Abstract Background Trauma transfer patients routinely undergo repeat imaging due to inefficiencies within the radiology system. In 2009 the virtual private network (VPN) telemedicine system was ...adopted throughout Oregon allowing virtual image transfer between hospitals. The startup cost was a nominal $3,000 per hospital. Methods A retrospective review from 2007-2012 included 400 randomly selected adult trauma transfer patients based on a power analysis (200 pre/200 post). The primary outcome evaluated was reduction in repeat CT scans. Secondary outcomes included cost savings, ED length of stay (LOS) and spared radiation. All data were analyzed using Mann-Whitney U and χ2 tests. P<0.05 indicated significance. Spared radiation was calculated as a weighted average per body region and savings was calculated using charges obtained from OHSU radiology CPT codes. Results Four-hundred patients were included. ISS, age, ED and overall LOS, mortality, trauma type and gender were not statistically different between groups. The percentage of patients with repeat CT scans decreased after VPN implementation: CT abdomen (13.2% v 2.8%, p<0.01) and cervical spine (34.4% v 18.2%, p<0.01). Post VPN, the total charges saved in 2012 for trauma transfer patients was $333,500 while the average radiation dose spared per person was 1.8mSV. Length of stay in the ED for patients with ISS<15 transferring to the ICU was decreased (p<0.05). Conclusions Implementation of a statewide teleradiology network resulted in fewer total repeat CT scans, significant savings, decrease in radiation exposure, and decreased LOS in the ED for patients with less complex injuries. The potential for healthcare savings by widespread adoption of a VPN is significant.
Abstract Background Antiplatelet (AP) medication use is common among trauma patients and is associated with poor outcomes. Management options for platelet dysfunction in trauma patients are ...controversial, expensive and potentially harmful. Although light transmission platelet aggregometry is considered the standard test to assess platelet function, it is cumbersome and not generally available. Currently, there are no widely accepted platelet function point-of-care tests for acute trauma. Study Design Prospective observational study from 2014–2015. Baseline Multiplate aggregometry aspirin area under the platelet aggregation curve (ASPI AUC), TEG platelet mapping percent inhibition of arachidonic acid (TEG-PM AA), and VerifyNow Aspirin Test (ARU) were compared for ability to detect any AP medication use (aspirin or clopidogrel), platelet dysfunction, and identify patients at risk for intracranial hemorrhage (ICH) progression by calculating the area under receiver operating characteristic curves (AUC), sensitivity, specificity, and positive and negative predictive values. Adenosine Diphosphate (ADP) assays were similarly evaluated. Results 64 patients were enrolled, 25 were taking AP medications. AP patients were older (71.6 v 35.0 years, p <0.001), and received more platelet transfusions, but other baseline characteristics were similar. Median ASPI AUC (22.0 v 53.5 p <0.001) and VerifyNow ARU (503.5 v 629.0, p <0.001) were lower, while TEG-PM AA (51.8% v 18.3%, p <0.001) was higher in AP patients. Multiplate ASPI AUC, TEG-PM AA percent inhibition and VerifyNow ARU could identify AP medication use (AUC 0.90, 0.77, 0.90 respectively). ADP assays did not correlate with AP medication use in this population. TEG-PM AA percent inhibition and VerifyNow ARU correlated well with Multiplate ASPI AUC to identify platelet dysfunction (AUC 0.78, 0.89 respectively). ICH occurred in 29 patients, 12 of which had progression of their injury. ASPI AUC (AUC 0.50) and Verifynow ARU (AUC 0.59) did not correlate,, and TEG-PM AA percent inhibition (AUC 0.66) minimally correlated with progression. Conclusions Multiplate, TEG-PM and VerifyNow are useful point-of-care tests which identify AP medication use and platelet dysfunction in trauma patients. Initial TEG-PM AA percent inhibition may be associated with risk for ICH progression. However, additional large, prospective studies are needed.
To determine the safety and efficacy of cryopreserved packed red blood cell (CPRBC) transfusion in trauma patients.
Liquid packed red blood cells (LPRBCs) have an abbreviated shelf-life and worsening ...storage lesion with age. CPRBCs are frozen 2 to 6 days after donation, stored up to 10 years, and are available for 14 days after thawing and washing. CPRBCs can be utilized in diverse settings, but the effect on clinical outcomes is unknown.
