Digital patient twins for personalized therapeutics and pharmaceutical manufacturing.

Digital twins are virtual models of physical artefacts that may or may not be synchronously connected, and that can be used to simulate their behavior. They are widely used in several domains such as manufacturing and automotive to enable achieving specific quality goals. In the health domain, so-called digital patient twins have been understood as virtual models of patients generated from population data and/or patient data, including, for example, real-time feedback from wearables.

High-power lasers for directed-energy applications: reply.

The comment by Vorontsov and Weyrauch [Appl. Opt.55, 9950 (2016)APOPAI0003-693510.

Laser beam self-focusing in turbulent dissipative media.

A high-power laser beam propagating through a dielectric in the presence of fluctuations is subject to diffraction, dissipation, and optical Kerr nonlinearity. A method of moments was applied to a stochastic, nonlinear enveloped wave equation to analyze the evolution of the long-term spot radius. For propagation in atmospheric turbulence described by a Kolmogorov-von Kármán spectral density, the analysis was benchmarked against field experiments in the low-power limit and compared with simulation results in the high-power regime.

Application of a scattered-light radiometric power meter.

The power measurement of high-power continuous-wave laser beams typically calls for the use of water-cooled thermopile power meters. Large thermopile meters have slow response times that can prove insufficient to conduct certain tests, such as determining the influence of atmospheric turbulence on transmitted beam power. To achieve faster response times, we calibrated a digital camera to measure the power level as the optical beam is projected onto a white surface.

A methodology for modular representation of guidelines.

Computer-based clinical practice guidelines often need to be modified when medical knowledge evolves or when guidelines are implemented in a local setting with specific constraints and preferences. To enable easy modifications to guidelines and maintain their integrity, we have developed a methodology for modular representation of guidelines. Using this approach, we create guidelines in a hierarchical and modular manner.

The tattooing paradox: are studies of acute hepatitis adequate to identify routes of transmission of subclinical hepatitis C infection?

Background: The Hepatitis Branch of the Centers for Disease Control and Prevention does not recommend routine regulation and inspection of tattoo parlors because surveillance of hepatitis C virus (HCV)-positive acute hepatitis cases rarely identifies tattooing in the incubation period. However, the majority of seroepidemiological studies agree that tattooing is a strong, independent risk factor for subclinical HCV seropositivity. We postulated that this paradox might be explained if transmission of HCV by tattooing generally caused subclinical HCV seropositivity without the acute hepatitis syndrome.

Commercial tattooing as a potentially important source of hepatitis C infection. Clinical epidemiology of 626 consecutive patients unaware of their hepatitis C serologic status.

Tattooing in commercial tattoo parlors is known to transmit blood-borne viral infections, including hepatitis C virus (HCV), in other countries, but its contribution to the high population prevalence of HCV infection in the United States has been incompletely evaluated. Risk factors for blood-borne infection were assessed by physician's interview of 626 consecutive patients undergoing medical evaluation for spinal problems in 1991 and 1992 while unaware of their HCV status. Later all were screened for HCV infection with enzyme-linked immunosorbent assay (EIA-1 and EIA-2), and positives were confirmed with second-generation recombinant immunoblot assay (RIBA).

The efficacy of magnetic resonance cholangiography for the evaluation of patients with suspected choledocholithiasis before laparoscopic cholecystectomy.

Background: Endoscopic retrograde cholangiography is the most commonly utilized tool for the identification of common bile duct stones (CBDS) before laparoscopic cholecystectomy, whereas the role of magnetic resonance cholangiography (MRC) for patient evaluation before laparoscopic cholecystectomy is currently undefined.

Methods: We prospectively evaluated the efficacy of MRC for the identification of CBDS among patients with high risk for choledocholithiasis. Patient selection was based on clinical, sonographic, and laboratory criteria.

Blunt versus penetrating subclavian artery injury: presentation, injury pattern, and outcome.

Background: Subclavian artery (SCA) injuries are rare vascular injuries and may be difficult to manage. The majority of SCA injuries are secondary to penetrating trauma. The purpose of this report is to examine the injury patterns, diagnostic and therapeutic approaches, and outcome of patients with blunt and penetrating SCA injuries.

"The demographics of trauma in 1995" revisited: an assessment of the accuracy and utility of trauma predictions.

Objective: In 1987, the article "The Demographics of Trauma in 1995" (DT95) attempted to predict the future needs of trauma centers based on changing population distributions. This article foresaw a relative increase in the number of injuries to the elderly and a relative decrease in total injuries. Based on these predictions, the paper recommended increasing the capabilities of existing trauma centers rather than developing new facilities.

Are scene flights for penetrating trauma justified?

Objective: To evaluate the medical efficacy of helicopter scene flights for patients with noncranial penetrating injuries.

