Pediatric trauma BIG score: predicting mortality in children after military and civilian trauma.

PubMed

Borgman, Matthew A; Maegele, Marc; Wade, Charles E; Blackbourne, Lorne H; Spinella, Philip C

2011-04-01

To develop a validated mortality prediction score for children with traumatic injuries. We identified all children (<18 years of age) in the US military established Joint Theater Trauma Registry from 2002 to 2009 who were admitted to combat-support hospitals with traumatic injuries in Iraq and Afghanistan. We identified factors associated with mortality using univariate and then multivariate regression modeling. The developed mortality prediction score was then validated on a data set of pediatric patients (≤ 18 years of age) from the German Trauma Registry, 2002-2007. Admission base deficit, international normalized ratio, and Glasgow Coma Scale were independently associated with mortality in 707 patients from the derivation set and 1101 patients in the validation set. These variables were combined into the pediatric "BIG" score (base deficit + [2.5 × international normalized ratio] + [15 - Glasgow Coma Scale), which were each calculated to have an area under the curve of 0.89 (95% confidence interval: 0.83-0.95) and 0.89 (95% confidence interval: 0.87-0.92) on the derivation and validation sets, respectively. The pediatric trauma BIG score is a simple method that can be performed rapidly on admission to evaluate severity of illness and predict mortality in children with traumatic injuries. The score has been shown to be accurate in both penetrating-injury and blunt-injury populations and may have significant utility in comparing severity of injury in future pediatric trauma research and quality-assurance studies. In addition, this score may be used to determine inclusion criteria on admission for prospective studies when accurately estimating the mortality for sample size calculation is required.

The Joint Facial and Invasive Neck Trauma (J-FAINT) Project, Iraq and Afghanistan 2003-2011

DTIC Science & Technology

2013-01-01

Original Research— Facial Plastic and Reconstructive Surgery The Joint Facial and Invasive Neck Trauma (J-FAINT) Project, Iraq and Afghanistan 2003...number and type of facial and penetrat- ing neck trauma injuries sustained in Operation Iraqi Freedom (OIF) and Operation Enduring Freedom (OEF). Study...queried for data from OIF and OEF from January 2003 to May 2011. Information on demographics; type and severity of facial , neck, and associated trauma

Emergency Blood Transfusions in Combat Theaters and Impact on HIV Testing Policy

DTIC Science & Technology

2008-06-02

or sickle cell traits, an approximate 8.6% misidentification of blood type is thought to have occurred, further indicating the importance of thorough...Military Medicine. 149:55-62. o. Spinella PC, Perkins JG, Gathwohl KW et al. (2007) Risks Associated with Fresh Whole Blood and Red Blood Cell ...administering trauma care in theater, tested packed red blood cells (PRBC) are the only blood component therapy available to the Forward Surgical Team

Evaluation of role 2 (R2) medical resources in the Afghanistan combat theater: Initial review of the joint trauma system R2 registry.

PubMed

Mann-Salinas, Elizabeth A; Le, Tuan D; Shackelford, Stacy A; Bailey, Jeffrey A; Stockinger, Zsolt T; Spott, Mary Ann; Wirt, Michael D; Rickard, Rory; Lane, Ian B; Hodgetts, Timothy; Cardin, Sylvain; Remick, Kyle N; Gross, Kirby R

2016-11-01

A Role 2 registry (R2R) was developed in 2008 by the US Joint Trauma System (JTS). The purpose of this project was to undertake a preliminary review of the R2R to understand combat trauma epidemiology and related interventions at these facilities to guide training and optimal use of forward surgical capability in the future. A retrospective review of available JTS R2R records; the registry is a convenience sample entered voluntarily by members of the R2 units. Patients were classified according to basic demographics, affiliation, region where treatment was provided, mechanism of injury, type of injury, time and method of transport from point of injury (POI) to R2 facility, interventions at R2, and survival. Analysis included trauma patients aged ≥18 years or older wounded in year 2008 to 2014, and treated in Afghanistan. A total of 15,404 patients wounded and treated in R2 were included in the R2R from February 2008 to September 2014; 12,849 patients met inclusion criteria. The predominant patient affiliations included US Forces, 4,676 (36.4%); Afghan Forces, 4,549 (35.4%); and Afghan civilians, 2,178 (17.0%). Overall, battle injuries predominated (9,792 [76.2%]). Type of injury included penetrating, 7,665 (59.7%); blunt, 4,026 (31.3%); and other, 633 (4.9%). Primary mechanism of injury included explosion, 5,320 (41.4%); gunshot wounds, 3,082 (24.0%); and crash, 1,209 (9.4%). Of 12,849 patients who arrived at R2, 167 (1.3%) were dead; of 12,682 patients who were alive upon arrival, 342 (2.7%) died at R2. This evaluation of the R2R describes the patient profiles of and common injuries treated in a sample of R2 facilities in Afghanistan. Ongoing and detailed analysis of R2R information may provide evidence-based guidance to military planners and medical leaders to best prepare teams and allocate R2 resources in future operations. Given the limitations of the data set, conclusions must be interpreted in context of other available data and analyses, not in isolation

Energy Theater

ERIC Educational Resources Information Center

Daane, Abigail R.; Wells, Lindsay; Scherr, Rachel E.

