Development of injury risk models to guide CT evaluation in the emergency department after motor vehicle collisions

Abstract

Objective: The clinical evaluation of motor vehicle collision (MVC) victims is challenging and commonly relies on computed tomography (CT) to detect internal injuries. CT scans are financially expensive and each scan exposes the patient to additional ionizing radiation with an associated, albeit low, risk of cancer. Injury risk prediction based on regression modeling has been to be shown to be successful in estimating Injury Severity Scores (ISSs). The objective of this study was to (1) create risk models for internal injuries of occupants involved in MVCs based on CT body regions (head, neck, chest, abdomen/pelvis, cervical spine, thoracic spine, and lumbar spine) and (2) evaluate the performance of these risk prediction models to predict internal injury.

Methods: All Abbreviated Injury Scale (AIS) 2008 injury codes were classified based on which CT body region would be necessary to scan in order to make the diagnosis. Cases were identified from the NASS-CDS. The NASS-CDS data set was queried for cases of adult occupants who sought medical care and for which key crash characteristics were all present. Forward stepwise logistic regression was performed on data from 2010–2014 to create models predicting risk of internal injury for each CT body region. Injury risk for each region was grouped into 5 levels: very low (<2%), low (2–5%), medium (5–10%), high (10–20%), and very high (20%). The models were then tested using weighted data from 2015 in order to determine whether injury rates fell within the predicted risk level.

Results: The inclusion and exclusion criteria identified 5,477 cases in the NASS-CDS database. Cases from 2010–2014 were used for risk modeling (n?=?4,826). Seven internal injury risk models were created based on the CT body regions using data from 2010–2014. These models were tested against data from 2015 (n?=?651). In all CT body regions, the majority of occupants fell in the very low or low predicted injury rate groups, except for the head. On average, 57% of patients were classified as very low risk and 15% as low risk for each body region. In most cases the actual rate of injury was within the predicted injury risk range. The 95% confidence interval overlapped with predicting injury risk range in all cases.

Conclusion: This study successfully demonstrated the ability for internal injury risk models to accurately identify occupants at low risk for internal injury in individual body regions. This represents a step towards incorporating telemetry data into a clinical tool to guide physicians in the use of CT for the evaluation of MVC victims.     

Development of Regional Curves for Hydrologic Landscape Regions (HLR) in the Contiguous United States

Regional curves relate drainage area to the bankfull channel characteristics discharge, cross‐sectional area, width, and mean depth. These curves are used for a variety of purposes, including aiding in the field identification of bankfull elevation and in the natural channel design process. When developing regional curves, the degree to which landform, geology, climate, and vegetation influence stream systems within a single physiographic province may not be fully considered. This study examined the use of the U.S. Geological Survey's Hydrologic Landscape Regions (HLR), as well as data from 2,856 independent sites throughout the contiguous United States (U.S.), to develop a set of regional curves (bankfull discharge, cross‐sectional area, width, and mean depth) for (1) the contiguous U.S., (2) each of the 20 HLRs, (3) each of the eight physiographic divisions, (4) 22 of the 25 physiographic provinces, and (5) individual HLRs within the physiographic provinces. These regional curves were then compared to each other, as well as those from the literature. Regional curves developed for individual HLRs, physiographic divisions, and physiographic provinces tended to outperform the contiguous U.S. indicating increased stratification was beneficial. Further stratifying physiographic provinces by HLR markedly improved regional curve reliability. Use of HLR as a basis of regional curve development, rather than physiographic region alone, may allow for the development of more robust regional curves.     

Measuring Urban Water Conservation Policies: Toward a Comprehensive Index

This article (1) discusses existing efforts to measure water conservation policies (WCPs) in the United States (U.S.); (2) suggests general methodological guidelines for creating robust water conservation indices (WCIs); (3) presents a comprehensive template for coding WCPs; (4) introduces a summary index, the Vanderbilt Water Conservation Index (VWCI), which is derived from 79 WCP observations for 197 cities for the year 2015; and (5) compares the VWCI to WCP data extracted from the 2010 American Water Works Association (AWWA) Water and Wastewater Rates survey. Existing approaches to measuring urban WCPs in U.S. cities are limited because they consider only a portion of WCPs or they are restricted geographically. The VWCI consists of a more comprehensive set of 79 observations classified as residential, commercial/industrial, billing structure, drought plan, or general. Our comparison of the VWCI and AWWA survey responses indicate reasonable agreement (ρ = 0.76) between the two WCIs for 98 cities where the data overlap. The correlation suggests the AWWA survey responses can provide fairly robust longitudinal WCP information, but we argue the measurement of WCPs is still in its infancy, and our approach suggests strategies for improving existing methods.     

