Mortality Risk in Pediatric Motor Vehicle Crash Occupants: Accounting for Developmental Stage and Challenging Abbreviated Injury Scale Metrics

Objective: Survival risk ratios (SRRs) and their probabilistic counterpart, mortality risk ratios (MRRs), have been shown to be at odds with Abbreviated Injury Scale (AIS) severity scores for particular injuries in adults. SRRs have been validated for pediatrics but have not been studied within the context of pediatric age stratifications. We hypothesized that children with similar motor vehicle crash (MVC) injuries may have different mortality risks (MR) based upon developmental stage and that these MRs may not correlate with AIS severity.

Methods: The NASS-CDS 2000–2011 was used to define the top 95% most common AIS 2+ injuries among MVC occupants in 4 age groups: 0–4, 5–9, 10–14, and 15–18 years. Next, the National Trauma Databank 2002–2011 was used to calculate the MR (proportion of those dying with an injury to those sustaining the injury) and the co-injury-adjusted MR (MR_MAIS) for each injury within 6 age groups: 0–4, 5–9, 10–14, 15–18, 0–18, and 19+ years. MR differences were evaluated between age groups aggregately, between age groups based upon anatomic injury patterns and between age groups on an individual injury level using nonparametric Wilcoxon tests and chi-square or Fisher's exact tests as appropriate. Correlation between AIS and MR within each age group was also evaluated.

Results: MR and MR_MAIS distributions of the most common AIS 2+ injuries were right skewed. Aggregate MR of these most common injuries varied between the age groups, with 5- to 9-year-old and 10- to 14-year-old children having the lowest MRs and 0- to 4-year-old and 15- to 18-year-old children and adults having the highest MRs (all P <.05). Head and thoracic injuries imparted the greatest mortality risk in all age groups with median MR_MAIS ranging from 0 to 6% and 0 to 4.5%, respectively. Injuries to particular body regions also varied with respect to MR based upon age. For example, thoracic injuries in adults had significantly higher MR_MAIS than such injuries among 5- to 9-year-olds and 10- to 14-year-olds (P =.04; P <.01). Furthermore, though AIS was positively correlated with MR within each age group, less correlation was seen for children than for adults. Large MR variations were seen within each AIS grade, with some lower AIS severity injuries demonstrating greater MRs than higher AIS severity injuries. As an example, MR_MAIS in 0- to 18-year-olds was 0.4% for an AIS 3 radius fracture versus 1.4% for an AIS 2 vault fracture.

Conclusions: Trauma severity metrics are important for outcome prediction models and can be used in pediatric triage algorithms and other injury research. Trauma severity may vary for similar injuries based upon developmental stage, and this difference should be reflected in severity metrics. The MR-based data-driven determination of injury severity in pediatric occupants of different age cohorts provides a supplement or an alternative to AIS severity classification for pediatric occupants in MVCs.     

Age- and Sex-Specific Thorax Finite Element Model Development and Simulation

Objective: The shape, size, bone density, and cortical thickness of the thoracic skeleton vary significantly with age and sex, which can affect the injury tolerance, especially in at-risk populations such as the elderly. Computational modeling has emerged as a powerful and versatile tool to assess injury risk. However, current computational models only represent certain ages and sexes in the population. The purpose of this study was to morph an existing finite element (FE) model of the thorax to depict thorax morphology for males and females of ages 30 and 70 years old (YO) and to investigate the effect on injury risk.

Methods: Age- and sex-specific FE models were developed using thin-plate spline interpolation. In order to execute the thin-plate spline interpolation, homologous landmarks on the reference, target, and FE model are required. An image segmentation and registration algorithm was used to collect homologous rib and sternum landmark data from males and females aged 0–100 years. The Generalized Procrustes Analysis was applied to the homologous landmark data to quantify age- and sex-specific isolated shape changes in the thorax. The Global Human Body Models Consortium (GHBMC) 50th percentile male occupant model was morphed to create age- and sex-specific thoracic shape change models (scaled to a 50th percentile male size). To evaluate the thoracic response, 2 loading cases (frontal hub impact and lateral impact) were simulated to assess the importance of geometric and material property changes with age and sex.

Results: Due to the geometric and material property changes with age and sex, there were observed differences in the response of the thorax in both the frontal and lateral impacts. Material property changes alone had little to no effect on the maximum thoracic force or the maximum percent compression. With age, the thorax becomes stiffer due to superior rotation of the ribs, which can result in increased bone strain that can increase the risk of fracture. For the 70-YO models, the simulations predicted a higher number of rib fractures in comparison to the 30-YO models. The male models experienced more superior rotation of the ribs in comparison to the female models, which resulted in a higher number of rib fractures for the males.

