ALBERT

Description: In the following, isomorphism of an arbitrary finite group of symmetry, non-crystallographic symmetry (quaternion groups, Pauli matrices groups, and other abstract subgroups), in addition to the permutation group, are considered. Application of finite groups of permutations to the packing space determines space tilings by policubes (polyominoes) and forms a structure. Such an approach establishes the computer design of abstract groups of symmetry. Every finite discrete model of the real structure is an element of symmetry groups, including non-crystallographic ones. The set packing spaces of the same order N characterizes discrete deformation transformations of the structure.

Description: Background: The ratio of systolic blood pressure (SBP) to heart rate (HR), called the reverse shock index (RSI), is used to evaluate the hemodynamic stability of trauma patients. A SBP lower than the HR (RSI 〈 1) indicates the probability of hemodynamic shock. The objective of this study was to evaluate whether the RSI as evaluated by emergency medical services (EMS) personnel at the injury scene (EMS RSI) and the physician in the emergency department (ED RSI) could be used as an additional variable to identify patients who are at high risk of more severe injury. Methods: Data obtained from all 16,548 patients added to the trauma registry system at a Level I trauma center between January 2009 and December 2013 were retrospectively reviewed. Only patients transferred by EMS were included in this study. A total of 3715 trauma patients were enrolled and subsequently divided into four groups: group I patients had an EMS RSI ≥1 and an ED RSI ≥1 (n = 3485); group II an EMS RSI ≥ 1 and an ED RSI 〈 1 (n = 85); group III an EMS RSI 〈 1 and an ED RSI ≥ 1 (n = 98); and group IV an EMS RSI 〈 1 and a ED RSI 〈 1 (n = 47). A Pearson’s χ2 test, Fisher’s exact test, or independent Student’s t-test was conducted to compare trauma patients in groups II, III, and IV with those in group I. Results: Group II and IV patients had a higher injury severity score, a higher incidence of commonly associated injuries, and underwent more procedures (including intubation, chest tube insertion, and blood transfusion in the ED) than patients in group I. Group II and IV patients were also more likely to receive a severe injury to the thoracoabdominal area. These patients also had worse outcomes regarding the length of stay in hospital and intensive care unit (ICU), the proportion of patients admitted to ICU, and in-hospital mortality. Group II patients had a higher adjusted odds ratio for mortality (5.8-times greater) than group I patients. Conclusions: Using an RSI 〈 1 as a threshold to evaluate the hemodynamic condition of the patients at the injury scene and upon arrival to the ED provides valid information regarding deteriorating outcomes for certain subgroups of patients in the ED setting. Particular attention and additional resources should be provided to patients with an EMS RSI ≥ 1 that deteriorates to an RSI 〈 1 upon arrival to the ED since a higher odds of mortality was found in these patients.

Description: Objectives: The shock index (SI) and its derivations, the modified shock index (MSI) and the age shock index (Age SI), have been used to identify trauma patients with unstable hemodynamic status. The aim of this study was to evaluate their use in predicting the requirement for massive transfusion (MT) in trauma patients upon arrival at the hospital. Participants: A patient receiving transfusion of 10 or more units of packed red blood cells or whole blood within 24 h of arrival at the emergency department was defined as having received MT. Detailed data of 2490 patients hospitalized for trauma between 1 January 2009, and 31 December 2014, who had received blood transfusion within 24 h of arrival at the emergency department, were retrieved from the Trauma Registry System of a level I regional trauma center. These included 99 patients who received MT and 2391 patients who did not. Patients with incomplete registration data were excluded from the study. The two-sided Fisher exact test or Pearson chi-square test were used to compare categorical data. The unpaired Student t-test was used to analyze normally distributed continuous data, and the Mann-Whitney U-test was used to compare non-normally distributed data. Parameters including systolic blood pressure (SBP), heart rate (HR), hemoglobin level (Hb), base deficit (BD), SI, MSI, and Age SI that could provide cut-off points for predicting the patients’ probability of receiving MT were identified by the development of specific receiver operating characteristic (ROC) curves. High accuracy was defined as an area under the curve (AUC) of more than 0.9, moderate accuracy was defined as an AUC between 0.9 and 0.7, and low accuracy was defined as an AUC less than 0.7. Results: In addition to a significantly higher Injury Severity Score (ISS) and worse outcome, the patients requiring MT presented with a significantly higher HR and lower SBP, Hb, and BD, as well as significantly increased SI, MSI, and Age SI. Among these, only four parameters (SBP, BD, SI, and MSI) had a discriminating power of moderate accuracy (AUC > 0.7) as would be expected. A SI of 0.95 and a MSI of 1.15 were identified as the cut-off points for predicting the requirement of MT, with an AUC of 0.760 (sensitivity: 0.563 and specificity: 0.876) and 0.756 (sensitivity: 0.615 and specificity: 0.823), respectively. However, in the groups of patients with comorbidities such as hypertension, diabetes mellitus, or coronary artery disease, the discriminating power of these three indices in predicting the requirement of MT was compromised. Conclusions: This study reveals that the SI is moderately accurate in predicting the need for MT. However, this predictive power may be compromised in patients with HTN, DM or CAD. Moreover, the more complex calculations of MSI and Age SI failed to provide better discriminating power than the SI.

