A nationwide US study of post-traumatic stress after hospitalization for physical injury.

Background: Injured survivors of individual and mass trauma are at risk for developing post-traumatic stress disorder (PTSD). Few investigations have assessed PTSD after injury in large samples across diverse acute care hospital settings.

Method: A total of 2931 injured trauma survivors aged 18-84 who were representative of 9983 in-patients were recruited from 69 hospitals across the USA.

Analysis of surgeon-controlled variables in the treatment of limb-threatening type-III open tibial diaphyseal fractures.

Background: The open tibial diaphyseal fracture remains a treatment challenge. The purpose of the present analysis of the long-term follow-up data on a previously reported cohort of patients was to identify surgeon-controlled variables that affected fracture union, complications, and final outcome in patients who had sustained a severe open tibial shaft fracture.

Methods: A cohort of 156 patients with a limb-threatening open tibial diaphyseal fracture was identified from the Lower Extremity Assessment Project (LEAP) study group.

Cell-permeating alpha-ketoglutarate derivatives alleviate pseudohypoxia in succinate dehydrogenase-deficient cells.

Succinate dehydrogenase (SDH) and fumarate hydratase (FH) are components of the tricarboxylic acid (TCA) cycle and tumor suppressors. Loss of SDH or FH induces pseudohypoxia, a major tumor-supporting event, which is the activation of hypoxia-inducible factor (HIF) under normoxia. In SDH- or FH-deficient cells, HIF activation is due to HIF1alpha stabilization by succinate or fumarate, respectively, either of which, when in excess, inhibits HIFalpha prolyl hydroxylase (PHD).

Injury prevention activities in U.S. trauma centres: are we doing enough?

Background: Despite the requirement for and endorsement of injury prevention efforts among U.S. trauma centres, little is known about the breadth and depth of their current activities.

The relevance of neuroactive steroids in schizophrenia, depression, and anxiety disorders.

1. Neuroactive steroids are steroid hormones that exert rapid, nongenomic effects at ligand-gated ion channels. There is increasing awareness of the possible role of these steroids in the pathology and manifestation of symptoms of psychiatric disorders.

Quantification of l-stepholidine in rat brain and plasma by high performance liquid chromatography combined with fluorescence detection.

A sensitive and reliable assay for the quantification of l-stepholidine (SPD) in rat plasma and brain was developed using high performance liquid chromatography (HPLC) combined with fluorescence detection. Brain regions (prefrontal cortex, striatum, and cerebellum) and plasma from rats treated with SPD (10 mg/kg s.c.

Gait symmetry and walking speed analysis following lower-extremity trauma.

Background And Purpose: Gait has been shown to be a major determining factor of function following limb-salvage surgery. However, little is known regarding the measures associated with gait recovery for this patient population. The purpose of this study was to identify clinical measures associated with impaired walking speed and gait asymmetry in patients with lower-extremity reconstruction.

Injury hospitalizations: using the nationwide inpatient sample.

Background: The aims of this study are to develop estimates of discharge rates and frequencies for all injury-related hospitalizations in the United States for the year 2000 and to characterize patterns of hospitalized injury and anatomic region using a modified Barell Matrix. The utility of the Nationwide Inpatient Sample (NIS) for providing national estimates of hospitalized injuries will be discussed.

Methods: This study is a retrospective analysis of hospital discharge data using the Nationwide Inpatient Sample.

Factors influencing outcome following limb-threatening lower limb trauma: lessons learned from the Lower Extremity Assessment Project (LEAP).

The Lower Extremity Assessment Project (LEAP) is a multicenter study of severe lower extremity trauma in the US civilian population. At 2- and 7-year follow-ups, the LEAP study found no difference in functional outcome between patients who underwent either limb salvage surgery or amputation. However, outcomes on average were poor for both groups.

The impact of an intensivist-model ICU on trauma-related mortality.

Objective: To evaluate the effect of an intensivist-model of critical care delivery on the risk of death following injury.

Summary Background Data: An intensivist-model of ICU care is associated with improved outcomes and less resource utilization in mixed medical and surgical ICUs. The process of trauma center verification assures a relatively high standard of care and quality assurance; thus, it is unclear what the effect of a specific model of ICU care delivery might have on trauma-related mortality.

National variability in out-of-hospital treatment after traumatic injury.

Study Objective: The optimal out-of-hospital treatment for trauma patients remains a subject of national debate. Researchers designing future studies to address these issues must understand the variability in treatment that exists across the United States. We define the variability in the out-of-hospital treatment provided to trauma patients in the United States.

Early predictors of long-term work disability after major limb trauma.

Background: A better understanding of the factors influencing return to work (RTW) after major limb trauma is essential in reducing the high costs associated with these injuries.

Methods: Patients (n = 423) who underwent amputation or reconstruction after limb threatening lower extremity trauma and who were working before the injury were prospectively evaluated at 3, 6, 12, 24, and 84 months. Time to first RTW was assessed.

Specific fracture configurations predict sexual and excretory dysfunction in men and women 1 year after pelvic fracture.

Purpose: We determined the prevalence and predictors of sexual and excretory dysfunction in patients 1 year after pelvic fracture.