Conclusion: In this study, age- and sex-specific thoracic models were developed and the biomechanical response was studied using frontal and lateral impact simulations. The development of these age- and sex-specific FE models of the thorax will lead to an improved understanding of the complex relationship between thoracic geometry, age, sex, and injury risk.     

Evaluation of a standardized method for determining soluble silver in workplace air samples

Several occupational exposure limits and guidelines exist for silver, but the values for each depend on the chemical form of the silver compound in question. In the past, it generally was not possible, without prior knowledge of the work process, to distinguish soluble silver from insoluble silver compounds collected in workplace air samples. Therefore, analytical results were historically reported as total silver. In this study, work was conducted to evaluate a method to differentiate between the quantities of water-soluble silver compounds and total silver collected on filters. The investigation entailed an evaluation of an International Organization for Standardization method to determine soluble silver in airborne particulate matter. The study design incorporated laboratory experiments to evaluate analytical figures of merit, such as selection of appropriate filter media and extraction solution, analytical recovery, and sample stability during storage. Polytetrafluoroethylene (PTFE) filters (2 microm, 37 mm) in opaque cassettes were either spiked with known amounts of silver nitrate or contained a known mass of solid silver nitrate. Results showed that over 90% of the silver was recovered from PTFE filters. Also, field studies were conducted in which workplace air samples were collected in two silver refineries. Some of these samples were analyzed only for soluble silver while others were sequentially extracted and analyzed, first, for soluble silver, then for total silver. The mass fractions of soluble silver, as compared to total silver, were approximately 2% or less. This investigation served to validate an international standard procedure for the determination of soluble silver in workplace air samples.     

Definitions and organizational practice of sustainability in the for-profit sector of Nova Scotia

The term “sustainability” has been a part of local, national, and international environmental discussions for well over a decade. First legitimized by the United Nations in 1987 with the release of the Brundtland Commission and Our Common Future (WCED, 1987), the term “sustainability” is now often used in more mainstream contexts. However, given our continued global ecological decline (Millennium Ecosystem Assessment, 2005), the question remains: do decision makers within organizations really have a clear idea of what sustainability is? Further, are they able to communicate that vision in such a way as it can be operationalized within their organizations?Organizations are faced with a high degree of uncertainty when attempting to move towards sustainability. The immense amount of literature and information available about the concept is daunting, especially for harried managers of small businesses who must respond to many competing needs and interests. Although many concepts, frameworks, and tools are available for business executives to use, there have been relatively less attempts to develop a rigorous, applied definition of sustainability that can be clearly understood, implemented, and measured within and across organizations. Given the abundance of concepts, frameworks, and tools, with the corresponding dearth of overarching frameworks, one may wonder what are executives learning from all this literature, and how it is being diffused into strategy, planning, and operations? This study aims to gain insight into executives’ thinking around definitions and the implementation of sustainability practices in Nova Scotia. The findings of this study indicate that there are three key relationships of significance in this area including: type of definition and ease of articulation; type of definition and type of experience; and type of definition, type of experience, and integration of strategic and operational planning.     

Interlaboratory evaluation of an extraction and fluorescence method for the determination of trace beryllium in soils

Analytical methods for the determination of trace beryllium in soils are needed so that anthropogenic sources of this element can be distinguished from native (background) levels of beryllium. In this work, a collaborative interlaboratory evaluation of a new extraction and fluorescence-based procedure for determining beryllium in soil samples was carried out to fulfil method validation requirements for ASTM International voluntary consensus standard test methods. A Canadian reference material, CCRMP Till-1 soil, with a background beryllium concentration of 2.4 microg g(-1), was selected for study. This certified reference material (CRM) was spiked and homogenized with varying levels of beryllium oxide in order to give batches of material with beryllium concentrations of 4.36 +/- 0.69, 11.5 +/- 0.7, 124 +/- 7 and 246 +/- 16 microg g(-1) (+/- values are standard deviations). In the interlaboratory study (ILS), which was carried out in accordance with an applicable ASTM International standard practice (ASTM E691), samples of these spiked soils were subjected to extraction in dilute ammonium bifluoride at approximately 90 degrees C for 40 h. Fluorescence measurement of the extracted beryllium was carried out via detection using the high quantum yield fluorophore, hydroxybenzoquinoline sulfonate (HBQS). Interlaboratory precision estimates from six participating laboratories ranged from 0.048 to 0.103 (relative standard deviations) for the five different beryllium concentrations. Pooled bias estimates resulting from this ILS were between -0.049 and 0.177 for the various beryllium levels. These figures of merit support promulgation of the analytical procedure as an ASTM International standard test method.     