Description: A highly ordered, mesoporous (pore size 2~50 nm) bioactive glass (MBG) structure has a greater surface area and pore volume and excellent bone-forming bioactivity compared with traditional bioactive glasses (BGs). Hence, MBGs have been used in drug delivery and bone tissue engineering. MBGs can be developed as either a dense or porous block. Compared with a block, microbeads provide greater flexibility for filling different-shaped cavities and are suitable for culturing cells in vitro. In contrast, the fibrous structure of a scaffold has been shown to increase cell attachment and differentiation due to its ability to mimic the three-dimensional structure of natural extracellular matrices. Hence, the aim of this study is to fabricate MBG microbeads with a fibrous structure. First, a sol-gel/electrospinning technique was utilized to fabricate the MBG nanofiber (MBGNF) structure. Subsequently, the MBGNF microbeads (MFBs) were produced by an electrospraying technology. The results show that the diameter of the MFBs decreases when the applied voltage increases. The drug loading and release profiles and mechanisms of the MFBs were also evaluated. MFBs had a better drug entrapment efficiency, could reduce the burst release of tetracycline, and sustain the release over 10 days. Hence, the MFBs may be suitable drug carriers. In addition, the cellular attachment of MG63 osteoblast-like cells is significantly higher for MFBs than for glass microbeads after culturing for 4 h. The nanofibrous structure of MFBs could provide an appropriate environment for cellular spreading. Therefore, MFBs have great potential for use as a bone graft material in bone tissue engineering applications.

Description: To investigate the injury characteristics and mortality of patients transported by emergency medical services (EMS) and hospitalized for trauma following a road traffic crash, data obtained from the Trauma Registry System were retrospectively reviewed for trauma admissions between 1 January 2009 and 31 December 2013 in a Level I trauma center. Of 16,548 registered patients, 3978 and 1440 patients injured in road traffic crashes were transported to the emergency department by EMS and non-EMS, respectively. Patients transported by EMS had lower Glasgow coma scale (GCS) scores and worse hemodynamic measures. Compared to patients transported by non-EMS, more patients transported by EMS required procedures (intubation, chest tube insertion, and blood transfusion) at the emergency department. They also sustained a higher injury severity, as measured by the injury severity score (ISS) and the new injury severity score (NISS). Lastly, in-hospital mortality was higher among the EMS than the non-EMS group (1.8% vs. 0.3%, respectively; p 〈 0.001). However, we found no statistically significant difference in the adjusted odds ratio (AOR) for mortality among patients transported by EMS after adjustment for ISS (AOR 4.9, 95% CI 0.33–2.26), indicating that the higher incidence of mortality was likely attributed to the patients’ higher injury severity. In addition, after propensity score matching, logistic regression of 58 well-matched pairs did not show a significant influence of transportation by EMS on mortality (OR: 0.578, 95% CI: 0.132–2.541 p = 0.468).

