Using data linkage to assess the impact of motorized recreational vehicle-related injuries in Ohio

Problem

Motorized recreational vehicle (MRV)-related injuries can result in severe medical and financial consequences. The objective of this study was to describe the epidemiology, and clinical and financial impact of MRV-related injuries in Ohio.

Method

Probabilistically linked statewide Emergency Medical Services (EMS) and hospital (inpatient and emergency department) data for 2003 and 2004 were examined. Record pairs with a MRV-related E-code (E821-E823, E825) were included in this study.

Results

There were 2,893 patients with MRV-related injuries, who had linked EMS and hospital records, resulting in more than $15 million in hospital charges and 1,921 inpatient days of hospitalization. The male-to-female ratio was nearly 4:1, and 19% were younger than 16. Almost 82% of cases were not wearing a helmet; there was a trend of decreasing helmet use with increasing age. Mean (SE) inpatient hospital charges and length of stay (LOS) were $22,218 ($1,290) and 3.8 (0.2) days, respectively. The mean (SE) Injury Severity Score (ISS) for inpatients was 9.2 (0.4). Individuals injured on a street/highway were 3.20 times more likely to sustain an ISS ≥ 16 (95% CI: 1.03, 9.88; p = 0.044) and 3.05 times more likely to sustain a traumatic brain injury (TBI) (95% CI: 1.17, 7.94; p = 0.024) than those who were injured at a place designated for sport or recreation. Children aged 12 to 15 and young adults aged 16 to 25 were 2.47 and 2.14 times more likely, respectively, to sustain a TBI than adults aged 36 or older (aged 12 to 15: 95% CI: 1.13, 5.38; p = 0.024; aged 16 to 25: 95% CI: 1.26, 3.64; p = 0.005). Higher ISS was associated with both higher total charges (p < 0.001) and longer LOS (p < 0.001).

Discussion

This study demonstrates that MRV-related injuries are an important public health problem in Ohio, with a substantial clinical and financial impact.

Impact on Industry

Enactment and enforcement of statewide MRV safety legislation and training of MRV users offer valuable opportunities to prevent these costly injuries.     

Evaluation of a healthcare safety climate measurement tool

Problem

Psychometrically validated measurement tools are needed to evaluate an organization's safety climate. In 2000, Gershon and colleagues published a new healthcare safety climate measurement tool to determine its relationship to safe work behavior (Gershon, R., Karkashian, C., Grosch, J., Murphy, L., Escamilla-Cejudo, A., Flanagan, P., et al. (2000). Hospital safety climate and its relationship with safe work practices and workplace exposure incidents. American Journal of Infection Control, 28, 211-21). The present study evaluated the psychometric properties of the Gershon tool when modified to address respiratory rather than bloodborne pathogen exposures.

Method

Medical practitioners, nurses, and nurse aides (n = 460) were surveyed using the modified Gershon tool. Data were analyzed by factor analysis and psychometric properties of the tool evaluated.

Results

Eight safety climate dimensions were extracted from 25 items (Cronbach's alpha range: 0.62 - 0.88). Factor extractions and psychometric properties were reasonably consistent with those of the Gershon tool.

Impact on Industry

The Gershon safety climate tool appears to have sufficient reliability and validity for use by healthcare decision makers as an indicator of employee perceptions of safety in their institution.     

Numerical simulation of hydrogen–air detonation for damage assessment in realistic accident scenarios

An accidental hydrogen release within an equipment enclosure may result in the presence of detonable mixture in a confined environment. From a safety standpoint, it is then useful to assess the potential for damage. In that context, numerical simulation of the sequence of events subsequent to detonative ignition provides a useful tool, although with obvious limitations. This article describes the procedure, summarizes two case studies, and reviews the limitations. First, a hydrogen dispersion pattern is obtained from numerical simulation of dispersion, using a commercial package designed primarily for incompressible flow. This dispersion cloud is then used as the initial condition in an inviscid, compressible, reactive flow simulation. To force detonative ignition, a sufficiently large amount of energy is deposited in a small region that corresponds to the ignition location. Chemistry is modeled using a single step Arrhenius model. Because the wave thickness is small compared with the computational domain, a fine mesh is needed, limiting the practicality of the process to two-dimensional geometries. This is the most significant limitation; it is conservative. The two cases described in the paper include an electrolyzer, in which a small release occurs, leading potentially to some damage to the enclosure, and a reformer, in which the consequences are potentially more serious.     