2014-01-01

Energy Theater is a dynamic, full-body activity that engages all students in representing the flow of energy in various phenomena, such as a light bulb burning steadily or a refrigerator cooling food. In Energy Theater, each participant acts as a unit of energy that has one form at a time. Regions on the floor correspond to objects in a physical…

SABER: A Theater Level Wargame

DTIC Science & Technology

1991-03-01

theater level conputerized wargame for the Air Force Wargaming Center, Maxwell AFB, Alabama to replace the Theater War Exercise (TWX), also known as... to replace the Theater War Exercise (TWX), also known as Agile. Given a recently developed land battle, this thesis’ effort links US Air Force...compu.eiized wargame for the Air Force Wargaming Center, Maxwell AFB, Alabama to replace the Theater War Exercise (TWX), also known as Agile. Saber is a

Patients with multiple traumatic amputations: An analysis of operation enduring freedom joint theatre trauma registry data.

PubMed

Godfrey, Brandon W; Martin, Ashley; Chestovich, Paul J; Lee, Gordon H; Ingalls, Nichole K; Saldanha, Vilas

2017-01-01

Improvised Explosive Devices (IED) are the primary wounding mechanism for casualties in Operation Enduring Freedom. Patients can sustain devastating traumatic amputations, which are unlike injuries seen in the civilian trauma sector. This is a database analysis of the largest patient registry of multiple traumatic amputations. The Joint Theater Trauma Registry was queried for patients with a traumatic amputation from 2009 to 2012. Data obtained included the Injury Severity Score (ISS), Glasgow Coma Score (GCS), blood products, transfer from theatre, and complications including DVT, PE, infection (Acinetobacter and fungal), acute renal failure, and rhabdomyolysis. Comparisons were made between number of major amputations (1-4) and specific outcomes using χ 2 and Pearson's rank test, and multivariable logistic regression was performed for 30-day survival. Significance was considered with p<0.05. We identified 720 military personnel with at least one traumatic amputation: 494 single, 191 double, 32 triple, and 3 quad amputees. Average age was 24.3 years (18-46), median ISS 24 (9-66), and GCS 15 (3-15). Tranexamic acid (TXA) was administered in 164 patients (23%) and tourniquets were used in 575 (80%). Both TXA and tourniquet use increased with increasing number of amputations (p<0.001). Average transfusion requirements (in units) were packed red blood cells (PRBC) 18.6 (0-142), fresh frozen plasma (FFP) 17.3 (0-128), platelets 3.6 (0-26), and cryoprecipitate 5.6 (0-130). Transfusion of all blood products increased with the number of amputations (p<0.001). All complications tested increased with the number of amputations except Acinetobacter infection, coagulopathy, and compartment syndrome. Transfer to higher acuity facilities was achieved in 676 patients (94%). Traumatic amputations from blast injuries require significant blood product transfusion, which increases with the number of amputations. Most complications also increase with the number of amputations

A joint latent class model for classifying severely hemorrhaging trauma patients.

PubMed

Rahbar, Mohammad H; Ning, Jing; Choi, Sangbum; Piao, Jin; Hong, Chuan; Huang, Hanwen; Del Junco, Deborah J; Fox, Erin E; Rahbar, Elaheh; Holcomb, John B