An evaluation of the interaction of morning residual layer and afternoon mixed layer ozone in Houston using ozonesonde data

The Tropospheric Ozone Pollution Project (TOPP) launched >220 ozonesondes in Houston (July 2004–June 2008) providing examples of pollution transported into, re-circulated within, and exported from the Houston area. Fifty-one launches occurred during the Texas Air Quality Study (TexAQS) II and the summer portion of IONS-06 (INTEX [Intercontinental Transport Experiment] Ozonesonde Network Study). On 11 days during TexAQS II and on 8 other occasions, ozonesondes were launched both at dawn and in the afternoon. Analysis of these “intensive” launch sequences shows that morning residual layer (RL) ozone concentrations ([O₃]) explained 60–70% of the variability found in the afternoon mixed layer (ML). Furthermore, maximum RL [O₃] is nearly identical to the mean ML [O₃] from the previous afternoon (morning minus afternoon = ?1.6 ± 8.4 ppbv). During TexAQS II, mean [O₃] below 1.3 km (the mean ML height from ozonesonde data) increased from 37 ± 22 ppbv in the morning to 74 ± 18 ppbv in the afternoon, suggesting an average net local daily O₃ production of ～500–900 tons over the metropolitan Houston area.     

Convergence and emergence in organizations: An integrative framework and review

In reaction to the growing attention to connecting individual‐level and unit‐level constructs, we first briefly review emergence terminology and theories that address the dynamic process by which a higher‐level phenomenon emerges from lower‐level elements. Next, we review the extant theory and research on emergence and convergence in organization science using an organizing framework that simultaneously considers the content area of lower‐level elements, the emergent factors, and the target of the emergent property. In addition to organizing and bridging current literature on emergence and convergence, gaps of existing research and new directions for future research, including compilation and divergence, are identified. Copyright © 2015 John Wiley & Sons, Ltd.     

Evaluation of developmental metrics for utilization in a pediatric advanced automatic crash notification algorithm

Objective: Appropriate treatment at designated trauma centers (TCs) improves outcomes among injured children after motor vehicle crashes (MVCs). Advanced Automatic Crash Notification (AACN) has shown promise in improving triage to appropriate TCs. Pediatric-specific AACN algorithms have not yet been created. To create such an algorithm, it will be necessary to include some metric of development (age, height, or weight) as a covariate in the injury risk algorithm. This study sought to determine which marker of development should serve as a covariate in such an algorithm and to quantify injury risk at different levels of this metric.

Methods: A retrospective review of occupants age < 19 years within the MVC data set NASS-CDS 2000–2011 was performed. R² values of logistic regression models using age, height, or weight to predict 18 key injury types were compared to determine which metric should be used as a covariate in a pediatric AACN algorithm. Clinical judgment, literature review, and chi-square analysis were used to create groupings of the chosen metric that would discriminate injury patterns. Adjusted odds of particular injury types at the different levels of this metric were calculated from logistic regression while controlling for gender, vehicle velocity change (delta V), belted status (optimal, suboptimal, or unrestrained), and crash mode (rollover, rear, frontal, near-side, or far-side).

Results: NASS-CDS analysis produced 11,541 occupants age < 19 years with nonmissing data. Age, height, and weight were correlated with one another and with injury patterns. Age demonstrated the best predictive power in injury patterns and was categorized into bins of 0–4 years, 5–9 years, 10–14 years, and 15–18 years. Age was a significant predictor of all 18 injury types evaluated even when controlling for all other confounders and when controlling for age- and gender-specific body mass index (BMI) classifications. Adjusted odds of key injury types with respect to these age categorizations revealed that younger children were at increased odds of sustaining Abbreviated Injury Scale (AIS) 2+ and 3+ head injuries and AIS 3+ spinal injuries, whereas older children were at increased odds of sustaining thoracic fractures, AIS 3+ abdominal injuries, and AIS 2+ upper and lower extremity injuries.

Conclusions: The injury patterns observed across developmental metrics in this study mirror those previously described among children with blunt trauma. This study identifies age as the metric best suited for use in a pediatric AACN algorithm and utilizes 12 years of data to provide quantifiable risks of particular injuries at different levels of this metric. This risk quantification will have important predictive purposes in a pediatric-specific AACN algorithm.     

The Truth About Science: A middle school curriculum teaching the scientific method and data analysis in an ecology context

The Truth About Science is a 40-lesson middle school curriculum module that teaches the process of scientific research, integrating mathematics and science concepts and skills. The goal of the curriculum is to teach students to think systematically and statistically about science inquiry. Students participate in each step of the scientific inquiry process, from asking testable research questions, designing unbiased experiments, and collecting their own data, to analyzing these data via graphical representations and statistical summaries, and communicating their research results as both poster and oral presentations. While the necessary statistical skills depend on difficult and abstract mathematical concepts, middle school students have been successful in applying them to their own research projects. The curriculum meets local and national standards in science and mathematics education and fills a gap in available educational materials. It has been piloted and revised through multiple iterations and published by the National Science Teachers Association Press. Feedback from teachers and students has been extremely positive.