Survival of seriously injured patients first treated in rural hospitals

BACKGROUND: Patients injured in rural counties are hypothesized to have improved survival if local hospitals are categorized as Level III, Level IV, and Level V trauma centers. METHODS: Data were abstracted on patients with brain, liver, or spleen injuries who were first treated in 16 rural hospitals in Oregon (with categorized trauma centers) and 16 hospitals in Washington (without categorized trauma centers). Logistic regression models evaluated survival up to 30 days after hospital discharge. RESULTS: Among Oregon's 642 study patients, 63% were transferred to another hospital. Among Washington's 624 patients, a higher proportion, 70%, were transferred. Risk-adjusted odds of death for Washington patients (reference odds, 1) were the same as for Oregon patients (odds ratio, 0.82; 95% confidence interval, 0.53-1.28). Most patients died after transfer to another hospital. CONCLUSION: In states with a prevailing practice of promptly transferring brain-injured patients, survival of these patients may not be enhanced by categorization of hospitals as rural trauma centers. To further improve the outcome of these patients, policy makers should adjust statewide trauma system guidelines to enhance integration and to perfect coordination among sequential decision makers.     

Applications of sliding window reconstruction with cartesian sampling for dynamic contrast enhanced MRI

Applications of dynamic contrast enhanced MR imaging are increasing and require both high spatial resolution and high temporal resolution. Perfusion studies using susceptibility contrast in particular require very high temporal resolution. The sliding window reconstruction is a technique for increasing temporal resolution. It has previously been applied to radial and spiral sampling, but these schemes require extensive correction and interpolation during image reconstruction. Fourier raw data can be reconstructed simply and quickly using the fast fourier transform (FFT). This paper presents a new Fourier-based sampling scheme and sliding window reconstruction that facilitates fast scanning without needing correction or interpolation. This technique can be used on virtually any MR scanner since it requires no specialized hardware. It is implemented here as a dual gradient echo sequence providing simultaneous T(1)- and T(2)*-weighted images with a time resolution of 1.1 s.     

The dental curriculum in Gies' time,now, and in the future

Writing in the 1920s, William J. Gies was a champion for the importance of dentistry to general health, the scientific foundation for dentistry, and the need to develop and integrate an efficient curriculum. He argued that admissions standards should be made uniform and raised. He also proposed that the predoctoral dental curriculum should be reduced to three year's length by eliminating unnecessary material and improving efficiency. Gies called for available postgraduate experiences on an optional basis. Perhaps it is time to consider a three-plus-one model combining a three-year program focused on general dentistry with a mandatory fourth year along the lines of a postdoctoral general education experience.     

Optimizing interpretation of in situ effects of riverine pollutants: impact of upwelling and downwelling

In situ toxicity and bioaccumulation tests with Ceriodaphnia dubia (48 h), Chironomus tentans (96 h), Hyalella azteca (96 h), and Lumbriculus variegatus (96 h) were conducted at three stations on a river that was contaminated primarily with chlorobenzenes (CBs), and results were compared to a nearby reference site. Exposures were characterized by using minipiezometers for contaminant profiling and determination of hydraulic heads and vertical flow direction within the sediments and measuring contaminants in sediment, surface water, and exposure chamber water samples. Localized zones of upwelling and downwelling existed in the exposure areas at contaminated sites 5 and 18, while site 23 was downwelling at all measurement positions. Pore-water samples from minipiezometers contained CBs at the three contaminated sites that were highest at site 23. However, sediment and water samples from exposure chambers at site 23 contained the lowest levels of CBs among the contaminated sites. The CBs were not detected at the reference site, but other organic contaminants and metals were detected at all sites, with the highest concentrations occurring at sites 5 and 18. In water column exposures, no significant (p > 0.05) differences were observed in species survival between the contaminated sites and the reference. Mean percentage survival of H. azteca, C. dubia, and C. tentans exposed to surficial sediments (SS) at sites 5 and 18 was significantly (p < 0.05) reduced compared to the reference, whereas only C. tentans survival was significantly reduced at site 23. Body residues of total CB congeners in L. variegatus exposed to SS were highest at site 18 (618 micromol/kg lipid) and lowest at site 23 (21 micromol/kg lipid). The data suggest that downwelling reduced the bioavailability of CBs in surficial sediments, most likely by mobilizing the freely dissolved and colloid-bound fractions to deeper sediments. Overall, downwelling conditions reduced the in situ exposure of organisms in surficial sediments and hence the toxicity and bioaccumulation of CBs. Hydrologic and chemistry data from nested minipiezometers improved the interpretation of exposure-effects relationships.     

