046537
Author(s):  
Sheera Sutherland ◽  
Kirsty E Durley ◽  
Kirsty Gillies ◽  
Margaret Glogowska ◽  
Daniel S Lasserson ◽  
...  
Keyword(s):  
Qualitative Study ◽  
Clinical Setting ◽  
Support Services ◽  
Research Team ◽  
Central Importance ◽  
Semistructured Interviews ◽  
Age Range ◽  
The Impact ◽  
Community Patients

ObjectiveTo explore the impact of the death of a patient in the haemodialysis unit on fellow patients.MethodsWe interviewed patients on dialysis in a tertiary dialysis centre using semistructured interviews. We purposively sampled patients who had experienced the death of a fellow patient. After interviews were transcribed, they were thematically analysed by independent members of the research team using inductive analysis. Input from the team during analysis ensured the rigour and quality of the findings.Results10 participants completed the interviews (6 females and 4 males with an age range of 42–88 years). The four core themes that emerged from the interviews included: (1) patients’ relationship to haemodialysis, (2) how patients define the haemodialysis community, (3) patients’ views on death and bereavement and (4) patients’ expectations around death in the dialysis community. Patients noticed avoidance behaviour by staff in relation to discussing death in the unit and would prefer a culture of open acknowledgement.ConclusionStaff acknowledgement of death is of central importance to patients on haemodialysis who feel that the staff are part of their community. This should guide the development of appropriate bereavement support services and a framework that promotes the provision of guidance for staff and patients in this unique clinical setting. However, the authors acknowledge the homogenous sample recruited in a single setting may limit the transferability of the study. Further work is needed to understand diverse patient and nurse experiences and perceptions when sharing the knowledge of a patient’s death and how they react to loss.

scholarly journals Validation of the BATT score for prehospital risk stratification of traumatic haemorrhagic death: usefulness for tranexamic acid treatment criteria

2021 ◽  
Vol 29 (1) ◽  
Author(s):  
Francois-Xavier Ageron ◽  
Timothy J. Coats ◽  
Vincent Darioli ◽  
Ian Roberts
Keyword(s):  
Tranexamic Acid ◽  
Acid Treatment ◽  
Injury Severity ◽  
External Validation ◽  
Research Network ◽  
Brier Score ◽  
Trauma Patients ◽  
Using Data ◽  
The Uk ◽  
The Impact

Abstract Background Tranexamic acid reduces surgical blood loss and reduces deaths from bleeding in trauma patients. Tranexamic acid must be given urgently, preferably by paramedics at the scene of the injury or in the ambulance. We developed a simple score (Bleeding Audit Triage Trauma score) to predict death from bleeding. Methods We conducted an external validation of the BATT score using data from the UK Trauma Audit Research Network (TARN) from 1st January 2017 to 31st December 2018. We evaluated the impact of tranexamic acid treatment thresholds in trauma patients. Results We included 104,862 trauma patients with an injury severity score of 9 or above. Tranexamic acid was administered to 9915 (9%) patients. Of these 5185 (52%) received prehospital tranexamic acid. The BATT score had good accuracy (Brier score = 6%) and good discrimination (C-statistic 0.90; 95% CI 0.89–0.91). Calibration in the large showed no substantial difference between predicted and observed death due to bleeding (1.15% versus 1.16%, P = 0.81). Pre-hospital tranexamic acid treatment of trauma patients with a BATT score of 2 or more would avoid 210 bleeding deaths by treating 61,598 patients instead of avoiding 55 deaths by treating 9915 as currently. Conclusion The BATT score identifies trauma patient at risk of significant haemorrhage. A score of 2 or more would be an appropriate threshold for pre-hospital tranexamic acid treatment.

Speech Methodologies in Cleft Palate Assessment: A Pilot Project to Compare Two Phonetically Different Sentence Sets

2013 ◽  
Vol 20 (1) ◽  
pp. 49-72
Author(s):  
Jennie Smith ◽  
Tim Pring ◽  
Debbie Sell
Keyword(s):  
Cleft Palate ◽  
Pilot Project ◽  
Wilcoxon Test ◽  
Consecutive Series ◽  
Video Recordings ◽  
Significant Difference ◽  
The Difference ◽  
Audio Video ◽  
Age Range ◽  
The Impact