2015-10-24

In trauma research, "massive transfusion" (MT), historically defined as receiving ≥10 units of red blood cells (RBCs) within 24 h of admission, has been routinely used as a "gold standard" for quantifying bleeding severity. Due to early in-hospital mortality, however, MT is subject to survivor bias and thus a poorly defined criterion to classify bleeding trauma patients. Using the data from a retrospective trauma transfusion study, we applied a latent-class (LC) mixture model to identify severely hemorrhaging (SH) patients. Based on the joint distribution of cumulative units of RBCs and binary survival outcome at 24 h of admission, we applied an expectation-maximization (EM) algorithm to obtain model parameters. Estimated posterior probabilities were used for patients' classification and compared with the MT rule. To evaluate predictive performance of the LC-based classification, we examined the role of six clinical variables as predictors using two separate logistic regression models. Out of 471 trauma patients, 211 (45 %) were MT, while our latent SH classifier identified only 127 (27 %) of patients as SH. The agreement between the two classification methods was 73 %. A non-ignorable portion of patients (17 out of 68, 25 %) who died within 24 h were not classified as MT but the SH group included 62 patients (91 %) who died during the same period. Our comparison of the predictive models based on MT and SH revealed significant differences between the coefficients of potential predictors of patients who may be in need of activation of the massive transfusion protocol. The traditional MT classification does not adequately reflect transfusion practices and outcomes during the trauma reception and initial resuscitation phase. Although we have demonstrated that joint latent class modeling could be used to correct for potential bias caused by misclassification of severely bleeding patients, improvement in this approach could be made in the presence of time to event

Joint Implications for Contracted Logistics

DTIC Science & Technology

2007-03-30

authority with the host nation country and policy on using UCMJ for contracted personnel. As tailored theater policies are developed and contracting...responsibility, this paper recommends better joint training, leader development and joint enablers for contracting operations. JOINT...U.S. Joint Forces Command (JFCOM) are analyzing Congressional and DOD policy to develop procedures and force structure to support contractor

A rare case of idiopathic thumb CMC joint neuropathic arthropathy complicated by blunt trauma.

PubMed

Singh, Manavdeep; Butala, R R; Khedekar, R G; Tripati, Manish

2016-01-01

Neuropathic arthropathy (Charcot joints), which most frequently affects the weight-bearing joints of the body, is commonly associated with a variety of medical and neurological conditions, and is notoriously difficult to treat due to the nature of the underlying pathology. We present a case of idiopathic neuropathic arthropathy of the thumb CMC joint of an elderly female complicated by blunt trauma to the thumb. To our knowledge, this is the first reported case in the literature of this rare association.

Theater Instruction via Interactive Television.

ERIC Educational Resources Information Center

Merrion, Margaret

1992-01-01

Although experiencing theater through videotape is not equivalent to experiencing live theater, the magic of theater and live instruction was not entirely lost when one off-campus student transferred from classroom to off-campus viewing for a semester. Concentration on graphics became more important, and lighting and sound could be more easily…

Secrets of the Soil (LBNL Science at the Theater)

DOE Office of Scientific and Technical Information (OSTI.GOV)

Brodie, Eoin; Northen, Trent; Jansson, Janet

2011-11-07

Four Berkeley Lab scientists unveil the "Secrets of the Soil"at this Nov. 7, 2011 Science at the Theater event. Eoin Brodie, Janet Jansson, Margaret Torn and Trent Northen talk about their research and how soil could hold the key to our climate and energy future.The discussion was moderated by John Harte, who holds a joint professorship in the Energy and Resources Group and the Ecosystem Sciences Division of UC Berkeley's College of Natural Resources

Theater Level Distribution Statement

DTIC Science & Technology

1992-06-19

The United States Military’s theater level distribution management system is analyzed for adequacy and efficiency through a review of the current...considered. In order to maximize efficiency within the distribution management system it is important that more specific doctrine governing theater level

Theaters in Elementary Schools. AIA School Plant Studies.

ERIC Educational Resources Information Center

Brush, Martha S.

1963-01-01

A national volunteer program for producing a children's theater in elementary schools is severaly limited by the inadequacy of theater facilities in local school systems. A general discussion of the theater program is presented, the current state of theater facilities in elementary schools, difficulties in play production, and possible causes for…

Using Theater Concepts in the TESOL Classroom

ERIC Educational Resources Information Center

Badie, Gina Tiffany

2014-01-01

This article discusses practical ways to incorporate theater concepts into the ESL classroom. The notion of a theater ensemble lends itself well to group work in language learning. I have used my experience auditioning, participating in theater games, and improv techniques to encourage second language learning through public speaking, group…

Epidemiology of Modern Battlefield Colorectal Trauma: A Review of 977 Coalition Casualties

DTIC Science & Technology

2012-01-01

records, the ongoing Joint Surgical Transcolonic Injury or Ostomy Multi-theater Assessment project quantifies epidemiologic trends in colon injury...Transcolonic Injury or Ostomy Multi-theater Assessment (J-STOMA) project is an ongoing initiative to examine outcomes from OIF/OEF specific to co... ostomy reversal; (4) quality of life in injured US Service members who require fecal diversion (temporary or permanent); and (5) incidence and outcomes