Evaluating the Slope‐Area Method to Accurately Identify Stream Channel Heads in Three Physiographic Regions

Estimation of stream channel heads is an important task since ephemeral channels play a significant role in the transport of sediment and materials to perennial streams. The slope‐area method utilizes digital elevation model (DEM) and related information to develop slope‐area threshold relationships used to estimate the position of channel heads in the watershed. A total of 162 stream channel heads were mapped across the three physiographic regions of Alabama, including the Southwestern Appalachians (51), Piedmont/Ridge and Valley (61), and Coastal Plains (51). Using Geographic Information System and DEM, the local slope and drainage area for each mapped channel head was calculated and region‐specific models were developed and evaluated. Results demonstrated the local slope and drainage area had an inverse and strong correlation in the Piedmont/Ridge and Valley region (r² = 0.71) and the Southwestern Appalachian region (r² = 0.61). Among three physiographic regions, the weakest correlation was observed in the Coastal Plain region (r² = 0.45). By comparing the locations of modeled channel heads to those located in the field, calculated reliability and sensitivity indices indicated model accuracy and reliance were weak to moderate. However, the slope‐area method helped define the upstream boundaries of a more detailed channel network than that derived from the 1:24,000‐scale National Hydrography Dataset, which is commonly used for planning and regulatory purposes.     

An Institutional and Opinion Analysis of Colorado’s Hydraulic Fracturing Disclosure Policy

Hydraulic fracturing and oil and natural gas development are possibly the most contentious energy and environmental issues to face the USA in the twenty-first century. One point of contention is the disclosure of fluids used in the hydraulic fracturing process. This paper analyses the Colorado 2011 policy requiring disclosure of hydraulic fracturing fluid information, considered one of the first comprehensive hydraulic fracturing disclosure policies in the country. We conduct an institutional analysis of the disclosure policy to understand how the policy establishes information flows and grants and restricts choices by targeted actors. We then analyse the opinions of people actively involved in hydraulic fracturing debates in Colorado to assess whether they view the disclosure policy as resolving problems. The institutional analysis illustrates how the policy allocates responsibilities in sending and receiving information and the opinion survey shows divergence in perceptions of its potential to resolve problems associated with chemical use or disclosure. Most respondents are in agreement that the new policy failed to build public trust of the hydraulic fracturing process.     

Happiness and footprints: assessing the relationship between individual well-being and carbon footprints

This study investigates the nature of the empirical link between an individual’s well-being and their carbon footprint. It employs a novel approach matching data from the Household, Income and Labour Dynamics in Australia survey, to household expenditure and greenhouse gas-based carbon footprints. The carbon footprints are calculated using environmental factor multipliers from the detailed and globally integrated multi-regional input–output (MRIO) tables provided by the Eora MRIO database. The results indicate that higher carbon footprints are associated with marginally lower levels of well-being. This relationship appears to be linear. Furthermore, this relationship does not differ greatly for individuals across the well-being distribution. The findings of this study both: (1) add to the body of knowledge on the link between carbon footprints and well-being; and (2) provide policy makers with evidence and strategic guidance on the well-being implications of mitigating carbon footprints.     

A gis-based assessment on the vulnerability and future extent of the tropical forests of the congo basin

This paper examines the vulnerability of the Congo Basin's forests through a GIS platform, taking into consideration the variables of population growth, road density, logging concession, and forest fragmentation. The assessment indicates that the forests will continue to shrink towards the interior over the next 50 years. Current contiguous forests will fragment into three large blocks, including one on the west side of the Congo River and two in the Democratic Republic of Congo, while a large number of small forest patches will retain in the periphery of the large blocks. The study shows that integrated GIS assessment of the driving forces of tropical deforestation can shed light on the future forest distribution and provide a tool to address the broader implications of social and economic development for tropical deforestation.     