Objective: To investigate the impact of the phonetic content of two sentence sets on speech outcomes, specifically the effects of nasal phonemes. Method: Audio-video recordings of a consecutive series of 15 participants (age range 4–22 years), with cleft palate (syndromic or non-syndromic), with and without velopharyngeal dysfunction were taken. Participants repeated Sentence Set 1 (with nasals across sentences) and Sentence Set 2 (without nasals except the three nasal target sentences) during a routine speech recording. Two experienced Specialist Speech and Language Therapists, blinded to the study’s purpose, analyzed participants’ speech using the Cleft Audit Protocol for Speech-Augmented (CAPS-A). On day 1, recordings included Sentence Set 1. On day 2, 23 days later, recordings included Sentence Set 2. Main results: The difference between Sentence Set 1 and Sentence Set 2 ‘total scores’ (sum of scores on all CAPS-A parameters) was significant. The Pearson Product Moment showed high correlation. A Wilcoxon test revealed a significant difference between Sets 1 and 2 on the hypernasality parameter, and this alone accounted for the significant difference in total scores. Conclusion: The inclusion or exclusion of nasal consonants in the sentence set significantly affected perceptual ratings of hypernasality but none of the other CAPS-A parameters, highlighting the need for further investigation into perceptual nasality ratings.

A noise reduction method for semi-supervised community detection based on harmonic function

2018 ◽  
Vol 32 (14) ◽  
pp. 1850166 ◽  
Author(s):  
Lilin Fan ◽  
Kaiyuan Song ◽  
Dong Liu
Keyword(s):  
Harmonic Function ◽  
Prior Knowledge ◽  
Community Detection ◽  
Detection Methods ◽  
Detection Process ◽  
Knowledge Based ◽  
Detection Approach ◽  
Series Of Experiments ◽  
Novel Strategy ◽  
The Impact

Semi-supervised community detection is an important research topic in the field of complex network, which incorporates prior knowledge and topology to guide the community detection process. However, most of the previous work ignores the impact of the noise from prior knowledge during the community detection process. This paper proposes a novel strategy to identify and remove the noise from prior knowledge based on harmonic function, so as to make use of prior knowledge more efficiently. Finally, this strategy is applied to three state-of-the-art semi-supervised community detection methods. A series of experiments on both real and artificial networks demonstrate that the accuracy of semi-supervised community detection approach can be further improved.

An evaluation of opioid use during acute hospital admissions

2022 ◽  
Vol 4 (1) ◽  
pp. 24-31
Author(s):  
Alison Blackburn
Keyword(s):  
Acute Pain ◽  
Hospital Admissions ◽  
Hospital Setting ◽  
Acute Hospital ◽  
Opioid Use ◽  
Opioid Medication ◽  
Age Range ◽  
The Impact ◽  
Acute Hospital Setting

Long-term opioid use can begin with the treatment of acute pain. However, there is little evidence concerning the impact that better opioid awareness in the acute phase may have on reducing the use of opioids in the long term. This project explored which opioids are routinely prescribed within an acute hospital setting and how these opioids were used over the course of the hospital stay. Codeine and morphine remain the most commonly prescribed opioids. Opioids were prescribed and given to people across the age range, from 16 to 98 years. The project found that 19% of patients were admitted with a pre-existing opioid. Up to 66% of patients were discharged with opioid medication, with almost 20% leaving with more than one opioid. Regular opioid use routinely exposes patients to long-term opioid use and those patients initiated onto opioid medication during admission should have the benefit of planned de-escalation before discharge.

Secret Shame—Male Infertility and Donor Conception in the Wake of Retrospective Legislative Change

2021 ◽  
pp. 1097184X2110383
Author(s):  
Barbara Cosson ◽  
Deborah Dempsey ◽  
Fiona Kelly
Keyword(s):  
Emotional Labor ◽  
Early Adulthood ◽  
Friendship Networks ◽  
Male Factor ◽  
Perceived Vulnerability ◽  
Donor Conception ◽  
Infertile Men ◽  
Secret Keeping ◽  
Age Range ◽  
The Impact

