The impact of true partnership between a university Level I trauma center and a community Level II trauma center on patient transfer practices

OBJECTIVE: To examine the effect of a clinical and administrative partnership with an academic urban Level I trauma center on the patient transfer practices at a suburban/rural Level II center. METHODS: Data for 2 years before affiliation (PRE) abstracted from inpatient charts and the trauma registry were compared with that for 2 years after (POST). The following data were collected: number of, reason for, and destination and demographics of transfers. Chi(2) test and t test analyses were used; p < 0.05 defined significance; data are mean +/- SEM. RESULTS: Transfer rate increased from 4% PRE to 6.9% (p = 0.001) POST with no significant difference in age, Glasgow Coma Scale score, Injury Severity Score, or Revised Trauma Score. Repatriation occurred in 12.8% POST (none PRE). The current Level I facility accepted 1.8% of all transfers PRE and 36.4% POST (p = 0.0001). PRE/POST rates by reason are as follows: pediatric, 14.6%/9.0% (p = 0.04); intensive care unit, 0.4%/1.7% (p = 0.13); complex orthopedic, 100%/0% (p = 0.005); vascular, 50%/0% (p = 0.008); spinal cord injury, 100%/100%; and ophthalmologic, 0%/100% (p = 0.005). CONCLUSIONS: In this experience of Level I/II partnership (1) transfer patterns were altered, (2) select patient cohort transfers decreased (pediatric, complex orthopedic, vascular), whereas others increased (aortic work-up), and (3) repatriation rates were low.     

Monodisperse magnetic polymer particles. New biochemical and biomedical applications

The method of activated swelling of polymer particles developed by the authors allows the preparation of monodisperse spherical beads of predictable size from 1 to 100 microns in diameter. The polymer particles may be prepared from a number of different monomeric materials and with various morphologies including macroporous structures. The porous beads form the basis for magnetizable monodisperse polymer particles which have magnetic iron oxides distributed as small grains all through the volume of the beads. The magnetic particles are being used extensively for selective cell separation and for immunomagnetic separation within microbiology and molecular biology. A review of recent work within these fields is given. New methods for positive cell separation are announced.     

Psychiatric medication: what the occupational health nurse should know

1. Occupational health nurses need a general knowledge of psychiatric medications to work effectively with clients and their off site health providers. 2. Acquiring an understanding of the major classes of medications--anti-psychotic, anti-anxiety, anti-depressant, and antimanic--is important. 3. It is helpful to understand under what conditions and with which conditions psychotropic medications are helpful.     

Captopril-induced agranulocytosis: a case report

1,000 refugees living in Strasbourg have had a stoll parasitologic exam between 1986 and 1990. We have not retained results of South America and other areas of Asia subjects because of their scarce total number. Proportionally, the most numerous are the South East Asia Nationals (51.7%); followed by those from Middle East and Africa (20 and 15.5%) and more recently by those from East of Europe (5.2%). Their parasitic infestation's rate remains important (60.9%) but variable depending on their origin. Thus, people coming from Middle East and Africa are parasited mainly by protozoan, although those from South East Asia are parasited by helminths. It's interesant to notify that the prevalence of D. fragilis is ten times higher among East European people than in the common people.     

Revised test that a distribution is new better than used

The modified test of NBU-ness given by Green and Tiwari (1) related to more general null and alternative hypotheses than the corresponding test given by Hollander and Proschan (2). The Green and Tiwari test used an upper bound for the basic of the basic criterion, resulting in the test not being very powerful. In this revised test, suitable estimate of the variance is used instead of an upper bound. This is appropriate because a large sample size is assumed. The resulting test is more powerful than the earlier Green-Tiwari test, and more generally applicable than the Hollander-Proschan test.     

Testing that a distribution is new better than used of age to

Hollander and Proschan (1972) gave a test of NBU-ness of a distribution F, but it was pointed out by Green and Tiwari (1989) that the test more appropriately related to much wider null and alternative hypotheses than those stated, and provided suitable critical values. Similarly, Hollander, Park and Proschan (1986) later provided a test that a distribution is NBU-t_o and a modified test was given by Ebrahimi and Habibullah (1990). However, a similar criticism may be levelled against these tests and a modified test is here provided for appropriate, more general, hypotheses.     

Prediction of ductile fracture in axisymmetric tension by void coalescence

Fracture strains are predicted for ductile materials undergoing void growth and coalescence. The calculation scheme is based on Gurson–Tvergaard yield function and its associated flow rule. Fracture condition is identified by vanishing stress-carrying capacity of the material. The plastic flow parameters are all determined from experimental evidences for a variety of alloys. Comparison among predicted fracture strains and experimental ones is given for a wide range of conventional and superplastic materials as well as powder compacts. Finally an approximate fracture criterion is proposed.     

Anticonvulsant Profiles of Certain New 6-Aryl-9-substituted-6,9-diazaspiro-[4.5]decane-8,10-diones and 1-Aryl-4-substituted-1,4-diazaspiro[5.5]undecane-3,5-diones

Synthesis and anticonvulsant potential of certain new 6-aryl-9-substituted-6,9-diazaspiro[4.5]decane-8,10-diones (6a–l) and 1-aryl-4-substituted-1,4-diazaspiro[5.5]undecane-3,5-diones (6m–x) are reported. The intermediates 1-[(aryl)(cyanomethyl)amino]cycloalkanecarboxamides (3a–f) were prepared via adopting Strecker synthesis on the proper cycloalkanone followed by partial hydrolysis of the obtained nitrile functionality and subsequent N-cyanomethylation. Compounds 3a–f were subjected to complete nitrile hydrolysis to give the respective carboxylic acid derivatives 4a–f which were cyclized under mild conditions to give the spiro compounds 5a–f. Ultimately, compounds 5a–f were alkylated or aralkylated to give the target compounds 6a–i and 6m–u. On the other hand, compounds 6j–l and 6v–x were synthesized from the intermediates 5a–f through alkylation, dehydration and finally tetrazole ring formation. Anticonvulsant screening of the target compounds 6a–x revealed that compound 6g showed an ED₅₀ of 0.0043 mmol/kg in the scPTZ screen, being about 14 and 214 fold more potent than the reference drugs, Phenobarbital (ED₅₀ = 0.06 mmol/kg) and Ethosuximide (ED₅₀ = 0.92 mmol/kg), respectively. Compound 6e exhibited an ED₅₀ of 0.019 mmol/kg, being about 1.8 fold more potent than that of the reference drug, Diphenylhydantoin (ED₅₀ = 0.034 mmol/kg) in the MES screen. Interestingly, all the test compounds 6a–x did not show any minimal motor impairment at the maximum administered dose in the neurotoxicity screen.