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.     

中国石油资源的资产负债表编制初探

我国境内石油行业总体呈现原油开采量上升的态势,为之付出的经济和生态成本也越来越大。开展我国境内石油资源资产负债表的编制工作对于摸清我国石油资源的家底、评估我国石油资源开采的经济—资源—环境综合成本、探讨我国石油开采战略的合理性具有重要的意义。本文首先探讨了石油资源资产负债表的编制方法和框架,构建了集"生态系统服务"、"环境污染"和"资源消耗"三位于一体的"生态负债"账户。其次,收集并整理了重要的污染物处理成本和生态系统服务的价值评估成果,构建了价值化因子数据表。最后,基于2012年数据尝试编制了目前我国的第一份石油资源资产负债表。结果显示,(1)2012年末,我国石油资源的资产总额为1.47×109万元,负债总额为9.03×107万元,所有者权益为1.38×109万元;(2)石油资源资产总额占到当年政府资产总额的14.43%,占政府资源性资产比重达31.12%;(3)石油行业的资产负债率为6.15%,负债权益比达到了6.56%;(4)"生态系统服务"构成了负债的最大比重,达到了98.16%。总的来说,我国石油开采行业整体处于"高资产、高负债、强生态压力和弱可持续性"的状态。从这份资产负债表我们可以看出,我国境内石油开采的生态成本不容忽视。随着资源的不断开发,石油开采的边际生态成本只会越来越大,因此,能指向经济和生态两方面的综合成本应该取代账面成本成为政府进行石油资源开发的决策依据之一。此外,要落实石油资源资产负债表对于生态保护的实际指导意义,我们建议应该将石油资源开采的资产负债率、负债权益比等指标纳入官员的绩效考核体系。     

农田生态补偿横向财政转移支付额度研究——基于选择实验法的生态外溢视角

农田生态补偿横向财政转移支付是调整农田保护和农地发展之间利益关系的重要环境经济政策,对于实现区域生态环境保护和经济发展之间的相协调具有重要意义。以武汉城市圈为例证,基于生态外溢的视角,运用选择实验法计算基于市民支付意愿的农田生态补偿标准,并修正得到武汉城市圈42个县(市、区)的农田生态补偿横向财政转移支付标准介于683.10~6 169.60元/hm~2之间。进一步依据粮食安全法将武汉城市圈42个县(市、区)划分为17个支付区和25个受偿区,得到各县(市、区)的农田生态补偿横向财政转移支付面积。最后依据农田生态补偿横向财政转移支付标准和农田生态补偿横向财政转移支付面积计算出武汉城市圈地方政府县(市、区)间农田生态补偿横向财政转移支付额度的绝对值总和为44.03亿元。研究结果可为农田生态补偿横向财政转移支付体系的构建提供初步的政策建议。     

An enhanced sustainable approach for design and manufacturing with an application to fuselages for mono-seat civil sailplanes

Abstract

A number of tools and software systems have been developed in order to reduce the time for the design and manufacturing of industrial products. Nowadays, virtual modelling by Computer Aided Design (CAD) systems and process simulation by the application of Finite Element Method (FEM) software is a standard routine in order to compress product design activities and to achieve the optimal solution before producing any real components. These developments provided not only a reduction in the time to market but a higher complexity of the project and an improved quality of the industrial products. With the aim to further improve the sustainability of this activity, the implementation of a tool that adds automatic operations into the design activity is demonstrated. This software can interact with any CAD and helps designers when the object dimension and shape can be affected by limits and constraints deriving from different features and targets, such as the spatial collocation of the component and the interaction with other limiting items, for examples the material and the manufacturing issues. The concept was developed into the software SFIDA (Sailplane Fuselage Integrated Design Application) that is a first attempt to automatically manage multiple relations and optimise their combination.     

Evaluating efforts to build sustainable WEEE reverse logistics network design: comparison of regulatory and non-regulatory approaches

Many developing countries such as Turkey are still making an effort on building an infrastructure for waste of electrical and electronic equipment (WEEE) reverse logistic network design (RLND) processes. It is obvious that policies/laws/regulations related to WEEE management provide a sustainable framework for implementation in the RLND. The question is here: Does the implementation of WEEE directives make sense in terms of reducing the total cost of the network in the long term? This study aims to compare regulatory and non-regulatory situations of WEEE RLND in developing countries by formulating two models named as ‘regulatory’ and ‘non-regulatory’. Model 1 is considered as sustainable with economic, environmental and social goals, and the quotas imposed by the environmental directive are taken into consideration as the data of product return amount. In Model 2, only economic goal is considered, and product return amount is forecasted using Artificial Neural Network (ANN). A case study is conducted in a recycling company in order to evaluate performance of the proposed models. This study contributes to the relevant literature by (1) comparing the regulatory and non-regulatory situations RL models explicitly and (2) proposing ANN model to forecast EEE product return or WEEE quantity for non-regulatory situation.     