Design: A retrospective review of 122 consecutive victims of noncranial penetrating injuries evacuated by helicopter from the scene of injury to a level I trauma center. There were no medical criteria for accepting or rejecting a request for a scene flight by any public safety agency or emergency medical service (EMS).

Traumatic lung herniation.

Traumatic lung herniation is a poorly described entity. An important factor in the etiology of these lesions is the relative lack of muscular support afforded by the anterior thorax. We report a case of blunt thoracic trauma complicated by an incarcerated lung herniation.

The pocket laser pointer as a teaching tool in laparoscopic surgery.

The common pen-sized laser pointer can be used during laparoscopic procedures to indicate landmarks on the video screen and facilitate communication between surgeon and the assistants. We describe a simple and inexpensive technique that allows scrubbed members of the surgical team to use the laser pointer without the need to sterilize the instrument.

Does the potential for organ donation justify scene flights for gunshot wounds to the head?

Objective: The goal of this study was to evaluate helicopter transport to an urban level I trauma center from the scene of injury for patients with self-inflicted gunshot wounds to the head.

Design: This study is a retrospective review of the prehospital, hospital, and billing records.

Measurements And Main Results: Despite the fact that 10 of 28 patients (36%) had an airway established by the medical flight crews, scene flights did not enhance survival.

The spectrum of blunt injury to the carotid artery: a multicenter perspective.

The relative infrequency of blunt carotid artery trauma prompted a multicenter review to determine the spectrum of injuries, treatment strategies, and neurologic outcome. During a six-year period, 60 carotid artery injuries from blunt mechanisms in 49 patients were treated at 11 institutions. There were 11 bilateral injuries.

Tampon occlusion of colostomy stoma during laparotomy.

A new technique for the occlusion of the colostomy stoma during colostomy takedown is prevented. Utilization of this technique prevents contamination and allows maintenance of colostomy length for anastomosis. It can be easily and safely performed.

A multicenter trial for resuscitation of injured patients with 7.5% sodium chloride. The effect of added dextran 70. The Multicenter Group for the Study of Hypertonic Saline in Trauma Patients.

Objective: To evaluate the use of 250 mL of a 7.5% sodium chloride solution, both with and without added dextran 70, for the prehospital resuscitation of hypotensive trauma patients.

Design: Double-blind randomized trial.

Continuing evolution in the approach to severe liver trauma.

Surgical and radiologic techniques from computed tomography (CT) scanning and embolization to temporary gauze packing and mesh hepatorrhaphy have been developed to make the management of severe liver injuries more effective. Surgical approaches for severe liver trauma have been oriented to two major consequences of these injuries: hemorrhage and infection. Early attempts at hemorrhagic control found benefit only in temporary intrahepatic gauze packing.

The disparity between hypothermic coagulopathy and clotting studies.

Hypothermic patients commonly develop coagulopathy, but the effects of hypothermia on coagulation remain unclear because clinical laboratories routinely perform clotting tests only at 37 degrees C. Measurements of activated partial thromboplastin times (APTT), prothrombin times (PT), and thrombin times (TT) were performed on plasma from normothermic and hypothermic rats at a range of temperatures (25 degrees-37 degrees C) to assess the effects of hypothermia on apparent clotting factor levels and clotting factor activities. In general, clotting times were more severely prolonged when test temperatures were hypothermic than when body temperatures were hypothermic.

The pharmacokinetics of prophylactic antibiotics in trauma.

Despite prophylactic antibiotic use in abdominal trauma patients, infection rates remain high. A previous study from our institution indicated that higher doses of prophylactic antibiotics in trauma patients could significantly reduce subsequent infection rates. To determine if this resulted from altered pharmacokinetic profiles, we performed individualized pharmacokinetic analysis of the prophylactic amikacin regimens given to 28 trauma patients undergoing laparotomy.

Mucormycosis in trauma patients.

Cutaneous mucormycosis is a rare but often fatal infection in trauma patients. We retrospectively reviewed a 9-year experience with mucormycosis among injured patients. Eleven patients had biopsy- or culture-proven mucormycosis.

Hypertonic saline alters plasma clotting times and platelet aggregation.

Hypertonic (7.5%) saline (HS) is advocated for resuscitation of injured and burned patients. Recent animal studies indicate that HS increases bleeding during uncontrolled hemorrhage, although the mechanisms for this are unclear.

Hypothermia and blood coagulation: dissociation between enzyme activity and clotting factor levels.

Previous studies of hypothermia and blood coagulation have focused on alterations in the levels of blood clotting elements using coagulation tests performed under normothermic conditions. However, because of the enzymatic nature of activated clotting factors, hypothermia should also be expected to affect clotting factor activities. Multiple determinations of activated partial thromboplastin times (APTT), prothrombin times (PT), and thrombin times (TT) were performed on commercially available normal human plasma at assay temperatures similar to those encountered clinically (25-37 degrees C).