We performed a prospective, randomized, double-blind study at 5 level 1 trauma centers. Stable trauma patients requiring transfusion were randomized to young LPRBCs (≤14 storage days), old LPRBCs (>14 storage days), or CPRBCs. Tissue oxygenation (StO2), biochemical and inflammatory mediators were measured, and clinical outcomes were determined.
Two hundred fifty-six patients with well-matched injury severity and demographics (P > 0.2) were randomized (84 young, 86 old, and 86 CPRBCs). Pretransfusion and final hematocrits were similar (P > 0.68). Patients in all groups received the same number of units postrandomization (2 1-4; P > 0.05). There was no difference in the change in tissue oxygenation between groups. CPRBCs contained less α2-macrogobulin, haptoglobin, C-reactive protein, and serum amyloid P (P < 0.001). Organ failure, infection rate, and mortality did not differ between groups (P > 0.2).
Transfusion of CPRBCs is as safe and effective as transfusion of young and old LPRBCs and provides a mechanism to deliver PRBCs in a wide variety of settings.
Abstract
The objective of this study was to measure and examine 3-axis acceleration data from 6 locations within commercial transport trailers shipping market pigs. Over winter months (December ...through February) of 2018 to 2019 and 2019 to 2020, 16 pot-belly and 14 straight-deck trailer loads of market pigs were measured from 2 producers located in Kansas and North Carolina, respectively. Six accelerometers were placed in protective cases and affixed to the underside of the floor in the approximate center of the front compartment, middle of the trailer, and back compartment of the top and bottom decks. Data were post-processed to calculate power spectral density (PSD) functions and corresponding root mean square (RMS) accelerations. The PSDs lend insight into the vibrational frequency content of the trailers, while the RMS values indicate the severity of the vibration over the duration of each trip. With the exception of the lower aft portion of the trailer where levels are significantly higher, RMS values were consistent across trips and largely similar between sensor location and axis. Accelerations ranged between 0.06 and 0.18 g and varied in time, indicating data were non-stationarity. The PSD results reveal a largely broadband frequency response of the loaded trailers between 0 and 50 Hz, especially for sensors on the lower deck. Preliminary analysis of the data indicates the severity of vibrations experienced by pigs during transport would be considered uncomfortable by humans.
The objective of this study was to measure and examine 3-axis acceleration data from 6 locations within commercial transport trailers shipping market pigs. Over winter months (December through ...February) of 2018 to 2019 and 2019 to 2020, 16 pot-belly and 14 straightdeck trailer loads of market pigs were measured from 2 producers located in Kansas and North Carolina, respectively. Six accelerometers were placed in protective cases and affixed to the underside of the floor in the approximate center of the front compartment, middle of the trailer, and back compartment of the top and bottom decks. Data were post-processed to calculate power spectral density (PSD) functions and corresponding root mean square (RMS) accelerations. The PSDs lend insight into the vibrational frequency content of the trailers, while the RMS values indicate the severity of the vibration over the duration of each trip. With the exception of the lower aft portion of the trailer where levels are significantly higher, RMS values were consistent across trips and largely similar between sensor location and axis. Accelerations ranged between 0.06 and 0.18 g and varied in time, indicating data were non-stationarity. The PSD results reveal a largely broadband frequency response of the loaded trailers between 0 and 50 Hz, especially for sensors on the lower deck. Preliminary analysis of the data indicates the severity of vibrations experienced by pigs during transport would be considered uncomfortable by humans.