Nonoperative Management of Splenic Injury in Combat: 2002-2012

DTIC Science & Technology

2015-03-01

recognized as the defini- tive treatment for splenic injury when Dr. Johnston reported 150 splenectomies for trauma in 1908.4 However, in 1968, Upadhyaya...management safe and effective for all splenic blunt trauma ? A systematic review. Crit Care 2013; 17(5): R185. 6. Joint Theater Trauma System Clinical Practice...2014. 7. Zonies D, Eastridge B: Combat management of splenic injury: trends during a decade of conflict. J Trauma Acute Care Surg 2012; 73(2 Suppl 1

The Military Theater Distribution Network Design Problem

DTIC Science & Technology

2015-03-26

The Military Theater Distribution Network Design Problem THESIS MARCH 2015 Robert R. Craig, MAJ, USA AFIT-ENS-MS-15-M-137 DEPARTMENT OF THE AIR FORCE...subject to copyright protection in the United States. AFIT-ENS-MS-15-M-137 THE MILITARY THEATER DISTRIBUTION NETWORK DESIGN PROBLEM THESIS Presented...B.S., M.S. MAJ, USA MARCH 2015 DISTRIBUTION STATEMENT A APPROVED FOR PUBLIC RELEASE; DISTRIBUTION UNLIMITED. AFIT-ENS-MS-15-M-137 THE MILITARY THEATER

Joint Effects of Exposure to Prenatal Infection and Peripubertal Psychological Trauma in Schizophrenia

PubMed Central

Debost, Jean-Christophe P. G.; Larsen, Janne Tidselbak; Munk-Olsen, Trine; Mortensen, Preben Bo; Meyer, Urs; Petersen, Liselotte

2017-01-01

Context: Prenatal infection and traumatizing experiences have both been linked with schizophrenia, but none of these factors seem sufficient to cause the disorder. However, recent evidence suggests that these environmental insults act in synergy to increase schizophrenia risk. Objective: To estimate the independent and joint effects of exposure to prenatal infection and peripubertal psychological trauma on the risk of schizophrenia. Design: Danish nationwide registers were linked in this prospective cohort study. We used survival analysis to report incidence rate ratios (IRRs) and corresponding 95% confidence intervals (95% CIs). Analyses were adjusted for age and calendar period and stratified by sex. Participants: A total of 979701 persons born between 1980 and 1998 were followed up from January 1, 1995 through December 31, 2013, with 9656 having a hospital contact for schizophrenia. Results: Females exposed to prenatal infection had a significantly increased risk of schizophrenia (IRR: 1.61, 95% CI: 1.30–2.00), but not males (IRR: 0.99, 95% CI: 0.77–1.28). Peripubertal trauma was associated with increased risk in both sexes. Males, however, had a significantly higher risk of schizophrenia after exposure to both prenatal infection and peripubertal psychological trauma (IRR: 2.85, 95% CI: 2.32–3.51), with significant interaction between infection and peripubertal trauma on the multiplicative scale (P = .007). Conclusions: Our study demonstrated for the first time that prenatal infection and psychological trauma in peripubertal life can act in synergy to increase the risk of schizophrenia, with a potentially stronger susceptibility in males. PMID:27343007

The story about theater organizations, the public's approval, and the actors' identity formation in Nordic disability theater.

PubMed

Gjærum, Rikke Gürgens; Ineland, Jens; Sauer, Lennart

2010-01-01

Nordic disability theater is a relatively new and interesting field of disability research. In this article, the authors provide an overview of the field of disability theater in a Nordic context. The article is based on a comparative analysis from 3 research projects conducted in Sweden and Norway. The projects used qualitative methods and were analyzed from different theoretical perspectives. Interviews were conducted at 4 different disability theaters involving actors with hearing impairments, intellectual disabilities, physical disabilities, and mental disabilities. The aim of this article is to illustrate how the organizational settings reflect different goals and aims at the political and artistic levels. The authors will also address the relationship between the theaters and the public opinion and media. Finally, they will illustrate in what way organization, recognition, and public approval play an important role for the actors' identity formation and sense of belonging.