Description: This paper compares carbon (C) and nutrient contents in soils (Alfisols derived from andesite), forest floor and vegetation in a former fire (1960) and an adjacent forest in the Sagehen Watershed in the Sierra Nevada Mountains of California. Soils from the former fire (now occupied predominantly by Ceanothus velutinus, a nitrogen-fixing shrub) had significantly lower contents of extractable SO42− and P (both Bray and bicarbonate) but significantly greater contents of exchangeable Ca2+ than the adjacent forested site (dominated by Pinus jeffreyii). 15N data suggested that N fixation had occurred in the former fire site, but N contents did not differ between the two sites. O horizon C and nutrient contents did not differ between the two sites, but vegetation C and nutrient contents were significantly greater in the forested than former fire site. These results contrast with those from a nearby, previous study at Little Valley Nevada, also dominated by P. jeffreyii growing on a different soil type (Entisols derived from granite). In the Little Valley study, soil C, N, Ca2+, Mg2+, and K+ contents within the former fire (1981, now also occupied predominantly by Ceanothus velutinus) were greater than in the adjacent forest (Pinus jeffreyii) but soil extractable P contents either did not differ or were greater in the former fire. We conclude that soil parent material is an indirect but strong mediator of the effects of post-fire vegetation on soils in this region, especially with respect to soil P changes, which vary substantially between andesite- and granite-derived soils.

Description: A land-based mobile mapping system (MMS) is flexible and useful for the acquisition of road environment geospatial information. It integrates a set of imaging sensors and a position and orientation system (POS). The positioning quality of such systems is highly dependent on the accuracy of the utilized POS. This limitation is the major drawback due to the elevated cost associated with high-end GPS/INS units, particularly the inertial system. The potential accuracy of the direct sensor orientation depends on the architecture and quality of the GPS/INS integration process as well as the validity of the system calibration (i.e., calibration of the individual sensors as well as the system mounting parameters). In this paper, a novel single-step procedure using integrated sensor orientation with relative orientation constraint for the estimation of the mounting parameters is introduced. A comparative analysis between the proposed single-step and the traditional two-step procedure is carried out. Moreover, the estimated mounting parameters using the different methods are used in a direct geo-referencing procedure to evaluate their performance and the feasibility of the implemented system. Experimental results show that the proposed system using single-step system calibration method can achieve high 3D positioning accuracy.

Description: Visually impaired people have difficulty accessing information about public transportation systems. Several systems have been developed for assisting visually impaired and blind people to use the city bus. Most systems provide only one-way communication and require high-cost and complex equipment. The purpose of this study is to reduce the difficulties faced by visually impaired people when taking city buses, using an interactive wireless communication system. The system comprised a user module and a bus module to establish a direct one-to-one connection. When the user inputs 4-digit numbers, the user module immediately sends out the information. If the bus module receives the matched bus number, it buzzes and the warning LED flashes to notify the bus driver that someone is waiting to board on the bus. User tests were conducted by two visually impaired people in a simulated vehicle and a city bus. The success rate of interactive wireless communication, recognizing the arrival of the bus and boarding the correct bus reached 100% in all of the tests. The interactive wireless communication aid system is a valid and low-cost device for assisting visually impaired people to use city buses.

Description: Background: Hemorrhage is a leading cause of preventable trauma death. In this study, we used the reverse shock index (RSI), a ratio of systolic blood pressure (SBP) to heart rate (HR), to evaluate the hemodynamic stability of trauma patients. As an SBP lower than the HR (RSI 〈 1) may indicate hemodynamic instability, the objective of this study was to assess the associated complications in trauma patients with an RSI 〈 1 upon arrival at the emergency department (ED) (indicated as (A)RSI) and at the time of departure from the ED (indicated as (L)RSI) to the operative room or for admission. Methods: Data obtained from all 16,548 hospitalized patients recorded in the trauma registry system at a Level I trauma center between January 2009 and December 2013 were retrospectively reviewed. A total of 10,234 adult trauma patients aged ≥20 were enrolled and subsequently divided into four groups: Group I, (A)RSI ≥ 1 and (L)RSI ≥ 1 (n = 9827); Group II, (A)RSI ≥ 1 and (L)RSI 〈 1 (n = 76); Group III, (A)RSI 〈 1 and (L)RSI ≥ 1 (n = 251); and Group IV, (A)RSI 〈 1 and (L)RSI 〈 1 (n = 80). Pearson’s χ2 test, Fisher’s exact test, or independent Student’s t-test was conducted to compare trauma patients in Groups II, III, and IV with those in Group I. Results: Patients in Groups II, III, and IV had a higher injury severity score and underwent a higher number of procedures, including intubation, chest tube insertion, and blood transfusion, than Group I patients. Additionally, patients of these groups had increased hospital length of stay (16.3 days, 14.9 days, and 22.0 days, respectively), proportion of patients admitted to the intensive care unit (ICU) (48.7%, 43.0%, and 62.5%, respectively), and in-hospital mortality (19.7%, 7.6%, and 27.5%, respectively). Although the trauma patients who had a SBP 〈 90 mmHg either upon arrival at or departure from the ED also present a more severe injury and poor outcome, those patients who had a SBP ≥ 90 mmHg but an RSI 〈 1 had a more severe injury and poor outcome than those patients who had a SBP ≥ 90 mmHg and an RSI ≥ 1. Conclusions: SBP lower than heart rate (RSI 〈 1) either upon arrival at or departure from the ED may indicate a detrimental sign of poor outcome in adult trauma patients even in the absence of noted hypotension.

