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Helicopter emergency medical services (HEMS) are intended to expedite care to definitive management. Studies are inconclusive in demonstrating appropriate use. We aimed to examine emergent interventions after interfacility helicopter transport (IHT) to our pediatric trauma center.
Trauma patients 0-18 years undergoing IHT or interfacility ground transport (IGT) to our institution from January 2011-December 2020 were studied. We evaluated the rate of IHT patients undergoing emergent (1h), urgent (6h), and semi urgent (48h) operating room (OR) intervention compared to IGT as a measure of appropriate transport.
Inclusion was met by 1003 IHT and 7829 IGT patients. OR intervention was required in 29.6% of IHT patients, emergent in 1.3%, urgent in 12.6%, and semi urgent in 10.6%. Overall, IHT patients had higher mean injury severity score (ISS; IHT14.5; SD11.0vs. IGT6.0; SD5.0; p<0.01) and lower GCS (IHT12.0; SD4.9vs. IGT14.8; SD1.4; p<0.01), though over triage (ISS≤15) occurred in 67.9% of patients.
More interfacility helicopter transport patients underwent emergent and urgent procedures compared to interfacility ground transport patients; however, emergent intervention was not required in 98.7% of interfacility helicopter transport patients and over two thirds had ISS≤15, possibly suggesting overutilization of interfacility helicopter transport for pediatric trauma patients at our center.
Level III.
Level III.
Erythropoietic dysfunction after trauma and critical illness is associated with anemia, persistent inflammation, increased hematopoietic progenitor cell mobilization from the bone marrow, and reduced erythroid progenitor growth. Yet the duration and reversibility of these postinjury bone marrow changes remain unknown. This study sought to determine whether removal of chronic postinjury stress could induce improvements in erythroid progenitor growth.
Sprague-Dawley rats (n= 8-11/group) were assigned to the following naïve, lung contusion and hemorrhagic shock, lung contusion and hemorrhagic shock plus daily chronic stress for 7 days followed by 7 days of routine handling to allow recovery (lung contusion and hemorrhagic shock+ chronic stress 7), or lung contusion and hemorrhagic shock plus chronic stress for 14 days (lung contusion and hemorrhagic shock+ chronic stress 14). Circulating CD117
CD71
erythroid progenitors were detected by flow cytometry. Rodents were killed on day 14, and bone marrow erythrs. This study suggests that postinjury anemia is reversible and has the potential to improve with the cessation of stress.
Improvements in erythroid progenitor growth and reduced hematopoietic progenitor cell mobilization were seen 7 days after cessation of chronic stress and were associated with an improvement in hemoglobin. Early bone marrow erythropoietic functional recovery may result from resolution of hematopoietic progenitor mobilization rather than upregulation of pro-erythroid transcription factors. This study suggests that postinjury anemia is reversible and has the potential to improve with the cessation of stress.Various techniques have been developed for a 3-dimensional (3D) virtual patient. However, those techniques do not enable the registration of the alignment of the facial and intraoral digital scans, the registration for the mounting on the virtual articulator, and the integration of the natural head position (NHP) together. In the present manuscript, a scan body system is described that assists with the translation of the horizon orientation within the NHP of the patient into a computer-aided design software program. Additionally, the scan body system facilitates the facial and intraoral alignment, as well as the mounting of the maxillary virtual cast on the virtual articulator. This scan body system facilitates the integration of the 3D virtual patient and reduces chair and laboratory time.This paper proposes a unified control method based on an improved grey wolf optimization algorithm to improve the performance of the switched reluctance motors (SRMs) to cope with various operating conditions. Compared with the single control mode of traditional SRMs, an SRM with 12/10 poles is called a multimode switched reluctance motor, which can be used not only as a six-phase motor but also as a three-phase motor. The control method proposed is based on a 12/10 pole SRMs. In the TSRM mode, an improved torque sharing function with parameters is utilized to reduce torque ripple and widen the speed range. In the SSRM mode, the linear active disturbance rejection control (LADRC) method is used to increase the anti-interference ability of the system. For the switching modes, an improved gray wolf optimization algorithm is designed to ensure smooth switching. The global optimal solution is obtained by introducing the coyote group to avoid falling into the local optimal solution. Finally, the experimental results prove the effectiveness of the control method.This paper presents a high-order low-pass filter for the equivalent-input-disturbance (EID) approach to improving the disturbance-rejection performance. The configuration characteristic of the presented filter clearly explains the reason why the disturbance-rejection performance is improved and provides a guideline to design it. Using the presented filter to replace the conventional filter derives a high-order EID (HEID) approach. It is easy to apply the small-gain theorem in deriving stability conditions of the HEID-based control system. Moreover, the presented filter is proved to be better than the conventional one. Finally, a comparison shows the validity and superiority of the presented method. And a simulation result shows that the HEID approach is easily extended in a multiple-input, multiple-output system even with effects of a white noise and parameter uncertainties.This paper investigates the recursive filtering problem for a class of networked systems subject to the uniform quantization effects and stochastic transmission delays. The system output is quantized according to a uniform quantization mechanism, and then sent to the remote filter via a communication network undergoing stochastic transmission delays (which are modeled by a sequence of independent and identically distributed variables). To deal with the stochastic transmission delays, an indicator function is delicately designed to ensure that the filtering process is implemented based on the quantized measurement with the newest timestamp available for the filter. With the aid of the indicator function, a free-delay system is obtained by using the augmented system method. The aim of this paper is to design a Kalman-type filter for the augmented system such that an upper bound of the filtering error covariance is guaranteed and minimized. With the aid of the stochastic analysis method, the desired upper bound of the filtering error covariance is derived by recursively solving two Riccati-like difference equations. Then, the upper bound is minimized by properly selecting the filter parameters. Finally, a numerical example is provided to illustrate the validity of the developed filtering scheme.