Prevention of deaths and injuries caused by house fires: survey of local authority smoke alarm policies

BACKGROUND: Despite an increased risk of fire in disadvantaged households, smoke alarm ownership is considerably lower than in the general population. The government currently recommends that local authorities install battery-operated smoke alarms in all public sector properties regardless of tenure. However, the extent to which local authorities comply is currently not known. We conducted a survey of local authorities to establish the extent of their smoke alarm provision to public sector households. METHODS: A telephone survey of all 405 local authorities within England and Wales was carried out. RESULTS: We obtained responses from 390 (97 per cent) local authorities, 266 of which had responsibility for housing. Over half of all public-sector households are offered smoke alarms by the local authorities. The majority of local authorities offer ionization and/or optical sensor alarm types (78 per cent), with many local authorities providing battery-operated alarms alone (17 per cent) or in combination with hardwired alarms (31 per cent). CONCLUSIONS: Many local authorities offer smoke alarm provision to their public-sector households. Whether this represents an effective and cost-effective use of resources requires further investigation.     

Genetically modified foods,science, consumers and the media

In contrast to the situation in the USA, where a wide range of genetically modified (GM) foods is available, in Europe very few GM products have been approved for marketing as foods, and there is widespread public concern about their safety and environmental impact. The marketing of a GM crop for food use in Europe falls under the EC novel foods regulations, and applications require the submission of an extensive dossier of information. The safety evaluation of GM foods presents considerable problems both in the conduct and interpretation of experimental studies, because conventional toxicity tests used in the evaluation of simple chemicals may not be appropriate for whole foods. To rationalise the safety evaluation process and to circumvent the difficulties in toxicological assessment of food materials, the concept of substantial equivalence has been developed. The concept is that if it can be demonstrated that the novel food is essentially similar to its conventional counterpart in terms of critical nutritional or anutritional components, then it is likely to be no more or less toxic than the latter. The possible introduction of unintended effects by the genetic modification process is particularly problematic for the safety evaluation process. The new genomic and post-genomic techniques are potentially valuable in the safety evaluation of GM foods, although they are as yet in their infancy.     

Effect of opioid and cannabinoid receptor antagonism on orphanin FQ-induced hyperphagia in rats

Feeding induced in rats by cerebroventricular (i.c.v.) injection of orphanin FQ was potently and dose-dependently reversed by peripheral injection of either the opioid antagonist naloxone or the cannabinoid CB(1) receptor antagonist SR 141716[N-piperidino-5-(4-chlorophenyl)-1-(2,4-dichlorophelyl)-4-methyl-3-pyrazole-carboxamine]. The combination of these two agents inhibited food intake in a manner suggestive of additivity or supra-additivity.     

Biological Responses of Lumbriculus variegatus Exposed to Fluoranthene-Spiked Sediment

Lumbriculus variegatus was used as a bioassay organism to examine the impact of the sediment-associated polycyclic aromatic hydrocarbon (PAH) fluoranthene on behavior, reproduction, and toxicokinetics. The number of worms increased between the beginning and end of the experiment at 59 μg g⁻¹ fluoranthene, but at the next higher treatment (108 μg g⁻¹) the number of worms found was lower and not different from the control. Worms exposed to 95 μg g⁻¹ also exhibited increased reproduction when fed a yeast-cerophyl-trout chow mixture. On a total biomass basis, only the 95 μg g⁻¹ exposure with food exhibited a statistically significant increase over the nonfed control. Evaluation of reproduction at the two highest treatments was compromised by a brief aeration failure 2 days before the end of the experiment. The behavioral responses were followed as changes in biological burial rate (sediment reworking rate) of a ¹³⁷Cs-labeled marker layer. The biological burial rate increased toward a plateau as the concentration increased from the control (3.9 μg g⁻¹ dry weight total PAH) to 355 μg g⁻¹ dry weight fluoranthene in sediment. The aeration failure had minimal impact on the determination of reworking rate because all the data for the rate determination were collected prior to the aeration failure. Uptake and elimination rates declined with increasing treatment concentration across the range of fluoranthene concentrations, 59–355 μg g⁻¹ dry weight sediment. The disconnect between the increasing biological burial rates and the decreasing toxicokinetics rates with increasing exposure concentration demonstrates that the toxicokinetic processes are dominated by uptake and elimination to interstitial water. The bioaccumulation factor (concentration in the organisms on a wet weight basis divided by the concentration in sediment on a dry weight basis) ranged from 0.92 to 1.88 on day 10 and declined to a range of 0.52 to 0.99 on day 28 with the lowest value at the highest dose. Received: 31 May 2001/Accepted: 9 November 2001     

Prevalence of medication treatment for attention deficit-hyperactivity disorder among elementary school children in Johnston County, North Carolina

OBJECTIVES: This study estimated the prevalence of medication treatment for attention deficit-hyperactivity disorder (ADHD) among elementary school children in a North Carolina county. METHODS: Parents of 7333 children in grades 1 through 5 in 17 public elementary schools were asked whether their child had ever been given a diagnosis of ADHD by a psychologist or physician and whether their child was currently taking medication to treat ADHD. Parents of 6099 children (83%) responded. RESULTS: By parental report, 607 children (10%) had been given an ADHD diagnosis and 434 (7%) were receiving ADHD medication treatment. Seventy-one % of the diagnosed children were receiving medication. Treatment rates varied by sex, race/ethnicity, and grade. CONCLUSIONS: If treatment patterns observed in this study are representative, the public health impact of ADHD may be underestimated.