Ten Years of War: A Characterization of Craniomaxillofacial Injuries Incurred During Operations Enduring Freedom and Iraqi Freedom

DTIC Science & Technology

2012-01-01

been proposed. A comprehensive characterization of the injury pattern sustained during this 10-year period to the craniomaxillofacial region is needed...development of protective equipment in the future. METHODS: The Joint Theater Trauma Registry was queried from October 19, 2001, to March 27, 2011, covering...injury involved explosive devices, followed by ballistic trauma . CONCLUSION: Modern combat, characterized by blast injuries, results in higher than

The Urgent Need for a Comprehensive, Fully Integrated, Joint Intra-Theater Aeromedical Evacuation System

DTIC Science & Technology

2017-04-06

future demands for intra-theater AE for all services and coalition partners in accordance with DoD Directive 5100.01 and the SECDEF’s Memorandum for... demand signal for AE assets approximately doubled. In 2009, the Medical Evacuation Proponency Directorate at Fort Rucker, AL conducted an...Analysis (TAA), but the Army only possessed 38 Air Ambulance Companies in its force structure to meet all of DoD’s AE demands .9 These results included nine

Management of colonic injuries in the combat theater.

PubMed

Cho, S David; Kiraly, Laszlo N; Flaherty, Stephen F; Herzig, Daniel O; Lu, Kim C; Schreiber, Martin A

2010-05-01

Combat injuries are more often associated with blast, penetrating, and high-energy mechanisms than civilian trauma, generating controversy about the management of combat colonic injury. Despite implementation of mandatory colostomy in World War II, recent civilian data suggest that primary repair without diversion is safe and feasible. This study describes the modern management of battle-related colonic injuries and seeks to determine whether management strategy affects early complications. Records from the combat theater (downrange) and tertiary referral center in Germany were retrospectively reviewed from 2005 to 2006. Patient characteristics, management strategy, treatment course, and early complications were recorded. Comparison groups by management strategy were as follows: primary repair, diversion, and damage control. A total of 133 (97% male) patients sustained colonic injuries from penetrating (71%), blunt (5%), and blast (23%) mechanisms. Average injury severity score was 21 and length of stay in the referral center was 7.1 days. Injury distribution was 21% ascending, 21% descending, 15% transverse, 27% sigmoid, and 25% rectum. Downrange complications for primary repair, initial ostomy, and damage control groups were 14%, 15%, and 30%, respectively. On discharge from the center, 62% of patients had undergone a diversion. The complication rate was 18% overall and was unrelated to management strategy (P = .16). Multivariate analysis did not identify independent predictors of complications. Early complications were similar by mechanism, anatomic location, severity of injury, and management strategy. More diversions were performed for rectosigmoid injury. Good surgical judgment allows for low morbidity and supports primary repair in selected cases. Damage control surgery is effective in a multinational theater of operations.

Using Readers' Theater with Multicultural Literature

ERIC Educational Resources Information Center

Weisenburger, Stephanie

2009-01-01

The author needed a way to engage her students in the reading process and found one extremely successful strategy: using Readers' Theater. Readers' Theater "dramatizes" literature through a classroom performance and provides visual and oral stimulus to students who are not used to using imagination to appreciate literary texts. It involves a…

Nurses’ Role in the Joint Theater Trauma System

DTIC Science & Technology

2008-12-01

elevation, etc) and input for ventilator-associated pneumonia and infection control CPGs. In addition, a methicillin - resistant Staphylococcus aureus and...Standard Form 298 (Rev. 8-98) Prescribed by ANSI-Std Z39-18 REPORT DOCUMENTATION PAGE Form Approved OMB No. 0704-0188 Public reporting burden...MONITORING AGENCY REPORT NUMBER 12. DISTRIBUTION AVAILABILITY STATEMENT Distribution A: Approved for public release; distribution is

Using Theater to Increase Empathy Training in Medical Students

ERIC Educational Resources Information Center

Reilly, Jo Marie; Trial, Janet; Piver, Debra E.; Schaff, Pamela B.

2012-01-01

Abstract: Developing and nurturing empathy in medical trainees has been recognized as an essential element of medical education. Theater may be a unique instructional modality to increase empathy training. Methods: A multi-disciplinary team developed a theater workshop for first year medical students. Through the use of theater games, art images…

A descriptive analysis of data from the Department of Defense Joint Trauma System Prehospital Trauma Registry.

PubMed

Schauer, Stephen G; April, Michael D; Naylor, Jason F; Oliver, Joshua J; Cunningham, Cord W; Fisher, Andrew D; Kotwal, Russ S

