New Methodology for an Expert-Designed Map From International Classification of Diseases (ICD) to Abbreviated Injury Scale (AIS) 3+ Severity Injury

Objective: There has been a longstanding desire for a map to convert International Classification of Diseases (ICD) injury codes to Abbreviated Injury Scale (AIS) codes to reflect the severity of those diagnoses. The Association for the Advancement of Automotive Medicine (AAAM) was tasked by European Union representatives to create a categorical map classifying diagnoses codes as serious injury (Abbreviated Injury Scale [AIS] 3+), minor/moderate injury (AIS 1/2), or indeterminate. This study's objective was to map injury-related ICD-9-CM (clinical modification) and ICD-10-CM codes to these severity categories.

Methods: Approximately 19,000 ICD codes were mapped, including injuries from the following categories: amputations, blood vessel injury, burns, crushing injury, dislocations/sprains/strains, foreign body, fractures, internal organ, nerve/spinal cord injury, intracranial, laceration, open wounds, and superficial injury/contusion. Two parallel activities were completed to create the maps: (1) An in-person expert panel and (2) an electronic survey. The panel consisted of expert users of AIS and ICD from North America, the United Kingdom, and Australia. The panel met in person for 5 days, with follow-up virtual meetings to create and revise the maps. Additional qualitative data were documented to resolve potential discrepancies in mapping. The electronic survey was completed by 95 injury coding professionals from North America, Spain, Australia, and New Zealand over 12 weeks. ICD-to-AIS maps were created for: ICD-9-CM and ICD-10-CM. Both maps indicated whether the corresponding AIS 2005/Update 2008 severity score for each ICD code was AIS 3+, 1/2, or indeterminable. Though some ICD codes could be mapped to multiple AIS codes, the maximum severity of all potentially mapped injuries determined the final severity categorization.

Results: The in-person panel consisted of 13 experts, with 11 Certified AIS specialists (CAISS) with a median of 8 years and an average of 15 years of coding experience. Consensus was reached for AIS severity categorization for all injury-related ICD codes. There were 95 survey respondents, with a median of 8 years of injury coding experience. Approximately 15 survey responses were collected per ICD code. Results from the 2 activities were compared, and any discrepancies were resolved using additional qualitative and quantitative data from the in-person panel and survey results, respectively.

Conclusions: Robust maps of ICD-9-CM and ICD-10-CM injury codes to AIS severity categories (3+ versus <3) were successfully created from an in-person panel discussion and electronic survey. These maps provide a link between the common ICD diagnostic lexicons and the AIS severity coding system and are of value to injury researchers, public health scientists, and epidemiologists using large databases without available AIS coding.     

Adaptive co-management and network learning in the Room for the River programme

Adaptive co-management and learning are paramount for integrated flood risk management. Relevant literature focuses on adaptation at the level of physical and societal systems. The level of projects and programmes is largely overlooked, but they comprise interventions that adapt our physical systems and they provide opportunities for learning to contribute to transitions of societal systems. This paper aims to increase understanding on how learning takes place and can be stimulated within a programme. The mixed-method case study of Room for the River, a €2.3 billion programme for flood risk management, shows that a programme can be organised using various governance arrangements to stimulate learning and be a means for adaptive co-management to deliver upon environmental objectives.     

Influence of Riparian Seepage Zones on Nitrate Variability in Two Agricultural Headwater Streams

Riparian seeps have been recognized for their contributions to stream flow in headwater catchments, but there is limited data on how seeps affect stream water quality. The objective of this study was to examine the effect of seeps on the variability of stream NO₃‐N concentrations in FD36 and RS, two agricultural catchments in Pennsylvania. Stream samples were collected at 10‐m intervals over reaches of 550 (FD36) and 490 m (RS) on 21 occasions between April 2009 and January 2012. Semi‐variogram analysis was used to quantify longitudinal patterns in stream NO₃‐N concentration. Seep water was collected at 14 sites in FD36 and 7 in RS, but the number of flowing seeps depended on antecedent conditions. Seep NO₃‐N concentrations were variable (0.1‐29.5 mg/l) and were often greater downslope of cropped fields compared to other land uses. During base flow, longitudinal variability in stream NO₃‐N concentrations increased as the number of flowing seeps increased. The influence of seeps on the variability of stream NO₃‐N concentrations was less during storm flow compared to the variability of base flow NO₃‐N concentrations. However, 24 h after a storm in FD36, an increase in the number of flowing seeps and decreasing streamflow resulted in the greatest longitudinal variability in stream NO₃‐N concentrations recorded. Results indicate seeps are important areas of NO₃‐N delivery to streams where targeted adoption of mitigation measures may substantially improve stream water quality.     

Towards a governance of sustainable consumption transitions: how institutional factors influence emerging local food systems in Belgium

System innovations and transitions in the realm of sustainable consumption policies will seldom emerge automatically from the present socio-political and socio-technical contexts. This paper explores a set of perspectives related to the governance of transitions and develops their application to the relatively unexplored governance of sustainable consumption transitions. Empirical material stems from an extensive case study which analyses a food consumption niche in the form of collectively organised local food systems (LFS) in Belgium. More specifically, we analyse and discuss the institutional contexts and socio-political configurations within which the investigated system innovation cases are embedded. The results explore the role of governmental interplay in fostering innovative consumption practices for a transition towards a more sustainable, autonomous, citizen-based, LFS.     

Post‐tsunami relocation of fisher settlements in South Asia: evidence from the Coromandel Coast,India

The tsunami that struck the coasts of India on 26 December 2004 resulted in the large‐scale destruction of fisher habitations. The post‐tsunami rehabilitation effort in Tamil Nadu was directed towards relocating fisher settlements in the interior. This paper discusses the outcomes of a study on the social effects of relocation in a sample of nine communities along the Coromandel Coast. It concludes that, although the participation of fishing communities in house design and in allocation procedures has been limited, many fisher households are satisfied with the quality of the facilities. The distance of the new settlements to the shore, however, is regarded as an impediment to engaging in the fishing profession, and many fishers are actually moving back to their old locations. This raises questions as to the direction of coastal zone policy in India, as well as to the weight accorded to safety (and other coastal development interests) vis‐à‐vis the livelihood needs of fishers.     

Could wastewater analysis be a useful tool for China? — A review

Analysingwastewater samples is an innovative approach that overcomesmany limitations of traditional surveys to identify and measure a range of chemicals that were consumed by or exposed to people living in a sewer catchment area. First conceptualised in 2001, much progress has been made to make wastewater analysis (WWA) a reliable and robust tool for measuring chemical consumption and/or exposure. At the moment, the most popular application of WWA, sometimes referred as sewage epidemiology, is to monitor the consumption of illicit drugs in communities around the globe, including China. The approach has been largely adopted by lawenforcement agencies as a device tomonitor the temporal and geographical patterns of drug consumption. In the future, themethodology can be extended to other chemicals including biomarkers of population health (e.g. environmental or oxidative stress biomarkers, lifestyle indicators or medications that are taken by different demographic groups) and pollutants that people are exposed to (e.g. polycyclic aromatic hydrocarbons, perfluorinated chemicals, and toxic pesticides). The extension of WWA to a huge range of chemicals may give rise to a field called sewage chemical-information mining (SCIM) with unexplored potentials. China has many densely populated cities with thousands of sewage treatment plants which are favourable for applying WWA/SCIM in order to help relevant authorities gather information about illicit drug consumption and population health status. However, there are some prerequisites and uncertainties of the methodology that should be addressed for SCIM to reach its full potential in China.