Injury Severity Score alone predicts mortality when compared to EMS scene time and transport time for motor vehicle trauma patients who arrive alive to hospital

ABSTRACT

Objective: This study aims to identify the association, if any, between prehospital scene time, prehospital transport time, and Injury Severity Score (ISS) with in-hospital mortality.

Methods: A retrospective analysis was performed on patients at least 18 years of age who arrived to the hospital alive via emergency medical services (EMS) after a motor vehicle collision (MVC) between 1992 and 2016. These patients were divided into groups based on minutes spent at the scene and in transport. The ISS of the in-hospital mortalities, as well as the entire patient sample for each time frame, was collected. Patients without documented scene time, transport time, or ISS were excluded.

Results: Four thousand one hundred ninety-four patients were captured when analyzing scene time, though only 3,980 met inclusion criteria. In addition, 4,177 patients were captured when analyzing transport time, though only 3,979 met inclusion criteria. Scene time and transport time were not statistically significant predictors of in-hospital mortality (P = .31 and P = .458, respectively). ISS was found to be a statistically significant predictor of in-hospital mortality (P < .001).

Conclusions: ISS predicts mortality independent of scene time or transport time for patients who arrive to the hospital alive following an MVC at Guthrie Robert Packer Hospital. Limitations of our study include inability to capture prehospital deaths and inability to correlate ISS with prehospital injury severity scores.     

Five lessons to guide more effective biodiversity conservation message framing

Communication and advocacy approaches that influence attitudes and behaviors are key to addressing conservation problems, and the way an issue is framed can affect how people view, judge, and respond to an issue. Responses to conservation interventions can also be influenced by subtle wording changes in statements that may appeal to different values, activate social norms, influence a person's affect or mood, or trigger certain biases, each of which can differently influence the resulting engagement, attitudes, and behavior. We contend that by strategically considering how conservation communications are framed, they can be made more effective with little or no additional cost. Key framing considerations include, emphasizing things that matter to the audience, evoking helpful social norms, reducing psychological distance, leveraging useful biases, and, where practicable, testing messages. These lessons will help communicators think strategically about how to frame messages for greater effect.     

A comparison of overtime patrol stops made inside and out of cluster identified hotspots

Objective: The annual rate of impaired driving crashes in the United States has remained nearly constant over the last decade. While engineers, educators, enforcement, and emergency response personnel have worked diligently in their combined efforts to reduce the loss of life, there is still significant progress to be made. One area of recent interest is the use of data driven enforcement. The basis for data driven enforcement is the use of statistical clustering to identify geographic areas that represent the location of problem identification for various criminal or traffic offenses. In the case of impaired driving fatalities, the clustering represents locations with high rates of impaired driving crashes. Law enforcement officers and supervisors may allocate resources towards more specifically and efficiently addressing problem areas.

Methods: While data driven enforcement has been proven to be an effective tool in addressing crime and traffic safety problems, it has been a slow process for agencies to adopt data driven techniques. This study aims to explore the difference in traffic stops made inside and outside of hotspot identified areas. The study uses data from the Stark County Operating a Vehicle Impaired Task Force between 2013 and 2014.

Results: The analysis determined that stop occurring in hotspot defined areas are more likely to result in impaired driving arrests and seatbelt citations. Additionally it is found that the average cost of impaired driving arrests is significantly cheaper for stops occurring inside of hotspot areas.

Conclusion: Clustering as a means of directing law enforcement efforts are a way to increase the productivity and benefits of law enforcement agencies with limited finances or personnel. From this study it is seen that traffic stops made within defined cluster or hot spot areas are more effective in resulting in OVI arrests.     

Landscape assessment of side channel plugs and associated cumulative side channel attrition across a large river floodplain