2017-01-01

The active battlefield is an environment of chaos and confusion. Depending on the scale of combat, the chaos and confusion often extend into the prehospital combat setting with multiple personnel and units involved in the chain of care of casualties. The chaos of the prehospital combat setting has led to limitations in the availability of data for performance improvement and research. The Department of Defense (DoD) Joint Trauma System (JTS) Prehospital Trauma Registry (PHTR) was developed in conjunction with the updated Tactical Combat Casualty Care (TCCC) card and a TCCC after action report (AAR), and currently serves as the prehospital repository and module of the DoD Trauma Registry (DoDTR). We conducted a descriptive analysis of data from the DoDTR PHTR. The JTS collected trauma-associated data which comprise the PHTR are consolidated from TCCC cards and TCCC AARs. Where possible (requires 2 patient identifiers), JTS linked data from the PHTR module to other modules in the DoDTR to maximize availability of prehospital data and gain additional information regarding clinical outcomes. From January 2013 through September 2014, there were 705 patients available for research, of which 94.8% (668/705) had data from TCCC AARs, 3.3% (23/705) had data from TCCC cards, and 2.0% (14/705) had data available from DoDTR collection forms. There were one or more of the following data points per subject: pulse rate (77.4%, n=546), blood pressure (75.9%, n=535), respiratory rate (76.5%, n=539), pulse oximetry (61.8%, n=436), mental status (96.0%, n=677) and pain score (24.5%, n=173). Only 42.4% (647/1,527) of vital sign metrics had an associated time stamp. Documented interventions included limb tourniquets, of which only 27.3% (113/414) had an associated documentation of application time. Only 27.0% (190/705) of patients in the PHTR could be linked to the DoDTR due to missing identifiers. The PHTR data capture was suboptimal with many patients lacking documentation of vital

Single Neurosurgeon Operative Experience at Craig Joint Theater Hospital During the Afghanistan Surge (November 2010 to April 2011), Part II: Humanitarian Cases.

PubMed

Steele, John Joseph

2017-01-01

The Afghanistan Surge saw NATO troops working with their Afghan partners to remove Taliban governance and replace it with a more democratic model. As part of this endeavor, medical support for both trauma and humanitarian cases was needed. Identify and discuss disease trends to better prepare for future combat medical treatments. Retrospective review of operative experience from a neurosurgeon from November 2010 to April 2011. 63 cases were performed on 20 NATO and 43 Afghan patients. Combat-related neurotrauma represented 73% (46/63) of cases and humanitarian cases represented the remainder. The most common diseases among humanitarian cases were benign tumors (29%, 5/17), cranioplasty (23%, 4/17), obstructive hydrocephalus (11%, 2/17), nonobstructive hydrocephalus (11%, 2/17), hemifacial spasm (11%, 2/17), and cerebral angiography (11%, 2/17). There was 1 death from ventriculitis for a complication rate of 6%. In select well-nourished, patients with minimal risk of needing tracheostomy, humanitarian neurosurgery can be safely performed in theater with a complication rate (6%) no worse than patients operated on in the United States. Reprint & Copyright © 2017 Association of Military Surgeons of the U.S.

Headspace theater: an innovative method for experiential learning of psychiatric symptomatology using modified role-playing and improvisational theater techniques.

PubMed

Ballon, Bruce C; Silver, Ivan; Fidler, Donald

2007-01-01

Headspace Theater has been developed to allow small group learning of psychiatric conditions by creating role-play situations in which participants are placed in a scenario that simulates the experience of the condition. The authors conducted a literature review of role-playing techniques, interactive teaching, and experiential education, and performed consultations with experts in improvisational theater, live-action role-playing, and cognitive psychology (constructivism). Participants have universally rated the Headspace Theater experience positively. They affirmed that the simulations evoke emotions and cognitive distortions that create a window into the experience of a patient suffering from psychiatric symptoms. Several participants have also disseminated the techniques and scenarios to their local teaching setting. Headspace Theater may serve as a useful tool for helping various learners to experientially understand what a person may encounter when under the influence of a mental health condition, and thus help shape attitudes and increase empathy toward such people.

Joint Fire Support

DTIC Science & Technology

2010-06-30

intelligence application package for theater battle management core system ( TBMCS ) functionality at wing and squadron levels. The automated four... TBMCS , Joint Surveillance and Target Attack Radar System (Ground Control Station), and Global Command and Control System, as well as with Allied FA...The TBMCS is a force level integrated air C2 system. TBMCS provides hardware, software, and communications interfaces to support the preparation

Personal communications services: Improving theater deployable communications for the 21st century

NASA Astrophysics Data System (ADS)

Cournoyer, Ronald C., Jr.