Materials And Methods: The multicenter Pennsylvania Trauma Outcomes Study enrolled 1,238 patients and contacted them 1 year after injury. Sexual limitations and excretory dysfunction (bladder/bowel incontinence) were defined based on responses from the Functional Capacity Index.

Physical disability after severe lower-extremity injury.

Objective: To investigate the use of a combined measure of decreased walking speed and gait deviation to identify high physical disability in patients with lower-limb salvage.

Design: Longitudinal study of patients with severe lower-extremity trauma.

Setting: Eight level I trauma centers.

Comparison of Levitt- and Zwislocki-type adaptive procedures for stimulus placement in human listeners.

The "3-down, 1-up" adaptive stimulus placement rules attributed to Levitt and Zwislocki were compared in the context of human interaural time difference discrimination, employing otherwise commonly used procedures (e.g., averaging reversals to estimate threshold).

Prevalence of chronic pain seven years following limb threatening lower extremity trauma.

Although the etiology of chronic pain following trauma is not well understood, numerous retrospective studies have shown that a significant proportion of chronic pain patients have a history of traumatic injury. The present analysis examines the prevalence and early predictors of chronic pain in a cohort of prospectively followed severe lower extremity trauma patients. Chronic pain was measured using the Graded Chronic Pain Scale, which measures both pain severity and pain interference with activities.

Interface between residential aged care facilities and a teaching hospital emergency department in Western Australia.

Objective: To estimate the appropriateness of emergency department (ED) presentations by people aged>or=65 years living in residential care facilities.

Design, Setting And Participants: Retrospective cohort study of older residents of residential care facilities who presented to the ED of the Royal Perth Hospital, Western Australia, between January and June 2002. Data were reviewed by an expert clinical panel.

Is real reform of the Medicare Benefits Schedule for psychiatrists in Australia economically, socially or professionally desirable?

Objective: To propose alternative Medicare Benefits Schedule-based funding models for outpatient psychiatric services in Australia.

Method: Development of alternative funding schedules for a variety of under-serviced populations.

Conclusions: Consideration of alternative systems is necessary to address the restrictive work practices, inequity and poor distribution of the psychiatric workforce.

Delayed administration of deferoxamine reduces brain damage and promotes functional recovery after transient focal cerebral ischemia in the rat.

The mechanisms underlying functional recovery after stroke are poorly understood. Brain-adaptive responses to the hypoxic stress elicited by ischemia could contribute to these mechanisms. Indeed, hypoxia-inducible factor-1 (HIF-1), one of the main transcriptional factors regulated by oxygen level, increases the expression of several beneficial genes such as erythropoietin, glucose transporter-1 and vascular endothelial growth factor.

The delivery of critical care services in US trauma centers: is the standard being met?

Background: Although there is substantial evidence supporting the benefits of an intensivist model of critical care delivery, the extent to which this model has been adopted by trauma centers across the United States is unknown. We set out to evaluate how critical care is delivered in Level I and II trauma centers and the extent to which these centers implement evidence-based patient care practices known to improve outcome.

Methods: All Level I and Level II trauma centers in the United States were surveyed using a previously validated questionnaire pertaining to the organizational characteristics of critical care units.

Hemin-mediated regulation of an antioxidant-responsive element of the human ferritin H gene and role of Ref-1 during erythroid differentiation of K562 cells.

An effective utilization of intracellular iron is a prerequisite for erythroid differentiation and hemoglobinization. Ferritin, consisting of 24 subunits of H and L, plays a crucial role in iron homeostasis. Here, we have found that the H subunit of the ferritin gene is activated at the transcriptional level during hemin-induced differentiation of K562 human erythroleukemic cells.

Health care utilization and needs after pediatric traumatic brain injury.

Objective: Children with moderate to severe traumatic brain injury (TBI) show early neurobehavioral deficits that can persist several years after injury. Despite the negative impact that TBI can have on a child's physical, cognitive, and psychosocial well-being, only 1 study to date has documented the receipt of health care services after acute care and the needs of children after TBI. The purpose of this study was to document the health care use and needs of children after a TBI and to identify factors that are associated with unmet or unrecognized health care needs during the first year after injury.

Health-related quality of life during the first year after traumatic brain injury.

Objectives: To document health-related quality of life (HRQOL) of children with traumatic brain injury (TBI) and to examine the relationship between TBI severity and HRQOL during the first year after injury.

Design: Prospective cohort study.

Setting: Four pediatric level I trauma centers.

Environmental barriers experienced by amputees: the Craig Hospital Inventory of Environmental Factors-Short Form.

Objectives: To describe the prevalence of perceived environmental barriers in a population of amputees; to compare and contrast those barriers reported by amputees with reported barriers of a sample of disabled and nondisabled persons; and to identify the correlates of barriers among amputees.

Design: Cross-sectional survey.

Setting: A community sample who were interviewed by telephone.

Are Australian children iodine deficient? Results of the Australian National Iodine Nutrition Study.

Objective: To document the population iodine nutritional status in Australian schoolchildren.

Design And Setting: Cross-sectional survey of schoolchildren aged 8-10 years, based on a one-stage random cluster sample drawn from all Year 4 school classes in government and non-government schools in the five mainland Australian states of New South Wales, Victoria, South Australia, Western Australia and Queensland. The study was conducted between July 2003 and December 2004.