干旱地区水污染控制系统初探

应用数学规划方法,科学地组织污染物的排放或科学地协调各个治理环节,以乌鲁木齐市水磨河流域水污染控制系统为例,对干旱地区水污染控制系统进行了初步探索,从而得出干旱地区污水处理费用的合理负担,并得出污染物排放的数量,质量受自然地理条件制约的结论。     

基于轮廓似然函数的PM_(10)极值浓度分析

以R软件为分析工具,选择GEV(generalized extreme value distribution)模型拟合四川省泸州市2003～2007年期间PM10每月最高日平均浓度数据,采用极大似然法估计模型的3个参数即位置参数、尺度参数、形状参数,利用所得的参数估计值计算得出某一标准值(如GB3095—1996)的重现期;进一步利用参数估计值计算轮廓似然函数,估计某一段固定时间间隔的PM10浓度的重现值以及其置信区间。结果表明,GEV模型能很好地拟合泸州市PM10数据,利用轮廓似然函数估计的不同时间间隔的重现值准确度高,统计结果可以为环境主管部门发布污染状况预警信息提供参考。     

山区土壤重金属空间插值性能的改进

山区土壤重金属监测中,密集均匀的布点采样困难大,成本高。根据稀疏非均匀样本数据准确预测山区土壤重金属空间分布,对可视化描述检测元素的分布及趋势具有重要意义。基于云南省楚雄市南部山区表层土壤中重金属锰、钒的采样数据,对集成径向基函数神经网络(IRBFANNs)和传统插值方法:反距离(IDW)、普通克里格(OK)、径向基函数神经网络(RBFANNs),进行了不同等级采样密度下的插值性能比较。结果表明,样本点数量减少时,传统预测方法的插值精度都有所下降,而IRBFANNs算法在样本点较少情况下能够保持最好的插值精确度和稳定性,有效改进了空间插值性能。     

学龄儿童肺功能水平影响因素的研究

用逐步回归分析方法对与室内、外空气污染和机体状况等有关的因素对广州市学龄儿童肺功能 (FVC、FEV1 、PEFR和 FEF2 5～ 75 )水平的影响进行研究。结果提示 ,影响肺功能水平的主要因素是内因 ,身高的影响最明显 ,呼吸系统疾病或症状发生与肺功能水平下降有关 ;室外空气污染使肺功能水平下降 ,SO2 、NOx 和 PM2 .5 的影响明显 ,PM2 .5 的影响明显大于 PM1 0 和 TSP;居室或厨房通风不良、家庭烹饪用不洁燃料对儿童肺功能的生长不利 ;被动吸烟对女性儿童肺功能有不利影响。对各种影响因素 ,PEFR和 FEF2 5～ 75 比 FVC和 FEV1 更为敏感     

兰州市空气污染对儿童肺功能影响的前瞻性研究

从不同的角度阐述了室内外空气污染对儿童肺功能 ,特别是小气道功能的影响及其影响程度的前瞻性研究结果。并通过多因素、多指标的综合分析 ,揭示了一些影响儿童肺功能的主要因素。指出了从保护人体健康的角度来说 ,好的环境空气质量和良好的室内空气质量同样重要     

常州市臭氧污染传输路径和潜在源区

利用NCEP全球再分析资料和HYSPLIT4模式,计算了2013—2015年常州市臭氧(O_3)超标日的气流后向轨迹。结合聚类分析方法和常州市PM2.5、PM10、SO2、NO2、O_3数据,分析了O_3超标日不同类型气团来源对各污染物浓度的影响,并利用引入权重因子后的潜在污染源贡献函数分析了影响常州市O_3超标的潜在污染源区分布特征。结果表明:常州市O_3超标期间易受到东南和西南方向气流影响,其中从东海和黄海途经浙江东北部、上海、江苏南部等地的东南气流占比达50%以上。自内陆途经黄山-湖州-宜兴到常州的气流对应的O_3平均质量浓度最高,为116μg/m3。自山东经枣庄-宿迁-淮安-泰州-苏州-无锡到常州的气流对应的O_3平均质量浓度最低,为78μg/m3,但该气流对应的SO2和NO2平均值为各聚类中的最高。影响常州市O_3的潜在污染源区主要在常州周边200 km以内的区域,且集中在从南京至上海的长江下游沿线区域和杭州湾区域;其中太湖湖区为重点污染源源区之一。O_3超标日影响常州NO2的潜在污染源区主要集中在江苏南部、浙江东北部和上海3个区域,太湖周边的常州、无锡、苏州和湖州等几个临近城市为潜在的重点污染源区。与影响常州O_3的WPSCF高值区相比,影响NO2的高值区分布范围更大、距离更远。影响常州O_3的潜在污染源区分布,与长江三角洲地区人为源大气污染物的高排放区域较为一致,说明长江三角洲地区的O_3污染与本区域的人为源大气污染物排放有着极为密切的关联。