Historically, sperm donation was shrouded in secrecy to protect the normative family and the perceived vulnerability of infertile men. However, openness about donor conception is increasingly encouraged, in acknowledging that donor-conceived people may benefit from having access to information about their biogenetic origins. Since 2017 in the state of Victoria, Australia, donor-conceived people have been able to access previously anonymous donor records. Drawing on interviews with 17 donor-conceived adults who have come to know their donor through the new laws, this article explores the impact of finding out about the donor on relationships with mothers and fathers, and points to the persistent effects of stigma and shame about donor conception within families. Most of the donor-conceived participants were told about their donor conception in early adulthood. The age range for time of disclosure was mid-teens to early 40s. Most reported that their fathers did not want them to know. In some cases, mothers had disclosed, but sworn them to secrecy. Sensitivity to fathers’ feelings fostered a desire among participants to maintain secrecy about his infertility, especially in relation to wider family and friendship networks. Our findings revealed that secrecy about men’s infertility is heavily reliant on women’s emotional labor to protect ageing infertile fathers’ sense of manhood. Coupled with fathers’ overt resistance to openness, intergenerational secret keeping is perpetuated in families. Laws supporting openness potentially exacerbate the historical stigma associated with male factor infertility in a culture that continues to conflate virility, fertility, and masculinity.

scholarly journals Male and Female Cervical Spine Biomechanics and Anatomy: Implication for Scaling Injury Criteria

2017 ◽  
Vol 139 (5) ◽  
Author(s):  
Narayan Yoganandan ◽  
Cameron R. Bass ◽  
Liming Voo ◽  
Frank A. Pintar
Keyword(s):  
Cervical Spine ◽  
Female Population ◽  
Male And Female ◽  
Injury Criteria ◽  
Motion Responses ◽  
Geometric Scaling ◽  
Biomechanical Responses ◽  
The Difference ◽  
Female Specific ◽  
The Military

There is an increased need to develop female-specific injury criteria and anthropomorphic test devices (dummies) for military and automotive environments, especially as women take occupational roles traditionally reserved for men. Although some exhaustive reviews on the biomechanics and injuries of the human spine have appeared in clinical and bioengineering literatures, focus has been largely ignored on the difference between male and female cervical spine responses and characteristics. Current neck injury criteria for automotive dummies for assessing crashworthiness and occupant safety are obtained from animal and human cadaver experiments, computational modeling, and human volunteer studies. They are also used in the military. Since the average human female spines are smaller than average male spines, metrics specific to the female population may be derived using simple geometric scaling, based on the assumption that male and female spines are geometrically scalable. However, as described in this technical brief, studies have shown that the biomechanical responses between males and females do not obey strict geometric similitude. Anatomical differences in terms of the structural component geometry are also different between the two cervical spines. Postural, physiological, and motion responses under automotive scenarios are also different. This technical brief, focused on such nonuniform differences, underscores the need to conduct female spine-specific evaluations/experiments to derive injury criteria for this important group of the population.

Numerical Simulation on Concrete Median Barrier for Reducing Concrete Fragment Under Harsh Impact Loading of a 25-ton Truck

2017 ◽  
Vol 139 (2) ◽  
Author(s):  
Jaeha Lee ◽  
Goangseup Zi ◽  
Ilkeun Lee ◽  
Yoseok Jeong ◽  
Kyeongjin Kim ◽  
...  
Keyword(s):  
Impact Loading ◽  
Traffic Accident ◽  
Impact Analysis ◽  
Threshold Value ◽  
Rigid Wall ◽  
Wire Mesh ◽  
Element Size ◽  
Preliminary Study ◽  
The Impact ◽  
Controlling Behaviors

Recently, there was a collision accident involving vehicle–concrete median barrier in South Korea, and unfortunately, passengers on the opposite direction road were killed by the flying broken pieces of concrete generated by the collision. Primarily after this accident, we felt the need for developing an improved concrete median barrier up to level of SB6 impact severity in order to minimize the amount of broken pieces of concrete and any possibility of traffic accident casualty under the impact loading of truck. Accordingly, in this study, several designs of concrete median barriers have been examined, and a preliminary study has been conducted for developing and verifying appropriate collision model. First, type of vehicle was selected based on impact analysis on rigid wall. Then, the effects of element size and other key parameters on the capacity of the concrete median barrier under impact were studied. It was found that the key parameters for controlling behaviors of the median barrier under impact loading were contact option, threshold value, and mesh and boundary conditions. Furthermore, as a parametric study, effect of geometry and amount of wire-mesh or steel rebar in concrete median barrier on impact resistances of median barrier for reducing the collision debris were investigated. The amount of volume loss after the collision of truck was compared for various reinforcement ratios.

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