Determining the influences of anthropogenic perturbations on side channel dynamics in large rivers is important from both assessment and monitoring perspectives because side channels provide critical habitat to numerous aquatic species. Side channel extents are decreasing in large rivers worldwide. Although riprap and other linear structures have been shown to reduce side channel extents in large rivers, we hypothesized that small “anthropogenic plugs” (flow obstructions such as dikes or berms) across side channels modify whole-river geomorphology via accelerating side channel senescence. To test this hypothesis, we conducted a geospatial assessment, comparing digitized side channel areas from aerial photographs taken during the 1950s and 2001 along 512 km of the Yellowstone River floodplain. We identified longitudinal patterns of side channel recruitment (created/enlarged side channels) and side channel attrition (destroyed/senesced side channels) across n?=?17 river sections within which channels were actively migrating. We related areal measures of recruitment and attrition to the density of anthropogenic side channel plugs across river sections. Consistent with our hypothesis, a positive spatial relationship existed between the density of anthropogenic plugs and side channel attrition, but no relationship existed between plug density and side channel recruitment. Our work highlights important linkages among side channel plugs and the persistence and restoration of side channels across floodplain landscapes. Specifically, management of small plugs represents a low-cost, high-benefit restoration opportunity to facilitate scouring flows in side channels to enable the persistence of these habitats over time.     

Accounting for multiple testing in the analysis of spatio-temporal environmental data

The statistical analysis of environmental data from remote sensing and Earth system simulations often entails the analysis of gridded spatio-temporal data, with a hypothesis test being performed for each grid cell. When the whole image or a set of grid cells are analyzed for a global effect, the problem of multiple testing arises. When no global effect is present, we expect $$ \alpha $$% of all grid cells to be false positives, and spatially autocorrelated data can give rise to clustered spurious rejections that can be misleading in an analysis of spatial patterns. In this work, we review standard solutions for the multiple testing problem and apply them to spatio-temporal environmental data. These solutions are independent of the test statistic, and any test statistic can be used (e.g., tests for trends or change points in time series). Additionally, we introduce permutation methods and show that they have more statistical power. Real-world data are used to provide examples of the analysis, and the performance of each method is assessed in a simulation study. Unlike other simulation studies, our study compares the statistical power of the presented methods in a comprehensive simulation study. In conclusion, we present several statistically rigorous methods for analyzing spatio-temporal environmental data and controlling the false positives. These methods allow the use of any test statistic in a wide range of applications in environmental sciences and remote sensing.     

Island biogeographical theory: Can it be used to predict lotic recovery rates?

Classic island biogeographic theory predicts that equilibrium will be reached when immigration and extinction rates are equal. These rates are modified by number of species in source area, number of intermediate islands, distance to recipient island, and size of intermediate islands. This general model has been variously modified and proposed to be a stochastic process with minimal competitive interaction or heavily deterministic. Predictive models of recovery (regardless of the end point chosen) have been based on the appropriateness of the MacArthur-Wilson models. Because disturbance frequency, severity, and intensity vary in their effect on community dynamics, we propose that disturbance levels should first be defined before evaluating the applicability of island biogeographical theory. Thus, we suggest a classification system of four disturbance levels based on recovery patterns by primary and secondary succession and faunal organization by primary (invasion of vacant areas) and secondary (remnant of previous community remains) processes. Level 1A disturbances completely destroy communities with no upstream or downstream sources of colonizers, while some component of near surface interstitial or hyporheic flora and fauna survive level 1B disturbances. Recovery has been reported to take from five years to longer than 25 years, when most invading colonists do not have an aerial form. Level 2 disturbances destroy the communities but leave upstream and downstream colonization sources (level 2A) and, sometimes, a hyporheic pool of colonizers (level 2B). Recovery studies have indicated primary succession and faunal structuring patterns (2A) with recovery times of 90–400 days or secondary succession and faunal structuring patterns (2B) with recovery times of 40–250 days. Level 3 disturbances result in reduction in species abundance and diversity along a stream reach; level 4 disturbances result in reduction of abundance and diversity in discrete patches. Both disturbance types lead to secondary succession and secondary faunal organization. Recovery rates can be quite rapid, varying from less than 10 days to 100 or more days. We suggest that island biogeographical models seem appropriate to recovery by secondary processes after level 3 and 4 disturbances, where competition may be an important organizing factor, while models of numerical abundance and resource tracking are probably of better use where community development is by primary succession (levels 1 and 2). Development of predictive recovery models requires research that addresses a number of fundamental questions. These include the role of hydrologic patterns on colonization dynamics, the role of nonaerial colonizers in recovery from level 1 disturbances, and assessment of the impact of changes in the order of invasion by colonizers of varying energetic efficiencies. Finally, we must be able to assemble these data and determine whether information that guides community organization at one level of disturbance can provide insights into colonization dynamics at other levels.