Stop the Bleed-Wait for the Ambulance or Get in the Car and Drive? A Post Hoc Analysis of an EAST Multicenter Trial.

The Stop the Bleed campaign gives bystanders an active role in prehospital hemorrhage control. Whether extending bystanders' role to private vehicle transport (PVT) for urban penetrating trauma improves survival is unknown, but past research has found benefit to police and PVT. We hypothesized that for penetrating trauma in an urban environment, where prehospital procedures have been proven harmful, PVT improves outcomes compared to any EMS or advanced life support (ALS) transport.

Tranexamic Acid and Pulmonary Complications: A Secondary Analysis of an EAST Multicenter Trial.

Background: Anti-inflammatory effects of tranexamic acid (TXA) in reducing trauma endotheliopathy may protect from acute lung injury. Clinical data showing this benefit in trauma patients is lacking. We hypothesized that TXA administration mitigates pulmonary complications in penetrating trauma patients.

An analysis of police transport in an Eastern Association for the Surgery of Trauma multicenter trial examining prehospital procedures in penetrating trauma patients.

Background: Police transport (PT) of penetrating trauma patients in urban locations has become routine in certain metropolitan areas; however, whether it results in improved outcomes over prehospital Advanced life support (ALS) transport has not been determined in a multicenter study. We hypothesized that PT would not result in improved outcomes.

Methods: This was a multicenter, prospective, observational study of adults (18+ years) with penetrating trauma to the torso and/or proximal extremity presenting at 25 urban trauma centers.

Eastern Association for the Surgery of Trauma Multicenter Trial: Comparison of pre-injury antithrombotic use and reversal strategies among severe traumatic brain injury patients.

Background: Trauma teams are often faced with patients on antithrombotic (AT) drugs, which is challenging when bleeding occurs. We sought to compare the effects of different AT medications on head injury severity and hypothesized that AT reversal would not improve mortality in severe traumatic brain injury (TBI) patients.

Methods: An Eastern Association for the Surgery of Trauma-sponsored prospective, multicentered, observational study of 15 trauma centers was performed.

Neuromorphic computation with a single magnetic domain wall.

Machine learning techniques are commonly used to model complex relationships but implementations on digital hardware are relatively inefficient due to poor matching between conventional computer architectures and the structures of the algorithms they are required to simulate. Neuromorphic devices, and in particular reservoir computing architectures, utilize the inherent properties of physical systems to implement machine learning algorithms and so have the potential to be much more efficient. In this work, we demonstrate that the dynamics of individual domain walls in magnetic nanowires are suitable for implementing the reservoir computing paradigm in hardware.

An Eastern Association for the Surgery of Trauma multicenter trial examining prehospital procedures in penetrating trauma patients.

Background: Prehospital procedures (PHP) by emergency medical services (EMS) are performed regularly in penetrating trauma patients despite previous studies demonstrating no benefit. We sought to examine the influence of PHPs on outcomes in penetrating trauma patients in urban locations where transport to trauma center is not prolonged. We hypothesized that patients without PHPs would have better outcomes than those undergoing PHP.

Evidence-based review of trauma center care and routine palliative care processes for geriatric trauma patients; A collaboration from the American Association for the Surgery of Trauma Patient Assessment Committee, the American Association for the Surgery of Trauma Geriatric Trauma Committee, and the Eastern Association for the Surgery of Trauma Guidelines Committee.

Background: Despite an aging population and increasing number of geriatric trauma patients annually, gaps in our understanding of best practices for geriatric trauma patients persist. We know that trauma center care improves outcomes for injured patients generally, and palliative care processes can improve outcomes for disease-specific conditions, and our goal was to determine effectiveness of these interventions on outcomes for geriatric trauma patients.

Methods: A priori questions were created regarding outcomes for patients 65 years or older with respect to care at trauma centers versus nontrauma centers and use of routine palliative care processes.

Habitual tool use innovated by free-living New Zealand kea.

The emergence of flexible tool use is rare in the animal kingdom and thought to be largely constrained by either cognitive ability or ecological factors. That mostly birds with a high level of intelligence innovate tool use in captivity is consistent with the former hypothesis. We report here the first documented case of habitual tool use innovated in the wild by a bird species only known to have used tools in captivity.

Out with the old, in with the new: how changes in cricket helmet regulations affect the vision of batters.

The International Cricket Council recently introduced new regulations for helmets in cricket. Amongst other changes, these regulations limit batters from adjusting the gap between the peak and the grille, resulting in some controversy over whether the new helmet design reduces visibility of the ball. This study compared the visual field of individuals when wearing an old helmet that does not conform to the new regulations, and the equivalent replacement which does.

Information-theoretic analysis of iterated Bayesian acoustic source localization in a static ocean waveguide.

Fundamental constructs of information theory are applied to quantify the performance of iterated (sequential) Bayesian localization of a time-harmonic source in a range- and time-invariant acoustic waveguide using the segmented Fourier transforms of the received pressure time series. The nonlinear relation, defined by acoustic propagation, between the source location and the received narrowband spectral components is treated as a nonlinear communication channel. The performance analysis includes mismatch between the acoustic channel and the model channel on which the Bayesian inference is based.