Effects of land use on soil inorganic carbon stocks in the Russian Chernozem

Little is known about changes in soil inorganic carbon (SIC) stocks with depth and with land use in grassland ecosystems. This study was conducted to determine SIC stocks under different management regimes in the Mollisol, one of the typical soils in grasslands. Four sites were sampled: a native grassland field (not cultivated for at least 300 yr), an adjacent 50-yr continuous fallow field, a yearly cut hay field in the V.V. Alekhin Central-Chernozem Biosphere State Reserve in the Kursk region of Russia, and a continuously cropped field in the Experimental Station of the Kursk Institute of Agronomy and Soil Erosion Control. All sampled soils were classified as fine-silty, mixed, frigid Pachic Hapludolls. Significant differences occurred in SIC stocks between cultivated and grassland soil. The inorganic carbon stocks in the top 2 m were 107 Mg ha(-1) for the native grassland, 91 Mg ha(-1) for the yearly cut hay field, 242 Mg ha(-1) for the continuously cropped field, and 196 Mg ha(-1) for the 50-yr continuous fallow. The SIC was in the form of calcium carbonate and was mostly stored below the 1-m depth. The largest difference between inorganic carbon stocks was observed between the continuously cropped field and native grassland. The increase in inorganic carbon in the continuously cropped field and continuous fallow was attributed to initial cultivation and fertilization. Soil inorganic carbon in Mollisols is not accounted for in the current global carbon estimates.     

Assessment of prenatal mercury exposure in a predominately Caribbean immigrant community in Brooklyn, NY

Prenatal mercury exposure and its fetotoxic effects may be of particular concern in urban immigrant communities as a result of possible contributing cultural factors. The most common source of exposure in these communities is ingestion of fish and shellfish contaminated with methylmercury. Other sources of exposure may occur in ritualistic practices associated with Hispanic and Caribbean-based religions. This study 1) assessed total mercury levels in both random urine specimens from pregnant women, and in cord blood; and 2) examined environmental sources of exposure from a convenience sample in a predominantly Caribbean immigrant population in Brooklyn, New York. A questionnaire designed in collaboration with health professionals from the Caribbean community assessed the frequency of fish consumption, ritualistic practices, occupational exposures, and use of dental amalgams and mercury-containing skin and household products. The geometric mean for total mercury in cord blood was 2.14 μg L(-1) (95%CI: 1.76-2.60) (n = 78), and 0.45 μg L(-1) (95%CI: 0.37-0.55) (n = 183) in maternal urine corrected for creatinine (μg g(-1)). Sixteen percent of cord blood mercury levels exceeded the estimated equivalent of U.S. Environmental Protection Agency's Reference Dose (5.8 μg L(-1) blood). Predictors of cord blood mercury included maternal fish consumption and foreign birth of the mother. Predictors of urine mercury included foreign birth of the mother, number of dental amalgams, and special product use. There were no reports of mercury use in ritualistic practices or in cosmetics; however some women reported use of religious medals and charms. This study characterized risk factors for mercury exposure in a sample of urban, predominantly Caribbean-born blacks. Findings may help target interventions in this population, which might include appropriate fish selection and consumption frequency during pregnancy, and safe handling of mercury-containing products in the home.     

High-level aminoglycoside resistance and virulence characteristics among Enterococci isolated from recreational beaches in Malaysia

We report the first study on the occurrence of high-level aminoglycoside-resistant (HLAR) Enterococci in coastal bathing waters and beach sand in Malaysia. None of the encountered isolates were resistant to high levels of gentamicin (500 μg/mL). However, high-level resistance to kanamycin (2,000 μg/mL) was observed in 14.2 % of tested isolates, the highest proportions observed being among beach sand isolates. High-level resistance to kanamycin was higher among Enterococcus faecalis and Enterococcus faecium than Enterococcus spp. Chi-square analysis showed no significant association between responses to tested antibiotics and the species allocation or source of isolation of all tested Enterococci. The species classification of encountered Enterococci resistance to vancomycin was highest among Enterococcus spp. (5.89 %) followed by E. faecium (4.785) and least among E. faecalis. A total of 160 isolates were also tested for virulence characteristics. On the whole, caseinase production was profoundly highest (15.01 %) while the least prevalent virulence characteristic observed among tested beach Enterococci was haemolysis of rabbit blood (3.65 %). A strong association was observed between the source of isolation and responses for each of caseinase (C?=?0.47, V?=?0.53) and slime (C?=?0.50, V?=?0.58) assays. Analysis of obtained spearman’s coefficient showed a strong correlation between caseinase and each of the slime production (p?=?0.04), gelatinase (p?=?0.0035) and haemolytic activity on horse blood (p?=?0.004), respectively. Suggestively, these are the main virulent characteristics of the studied beach Enterococci. Our findings suggest that recreational beaches may contribute to the dissemination of Enterococci with HLAR and virulence characteristics.