1994-06-01

Personal Communications Services (PCS) may be the key ingredient for vastly improved military communications capabilities at the turn of the century. The Federal Communications Commission (FCC) defines PCS as a family of mobile or portable radio communications services which could provide services to individuals and businesses and be integrated with a variety of competing networks ... the primary focus of PCS will be to meet communications requirements of people on the move. Today's generation of Theater Deployable Communications, which provides joint tactical communications to deployed forces, is the Tri-Service Tactical Communications (TRI-TAC) system. A description of TRITAC's family of equipment, network topology, typical employment, and critical limitations is presented in this thesis. Five commercial Mobile Satellite Services (MSS) are described as viable candidates for augmenting existing communications systems. Cellular design principles such as frequency reuse, cell splitting, channel access methods, and propagation factors are also addressed. Finally, a framework for comparison of the candidate MSS systems is proposed as a baseline for further studies into the most beneficial implementation of PCS into theater deployable communications systems for the future.

Improvisational Theater Games: Performatory Team-Building Activities

ERIC Educational Resources Information Center

Ingalls, Joan S.

2018-01-01

This article describes five improvisational theater games for building "teams" in the classroom and on the sports field. Particular attention is given to understanding how teams must challenge the hyper-individuality of modern culture. Improvisational theater games for team building are designed to help participants find a balance…

Medical Situational Awareness in Theater Advanced Concept Technology Demonstration Project Proposal

DTIC Science & Technology

2004-06-01

making it an impossible task to sort, understand , and generate actionable knowledge within operational timeframes. Medical Situational Awareness in...need for greater medical situation awareness in theater and for greater integration of theater medical information into the net-centric rapid...There is a need for greater Medical Situation Awareness in theater and for greater integration of theater medical information into the ForceNet

From National to Theater: Developing Strategy

DTIC Science & Technology

2013-01-01

operational planning as it guides the development of the Theater Campaign Plan ( TCP ). Theater strategy, and the TCP that operationalizes it, should offer...doctrine or other guidance on developing it. Perhaps this is a contributing factor in Charles Bouchat’s observation that “No two combatant commands...approach to TCPs and country-level planning that considers ongoing security cooperation efforts, current operations, the Phase 0 component of con

Can the Army Provide Bulk Petroleum Support to Joint Force 2020?

DTIC Science & Technology

2013-03-01

Petroleum Officer (JPO) and one or more Sub Area Petroleum Officers ( SAPO ). The JPO coordinates petroleum support to all forces in a theater on behalf...position is the SAPO , established by the Combatant Commander or a Joint Force Commander (JFC) to fulfill bulk petroleum planning and execution in a...section of the theater for which the JPO is responsible.7 A key duty of the SAPO is to advise the JFC and his/her staff on petroleum logistics

Science Theater as an Interpretive Technique in a Science Museum.

ERIC Educational Resources Information Center

Black, Dana Riley; Goldowsky, Alexander

This paper investigates high school students' reactions to the science theater play "Mapping the Soul," which was developed by the Museum of Science in Boston, Massachusetts. Science theater is both an educational technique and a type of museum theater. This study explores these questions: (1) Do students differentiate learning science from…

On the acoustics of ancient Greek and Roman theaters.

PubMed

Farnetani, Andrea; Prodi, Nicola; Pompoli, Roberto

2008-09-01

The interplay of architecture and acoustics is remarkable in ancient Greek and Roman theaters. Frequently they are nowadays lively performance spaces and the knowledge of the sound field inside them is still an issue of relevant importance. Even if the transition from Greek to Roman theaters can be described with a great architectural detail, a comprehensive and objective approach to the two types of spaces from the acoustical point of view is available at present only as a computer model study [P. Chourmouziadou and J. Kang, "Acoustic evolution of ancient Greek and Roman theaters," Appl. Acoust. 69, re (2007)]. This work addresses the same topic from the experimental point of view, and its aim is to provide a basis to the acoustical evolution from Greek to Roman theater design. First, by means of in situ and scale model measurements, the most important features of the sound field in ancient theaters are clarified and discussed. Then it has been possible to match quantitatively the role of some remarkable architectural design variables with acoustics, and it is seen how this criterion can be used effectively to define different groups of ancient theaters. Finally some more specific wave phenomena are addressed and discussed.

Pitfalls in penetrating thoracic trauma (lessons we learned the hard way...).

PubMed

Degiannis, Elias; Zinn, Richard Joseph

2008-10-01

The majority of patients with penetrating thoracic trauma are managed non-operatively. Those requiring surgery usually go to theater with physiological instability. The critical condition of these patients coupled with the rarity of penetrating thoracic trauma in most European countries makes their surgical management challenging for the occasional trauma surgeon, who is usually trained as a general surgeon. Most general surgeons have a general knowledge of basic cardiothoracic operative surgery, knowledge originating from their training years and possibly enhanced by reading operative surgery textbooks. Unfortunately, the details included in most of these books are not extensive enough to provide him with enough armamentaria to tackle the difficult case. In this anatomical region, their operative dexterity and knowledge cannot be compared to that of their cardiothoracic colleagues, something that is taken for granted in their cardiothoracic trauma textbooks. Techniques that are considered basic and easy by the cardiothoracic surgeons can be unfamiliar and difficult to general surgeons. Knowing the danger points and the pitfalls that will be encountered in cardiothoracic trauma surgery will help them to avoid intraoperative errors and improve patient outcome. The purpose of this manuscript is to highlight the commonly encountered pitfalls by trauma surgeons operating on penetrating trauma to the chest.

