The complications of trauma and their associated costs in a level I trauma center

OBJECTIVES: To estimate the expected costs for acute trauma care, to quantify the costs associated with the development of complications in injury victims, and to determine the deficit incurred by patients in whom complications develop. DESIGN: A retrospective, cohort design. SETTING: A referral trauma center. PATIENTS: A total of 12,088 patients admitted to a single regional trauma center during a period of 5 years. INTERVENTIONS: This is an observational study, and no interventions specific to this study are included in the design. MAIN OUTCOME MEASURES: (1) The expected costs for injury victims based on readily available clinical data. (2) The costs associated with the most important complications of trauma. (3) The effect of complications on inadequate reimbursement for trauma care. RESULTS: The expected costs were estimated using a linear model incorporating demographic variables and measures of injury severity. The expected costs averaged $14,567, and the observed costs averaged $15,032. Six complications were important predictors of cost. These included adult respiratory distress syndrome, acute kidney failure, sepsis, pneumonia, decubitus ulceration, and wound infections. For 1201 individuals with these complications, the predicted costs averaged $23,266 and the observed costs averaged $47,457. The mean excess costs for a single complication ranged from $6669 to $18,052. Multiple complications led to greater increases in excess cost, averaging $110,007 for the 62 patients with 3 or more complications. Costs exceeded reimbursement to a much greater degree in those in whom any of the 6 complications developed. CONCLUSION: Expected hospital costs can be estimated using admission clinical data. Each of 6 complications was associated with enormous increases in costs, indicating their importance as a cause of avoidable expenditures in injury victims and identifying situations in which reimbursement may not be adequate.     

Synthesis and thermal stability of hybrid fluorosilicone polymers

Aromatic hybrid fluorosilicones, such as perfluorocyclobutane aromatic polyethers, have higher thermal stability than typical polysiloxanes. While these polyethers decompose by homolytic cleavage of the oxygen-perfluorocyclobutane bond, the enhanced thermal stability of the polyethers may, in part, arise from this oxygen through the anomeric effect. To determine the effect of the ether oxygen on thermal stability, two perfluorocyclobutane aromatic units, one with and one without the oxygen, were modeled. To confirm the results experimentally, a series of hybrid fluorosilicones based on the latter were synthesized by thermocyclodimerization of 1-bromo-4-(trifluorovinyl)benzene, metal-halogen exchange, and condensation with one of 1,3-dichlorotetramethyldisiloxane; 1,7-dichlorooctamethyltetrasiloxane; or chlorine-terminated poly(dimethylsiloxane). The degradation temperature (T_1%) was lower (∼240 °C) than the comparable polyethers (∼430 °C). These results demonstrate the importance of the ether oxygen to the stability of perfluorocyclobutane aromatic polyethers through a number of effects including the anomeric effect and enhancing the strength of the silicon-aromatic bond.     

Microstructure coarsening during static annealing of 60Sn40Pb solder joints: I stereology

The phase size distributions (PSDs) of the Sn, Pb, and the combined Pb and Sn phases, and the shape factor δ were determined for as-reflowed 60Sn40Pb solder joints and following their annealing at 50°C to 150°C. The PSDs in all cases had a positive skew which was approximated by a log-normal function. The PSDs were time invariant and were in accord with the Bitti and Nunzio model for phase coarsening. The shape factor, δ, decreased with the mean of the combined Pb and Sn phase size, and with temperature. Whether or not δ affects the PSDs is not clear.     

Temperature reduction due to the application of phase change materials

Overheating is a major problem in many modern buildings due to the utilization of lightweight constructions with low heat storing capacity. A possible answer to this problem is the emplacement of phase change materials (PCM), thereby increasing the thermal mass of a building. These materials change their state of aggregation within a defined temperature range. Useful PCM for buildings show a phase transition from solid to liquid and vice versa. The thermal mass of the materials is increased by the latent heat. A modified gypsum plaster and a salt mixture were chosen as two materials for the study of their impact on room temperature reduction. For realistic investigations, test rooms were erected where measurements were carried out under different conditions such as temporary air change, alternate internal heat gains or clouding. The experimental data was finally reproduced by dint of a mathematical model.     

From reading to spelling and spelling to reading: Transfer goes both ways.