A method for supporting the design of efficient heating systems using EU product policy data

The design of heating, ventilation and air conditioning systems is still a challenging engineering task which requires experienced and informed decision-making. These systems have a great energy-saving potential at the system level rather than at the level of the individual products of which they are composed. European environmental product policies have been very useful in facilitating a homogeneous rating scheme which can be used to compare the energy performance of different products that provide the same service. This paper proposes a simplified design method which uses the performance of components that are regulated by European product policies to obtain the overall performance of heating systems in residential buildings. It is a flexible method and allows different product configurations to be assessed so as to optimise the system performance during the design phase. The method is tested on a real case study with domestic hot water and space heating systems. The case study shows the potential for improving the heating systems according to the performance levels of its products currently available in the market. Results of the domestic hot water system show that upgrading its storage tank to the maximum energy class (A⁺) could bring the highest energy savings ( 4162 kWh/y).     

Valuing environmental amenities through inverse optimization: Theory and case study

Amenity values of private forests are implicit but play a critical role in decision and policy making. This study presents an innovative valuation approach integrating techniques of operations research and economic theory of pricing environmental goods. A forest planning problem was inversed through altering its reward function of timber values so that the observed harvesting behavior became optimal. The discrepancy between the original and new rewards uncovered amenities values which were linked to forest attributes via hedonic models. This method was applied to a case study of the U.S. southern pine region. Depending on forest conditions, total economic values of amenities varied from zero to just under one thousand dollar per ha. At a discount rate of 3%, a typically managed forest generated on average $243 ha⁻¹ of amenities values per annum, more than twice of harvested timber values. Structural diversity and density of large pine trees were the key determinants to preserving forests for environmental amenities.     

Ecosystem services in infrastructure planning – a case study of the projected deepening of the Lower Weser river in Germany

We consider how ecosystem services can be incorporated into water infrastructure planning by studying the projected deepening of the Lower Weser river channel in Germany. We recalculate the project's benefit–cost ratio by integrating the monetary value of changes in different ecosystem services, as follows: (1) the restoration costs of a mitigation measure for a loss in fresh water supply for agricultural production in the estuary region, (2) the costs of a loss in habitat services, transferring the willingness to pay from a contingent valuation study to the area assessed in the environmental impact assessment, and (3) the benefits of emissions savings induced by more efficient shipping, taking a marginal abatement cost approach. We find that including monetary values for ecosystem service changes leads to a substantial drop in the benefit–cost ratio. On this basis, we argue for a reform of the standard cost–benefit analysis to facilitate more complete welfare assessments.     

Household susceptibility to hydrological change in the Lower Mekong Basin

The hydrological conditions of the Lower Mekong Basin support a multitude of ecosystem services. Processes that influence water flow in the Mekong River will thus have implications for the tens of millions of people whose livelihoods depend on these services. This study presents an assessment of livelihood susceptibility to hydrological change in the Lower Mekong Basin. Using an index‐based approach, susceptibility scores were calculated for 2,703 households. Using those scores, we compared average household susceptibility across the basin, among countries and among eco‐zones. Due to their greater livelihood dependency on water‐related activities, mean household susceptibility was higher in Vietnam than in Cambodia, Laos, or Thailand. Households in Northern Laos also had high susceptibility, which was attributed to their low adaptive capacity. The findings suggest that policies aimed at reducing vulnerability to hydrological change in the Lower Mekong Basin should account for geographic context. Further, they highlight how policies may be able to strategically target the most susceptible households, but that poorly designed policies have the potential to exacerbate vulnerability. In the face of high uncertainty surrounding hydrological change in the Lower Mekong Basin, our assessment of susceptibility should help inform precautionary water management policies and provide baseline information needed for more comprehensive vulnerability assessments.     

Eliciting preferences for wetland services: a way to manage conflicting land uses

A choice experiment was used to analyse the preferences of residents neighbouring the Erstein polder (Alsace, France) for the different services that it provides. The heterogeneous nature of these preferences was shown through the use of a latent class model. Whilst the population as a whole values the improvement in water quality and the contribution, even partial, to flood protection, preferences differ when it comes to biodiversity and public access to the site. This study shows the potential conflicts between the different uses of the Erstein polder. These conflicts represent different communication themes for the site managers.