Coronavirus Disease 2019 (COVID-19) is a respiratory viral illness causing pneumonia and systemic disease. Abnormalities in pulmonary function tests (PFT) after COVID-19 infection have been ...described. The determinants of these abnormalities are unclear. We hypothesized that inflammatory biomarkers and CT scan parameters at the time of infection would be associated with abnormal gas transfer at short term follow-up. We retrospectively studied subjects who were hospitalized for COVID-19 pneumonia and discharged. Serum inflammatory biomarkers, CT scan and clinical characteristics were assessed. CT images were evaluated by Functional Respiratory Imaging with automated tissue segmentation algorithms of the lungs and pulmonary vasculature. Volumes of the pulmonary vessels that were less than or equal to5mm (BV5), 5-10mm (BV5_10), and greater than or equal to10mm (BV10) in cross sectional area were analyzed. Also the amount of opacification on CT (ground glass opacities). PFT were performed 2-3 months after discharge. The diffusion capacity of carbon monoxide (DLCO) was obtained. We divided subjects into those with a DLCO <80% predicted (Low DLCO) and those with a DLCO greater than or equal to80% predicted (Normal DLCO). 38 subjects were included in our cohort. 31 out of 38 (81.6%) subjects had a DLCO<80% predicted. The groups were similar in terms of demographics, body mass index, comorbidities, and smoking status. Hemoglobin, inflammatory biomarkers, spirometry and lung volumes were similar between groups. CT opacification and BV5 were not different between groups, but both Low and Normal DLCO groups had lower BV5 measures compared to healthy controls. BV5_10 and BV10 measures were higher in the Low DLCO group compared to the normal DLCO group. Both BV5_10 and BV10 in the Low DLCO group were greater compared to healthy controls. BV5_10 was independently associated with DLCO<80% in multivariable logistic regression (OR 1.29, 95% CI 1.01, 1.64). BV10 negatively correlated with DLCO% predicted (r = -0.343, p = 0.035). Abnormalities in pulmonary vascular volumes at the time of hospitalization are independently associated with a low DLCO at follow-up. There was no relationship between inflammatory biomarkers during hospitalization and DLCO. Pulmonary vascular abnormalities during hospitalization for COVID-19 may serve as a biomarker for abnormal gas transfer after COVID-19 pneumonia.
The purpose of this study was to determine the difference between hand and electronic timing of 40-yd dashes in college football players. National Collegiate Athletic Association Division II players ...(n = 59) were measured during a 40-yd sprint by electronic timing and simultaneously by 7 experienced hand timers using digital stopwatches. Electronic times were initiated by lifting the hand from a switch mat and stopped by the torso passing through an infrared beam. Hand timers initiated timing on first movement of the player from a 3-point stance. To establish performance and timing reliabilities, 32 players completed a second trial. Interrater reliability for hand timing was intraclass correlation coefficient (ICC) = 0.987 (p < 0.001). Five of the 7 timers did not differ significantly (p > 0.05) in their timing. The maximum difference among the hand timers on any given trial was 0.19 +/- 0.14 seconds, with a 95% confidence interval (CI) of -0.08 to 0.41 seconds. Hand timing (4.85 +/- 0.28 seconds) was significantly faster (p < 0.001) than electronic timing (5.16 +/- 0.28 seconds), producing an average difference of 0.31 +/- 0.07 seconds (6.0 +/- 1.3%) and a 95% CI on the average difference of -0.44 to -0.18 seconds. The correlation between electronic timing and hand timing was ICC = 0.985 (p < 0.001). Practically speaking, electronic timing produces the best measurement of 40-yd dash speed, and using the hand timing produces consistently but significantly faster times.
This manuscript reports on five cases of spontaneous myelogenous leukemia, similar to human disease, occurring within highly inbred, histocompatible sublines of Massachusetts General Hospital (MGH) ...MHC-defined miniature swine. In cases where a neoplasm was suspected based on clinical observations, samples were obtained for complete blood count, peripheral blood smear, and flow cytometric analysis. Animals confirmed to have neoplasms were euthanized and underwent necropsy. Histological samples were obtained from abnormal tissues and suspect lesions. The phenotype of the malignancies was assessed by flow cytometric analysis of processed peripheral blood mononuclear cells and affected tissues. Five cases of spontaneous myeloid leukemia were identified in adult animals older than 30 months of age. All animals presented with symptoms of weight loss, lethargy, and marked leukocytosis. At autopsy, all animals had systemic disease involvement and presented with severe hepatosplenomegaly. Three of the five myelogenous leukemias have successfully been expanded
in vitro. The clustered incidence of disease in this closed herd suggests that genetic factors may be contributing to disease development. Myelogenous leukemia cell lines established from inbred sublines of MGH MHC-defined miniature swine have the potential to be utilized as a model to evaluate therapies of human leukemia.
PDF