This study aimed to investigate the influence of the respective mechanical and chemical pre-treatments on the composite repair of a CAD/CAM hybrid ceramic using a microtensile bond strength test (μTBS).
15 CAD/CAM Blocks of Vita Enamic (VE) were randomly sectioned into three mechanical pre-treatments (1.) Diamond bur (D), (2.) Airborne abrasion (A), (3.) Tribochemical silica coating (T) and subsequently five chemical pre-treatments (1.) Clearfil SE Bond Bond (B; negative control), (2.) ESPE Sil (S), (3.) Clearfil Ceramic Primer Plus (CPP), (4.) Clearfil Repair (CR) and (5.) Scotchbond Universal (SCB). Per block, n=20 specimens were sawn. Half of the specimens were randomly selected and subjected to an immediate bond strength test, while the other half was subjected to artificial aging for 6 months 180 days at 37°C and subsequent thermocycling of 5000 cycles. A μTBS was performed and data (MPa) were compared in one-way and two-way ANOVA and Tukey's HSD. Paired-t-test was used for artificial aging (α=0.05). Debonded specimens were analyzed of for failure modes with a stereomicroscope (SEM).
The results of one-way ANOVA for the fifteen fastening procedures after aging indicated significant differences according to SCB-A and CPP-T. Two-way ANOVA after aging observed inferior bond strength for SCB. No differences were observed for mechanical pre-treatments. Artificial aging showed a significant reduction in bond strength on most of the fastening procedures.
SCB showed the lowest bond strength values besides B, S, CPP, and CR. MDP and silane are both suitable for the repair of VE.
SCB showed the lowest bond strength values besides B, S, CPP, and CR. MDP and silane are both suitable for the repair of VE.
To analyze WHODAS 2.0's diagnostic capacity and accuracy in stroke survivors.
Cross-sectional methodological study, in which individuals with chronic stroke were evaluated. Disability was considered the outcome variable, being evaluated by WHODAS 2.0; the modified Rankin scale (mRS) was used as the parameter variable. Disability was categorized in two levels being "No or mild disability" (mRS 0-2) and "Moderate to severe disability" (mRS 3-5). To identify the cutoff point, a Receiver-Operating Characteristic (ROC) curve was constructed with a confidence interval (CI) of 95% and considering sensitivity and specificity.
The cutoff point >39.62 proved acceptable for distinguishing individuals with moderate/severe disability from individuals with no or mild disability (≤39.62 points), with 66.22% sensitivity, 72.41% specificity, positive predictive value (PPV) of 45.45%, and negative predictive value (NPV) of 84.74%. The area under the curve (AUC) was 0.747 (CI 95% 0.65-0.83;
< 0.001).
WHODAS 2.0 demonstrated acceptable diagnostic capacity and the cutoff point of 39.62 proved suitable for distinguishing individuals with moderate/severe disability from those with no or mild disability after stroke.Implications for rehabilitationWHODAS 2.0 demonstrated acceptable diagnostic capacity.The WHODAS 2.0 cut-off point of >39.62 allows stratification of post-stroke disability into two different levels (no/mild disability versus moderate/severe disability).These results facilitate clinical decision-making by rehabilitation professionals.
39.62 allows stratification of post-stroke disability into two different levels (no/mild disability versus moderate/severe disability).These results facilitate clinical decision-making by rehabilitation professionals.
To develop and explore underlying dimensions of the Self-Regulation Assessment (SeRA) and psychometric features of potential components. Further, to identify associations between the SeRA and disability-management self-efficacy, type of diagnosis, and type of rehabilitation.
Based on a previously developed model of self-regulation, expert and patient opinions, and cognitive interviews, a list of 22 items on self-regulation (the SeRA) was constructed. The SeRA was included in a cross-sectional survey among a multi-diagnostic group of 563 former rehabilitation patients. Exploratory analyses were conducted.
Respondents had a mean age of 56.5 (
12.7) years. SB 204990 chemical structure The largest diagnostic groups were chronic pain disorder and brain injury. Four components were found within the SeRA, labelled as "insight into own health condition," "insight into own capabilities," "apply self-regulation," and "organization of help." Cronbach's alpha was high (total scale 0.93, subscales range 0.85-0.89). Only scores on the first subscale showed a ceiling effect.
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