This study compares the effects of practice spelling and reading specific words on the orthographic representations in memory involved in reading both practiced words and new, unfamiliar words. Typically developing readers in Grade 2 (mean age = 7 years, 7 months) participated in a training study examining whether transfer can occur between reading and spelling following a series of reading and spelling practice sessions. Practice consisted of either repeated reading or repeated spelling of words with shared orthographic rime patterns. A series of mixed analyses of variance was used to examine generalization within skill and transfer across skill. Following practice, word-specific transfer across skill was found. Specifically, children were better able to spell words they had practiced reading and to read words they had practiced spelling. In addition, generalization to new words with practiced rime units was found both within a skill and across skills. However, transfer from spelling to reading was greater than transfer from reading to spelling. Results indicate that the orthographic representations established through practice can be used for both reading and spelling. Subsequently, reading and spelling curricula should be coordinated to benefit children maximally. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Effects of ingesting protein with various forms of carbohydrate following resistance-exercise on substrate availability and markers of anabolism, catabolism, and immunity

Background  

Ingestion of carbohydrate (CHO) and protein (PRO) following intense exercise has been reported to increase insulin levels, optimize glycogen resynthesis, enhance PRO synthesis, and lessen the immuno-suppressive effects of intense exercise. Since different forms of CHO have varying glycemic effects, the purpose of this study was to determine whether the type of CHO ingested with PRO following resistance-exercise affects blood glucose availability and insulin levels, markers of anabolism and catabolism, and/or general immune markers.     

Simulation und Messung der thermischen Behaglichkeit

Vorgestellt wird ein Ansatz, der eine Bewertung der thermischen Behaglichkeit auch unter komplexen, inhomogenen raumklimatischen Verhältnissen unter Berücksichtung der menschlichen Physiologie zulässt. Dabei wird die Strömungssimulation an ein numerisches Modell (UC Berkeley Comfort Model), welches die Thermoregulation des menschlichen Körpers abbildet, gekoppelt. Mit Hilfe der Strömungssimulation können die klimatischen Bedingungen in Räumen detailliert ermittelt werden. Darauf basierend können durch das Thermoregulationsmodell die Temperaturverteilung im menschlichen Körper, die resultierende Wärmeabgabe an die Umgebung sowie die thermische Behaglichkeit bestimmt werden. Beispielhaft wird dieser Ansatz bei der Simulation der thermischen Behaglichkeit sowie des Empfindens bei einer Flächenkühlung angewendet. Simulation and measurement of thermal comfort. An approach is introduced, which enables the assessment of thermal comfort considering the complex and inhomogeneous climatic conditions in buildings as well as the human physiology. Computational fluid dynamic is linked with a numerical model representing the thermophysiological behavior of the human body (UC Berkeley Comfort Model). By dint of CFD, the climatic conditions in buildings are simulated with a detailed resolution. Basing on the simulations, the thermophysiological model is able to determine the temperature distribution of the human body, the heat flux to the environment as well as thermal comfort. The approach is used for the exemplified investigation of thermal comfort and sensation in a room equipped with a radiant cooling floor.     

Effect of different coagulants on the isoflavone levels and physical properties of prepared firm tofu

The objective of this study was to understand the effect of different coagulants in their ability to retain isoflavones in prepared firm tofu. Harovinton beans were processed to obtain soymilk and a specific amount of this soymilk was coagulated using different types of coagulants for the preparation of tofu. A reversed phase high performance liquid chromatographic method was used for determining the concentration of isoflavones in tofu and whey. Quality parameters such as the texture, color and moisture of tofu, prepared from different coagulants were also determined in this study. Tofus coagulated with different coagulants were found to contain different amounts of isoflavones. Calcium sulfate was found to be the most suitable coagulant for tofu making in terms of its high yield, retention of maximum amount of isoflavones and in obtaining a firm, but not hard texture of tofu.     

Power management system for a 2.5 W remote sensor powered by a sediment microbial fuel cell

One of the challenges in using wireless sensors that require high power to monitor the environment is finding a renewable power source that can produce enough power. Sediment microbial fuel cells (SMFCs) are considered an alternative renewable power source for remote monitoring, but current research on SMFCs has demonstrated that they can only produce several to tens of mW of continuous power. This limits the use of SMFCs as an alternative renewable remote power source to mW-level power. Such low power is only enough to operate a low-power sensors. However, there are many remote sensors that require higher power, on the order of watts. Current technology using a SMFC to power a remote sensor requiring watts-level intermittent power is limited because of limitations of power management technology. Our goal was to develop a power management system (PMS) that enables a SMFC to operate a remote sensor consuming 2.5 W of power. We designed a custom PMS to store microbial energy in capacitors and use the stored energy in short bursts. Our results demonstrate that SMFCs can be a viable alternative renewable power source for remote sensors requiring high power.