Description: IJERPH, Vol. 14, Pages 1045: Polytrauma Defined by the New Berlin Definition: A Validation Test Based on Propensity-Score Matching Approach International Journal of Environmental Research and Public Health doi: 10.3390/ijerph14091045 Authors: Cheng-Shyuan Rau Shao-Chun Wu Pao-Jen Kuo Yi-Chun Chen Peng-Chen Chien Hsiao-Yun Hsieh Ching-Hua Hsieh Background: Polytrauma patients are expected to have a higher risk of mortality than that obtained by the summation of expected mortality owing to their individual injuries. This study was designed to investigate the outcome of patients with polytrauma, which was defined using the new Berlin definition, as cases with an Abbreviated Injury Scale (AIS) ≥ 3 for two or more different body regions and one or more additional variables from five physiologic parameters (hypotension [systolic blood pressure ≤ 90 mmHg], unconsciousness [Glasgow Coma Scale score ≤ 8], acidosis [base excess ≤ −6.0], coagulopathy [partial thromboplastin time ≥ 40 s or international normalized ratio ≥ 1.4], and age [≥70 years]). Methods: We retrieved detailed data on 369 polytrauma patients and 1260 non-polytrauma patients with an overall Injury Severity Score (ISS) ≥ 18 who were hospitalized between 1 January 2009 and 31 December 2015 for the treatment of all traumatic injuries, from the Trauma Registry System at a level I trauma center. Patients with burn injury or incomplete registered data were excluded. Categorical data were compared with two-sided Fisher exact or Pearson chi-square tests. The unpaired Student t-test and the Mann–Whitney U-test was used to analyze normally distributed continuous data and non-normally distributed data, respectively. Propensity-score matched cohort in a 1:1 ratio was allocated using the NCSS software with logistic regression to evaluate the effect of polytrauma on patient outcomes. Results: The polytrauma patients had a significantly higher ISS than non-polytrauma patients (median (interquartile range Q1–Q3), 29 (22–36) vs. 24 (20–25), respectively; p < 0.001). Polytrauma patients had a 1.9-fold higher odds of mortality than non-polytrauma patients (95% CI 1.38–2.49; p < 0.001). Compared to non-polytrauma patients, polytrauma patients had a substantially longer hospital length of stay (LOS). In addition, a higher proportion of polytrauma patients were admitted to the intensive care unit (ICU), spent longer LOS in the ICU, and had significantly higher total medical expenses. Among 201 selected propensity score-matched pairs of polytrauma and non-polytrauma patients who showed no significant difference in sex, age, co-morbidity, AIS ≥ 3, and Injury Severity Score (ISS), the polytrauma patients had a significantly higher mortality rate (OR 17.5, 95% CI 4.21–72.76; p < 0.001), and a higher proportion of patients admitted to the ICU (84.1% vs. 74.1%, respectively; p = 0.013) with longer stays in the ICU (10.3 days vs. 7.5 days, respectively; p = 0.003). The total medical expenses for polytrauma patients were 35.1% higher than those of non-polytrauma patients. However, there was no significant difference in the LOS between polytrauma and non-polytrauma patients (21.1 days vs. 19.8 days, respectively; p = 0.399). Conclusions: The findings of this propensity-score matching study suggest that the new Berlin definition of polytrauma is feasible and applicable for trauma patients.