Empirical and quadrature approximation of acoustic field and array response probability density functions.

Numerical methods are presented for approximating the probability density functions (pdf's) of acoustic fields and receiver-array responses induced by a given joint pdf of a set of acoustic environmental parameters. An approximation to the characteristic function of the random acoustic field (the inverse Fourier transform of the field pdf) is first obtained either by construction of the empirical characteristic function (ECF) from a random sample of the acoustic parameters, or by application of generalized Gaussian quadrature to approximate the integral defining the characteristic function. The Fourier transform is then applied to obtain an approximation of the pdf by a continuous function of the field variables.

Management of pulmonary contusion and flail chest: an Eastern Association for the Surgery of Trauma practice management guideline.

Background: Despite the prevalence and recognized association of pulmonary contusion and flail chest (PC-FC) as a combined, complex injury pattern with interrelated pathophysiology, the mortality and morbidity of this entity have not improved during the last three decades. The purpose of this updated EAST practice management guideline was to present evidence-based recommendations for the treatment of PC-FC.

Methods: A query was conducted of MEDLINE, Embase, PubMed and Cochrane databases for the period from January 1966 through June 30, 2011.

Realization of the manipulation of ultracold atoms with a reconfigurable nanomagnetic system of domain walls.

Planar magnetic nanowires have been vital to the development of spintronic technology. They provide an unparalleled combination of magnetic reconfigurability, controllability, and scalability, which has helped to realize such applications as racetrack memory and novel logic gates. Microfabricated atom optics benefit from all of these properties, and we present the first demonstration of the amalgamation of spintronic technology with ultracold atoms.

Acoustic field and array response uncertainties in stratified ocean media.

The change-of-variables theorem of probability theory is applied to compute acoustic field and array beam power probability density functions (pdfs) in uncertain ocean environments represented by stratified, attenuating ocean waveguide models. Computational studies for one and two-layer waveguides investigate the functional properties of the acoustic field and array beam power pdfs. For the studies, the acoustic parameter uncertainties are represented by parametric pdfs.

Hemodynamic monitoring in the intensive care unit.

Patients in the intensive care unit are often critically ill with inadequate tissue perfusion and oxygenation. This inadequate delivery of substrates at the cellular level is a common definition of shock. Hemodynamic monitoring is the observation of cardiovascular physiology.

Impacting the problem of inner-city youth violence: "Educating Kids About Gun Violence" program.

The Educating Kids Against Gun Violence (EKG) program was developed in response to high levels of gun violence in an urban inner-city county through a partnership between the county prosecutor's office, local law enforcement, and a Level 1 trauma center. This program incorporates short video clips and interactive presentations, which address legal and medical consequences of gun violence. The program was presented to youths varying in age and degree of prior contact with the criminal justice system.

The impact of country and culture on end-of-life care for injured patients: results from an international survey.

Background: Up to 20% of all trauma patients admitted to an intensive care unit die from their injuries. End-of-life decision making is a variable process that involves prognosis, predicted functional outcomes, personal beliefs, institutional resources, societal norms, and clinician experience. The goal of this study was to better understand end-of-life processes after major injury by comparing clinician viewpoints from various countries and cultures.

Single- and multi-channel underwater acoustic communication channel capacity: a computational study.

Acoustic communication channel capacity determines the maximum data rate that can be supported by an acoustic channel for a given source power and source/receiver configuration. In this paper, broadband acoustic propagation modeling is applied to estimate the channel capacity for a time-invariant shallow-water waveguide for a single source-receiver pair and for vertical source and receiver arrays. Without bandwidth constraints, estimated single-input, single-output (SISO) capacities approach 10 megabitss at 1 km range, but beyond 2 km range they decay at a rate consistent with previous estimates by Peloquin and Leinhos (unpublished, 1997), which were based on a sonar equation calculation.

Implementation of antibiotic rotation protocol improves antibiotic susceptibility profile in a surgical intensive care unit.

Background: Antibiotic rotation has been proposed as a way to potentially reduce the development of antimicrobial resistant bacteria in intensive care units. We assessed the effect of an antibiotic rotation protocol on the antibiotic susceptibility profiles of three clinically relevant gram-negative microorganisms within our surgical intensive care unit (SICU).

Methods: Our SICU implemented an antibiotic rotation protocol in 2003.

Mid-infrared images of beta Pictoris and the possible role of planetesimal collisions in the central disk.

When viewed in optical starlight scattered by dust, the nearly edge-on debris disk surrounding the A5V star beta Pictoris (distance 19.3 pc; ref. 1) extends farther than 1,450 au from the star.

A cost and outcomes comparison of a novel integrated pediatric air and ground transportation system.

Background: The purpose of this study is to compare air transportation of critically ill pediatric patients with a mixed air-ground transportation system by evaluating timeliness, safety, and cost. The setting was a tertiary care "hub" center with three outlying-referral "spoke" facilities.

Study Design: Our study included 96 children transported between June and December 1997, with 45% constituting surgical admissions and 55% medical admissions.