Library Programs for Teens: Mystery Theater. VOYA Guides

ERIC Educational Resources Information Center

Siwak, Karen J.

2010-01-01

It's no mystery that fun and exciting programs bring teens into the library. Theater programs provide a venue for teens to express themselves creatively, encourage their participation in library programming, and offer them the opportunity for lively interaction with peers and adults. In "Library Programs for Teens: Mystery Theater," Karen Siwak…

The Role of the Teacher in Reader's Theater Instruction

ERIC Educational Resources Information Center

Rasisnski, Timothy; Stokes, Faida; Young, Chase

2017-01-01

Reader's Theater is a transformative and influential instructional tool for reading with far-reaching benefits for all students. Teachers are critical players in the use of Readers Theater in classroom; the effects of Reader's Theater are a direct result of a teacher's involvement. These effects include an increase in word recognition, fluency,…

Latino Teen Theater: A Theater Intervention to Promote Latino Parent-Adolescent Sexual Communication.

PubMed

Noone, Joanne; Castillo, Nancy; Allen, Tiffany L; Esqueda, Teresa

2015-01-01

Latina teen pregnancy rates continue to be a health disparity in the United States. This study evaluated a parenting intervention using interactive theater to facilitate Latino parent-adolescent communication about sexuality and pregnancy prevention. The intervention, conducted in Spanish and with teen actors, consisted of scenes involving the audience. Fifty-nine parents participated in this 3-month prospective study. Spanish measures of comfort with communication, general communication, and parent-child sexual communication were employed comparing paired t tests for each scale. Acceptability of the intervention was assessed and demonstrated. Eighty-six percent of parents used information from the performance to talk to their child. Improvements in general communication (p < .02), sexual communication (p < .001), and comfort (p < .001) occurred. Interactive theater is an innovative approach to facilitate Latino parent communication about sexuality and pregnancy prevention.

Treasured Texas Theaters

ERIC Educational Resources Information Center

Horton, Anita

2012-01-01

Dallas artist Jon Flaming's deep love of Texas is evident in his paintings and sculpture. Although he has created one sculptural Texas theater, his work primarily showcases old Texas barbershops, vacant homes, and gas stations. In this article, the author describes how her students, inspired by Flaming's works, created three-dimensional historical…

Archetypal Dreams: the Quantum Theater of Robert Wilson

NASA Astrophysics Data System (ADS)

Dietrich, Dawn Yvette

1992-01-01

My topic is situated within the larger framework of interdisciplinary study currently exploring the impact of new physics on various "soft" disciplines and sciences. Aligning myself with thinkers like Fritjof Capra and N. Katherine Hayles, who argue that quantum mechanics has brought about a new paradigm for the conceptualization of the physical world and our relation to it, I demonstrate that there is a connection, a kind of cultural translation, which relates contemporary physics to some avant-garde theater. Specifically, I center my research on American theater designer, Robert Wilson, who, recognized for his manipulation of the formal elements of stagecraft, owes much to the reconstruction of principles governing space and time. Taken further, I maintain that it is through the paradigm established from relativity theory and quantum mechanics that Wilson experiments with the elementary "forces" of the theater itself. This "restructuring" occurs through the dramatist's conceptions of space and time and the relation of those properties to both performers and spectators. Unlike most conventional theater, but as in many contemporary visual arts, time is manipulated through spatial metaphors and events take place in an amplified space--effecting a kind of dramatic space/time. Through manipulation of scale, the exploration of discontinuous time, and segregated stage zones, Wilson demonstrates that theater time is fluid and that it is not necessary for dramatic action to take place within the unified stage space delineated by the proscenium itself. Unlike conventional theater, where the stage is constructed with one perspective in mind, Wilson's theatrical mise-en-scene--a kind of new "perceptual field"--requires "imaginative watching"; that is, more perceptual discrimination from the audience who must sort and organize the visual material, highlighting the essential while reconfiguring the incidental. And this is where the myth is born, where archetypal dreams stir

Live theater on a virtual stage: incorporating soft skills and teamwork in computer graphics education.

PubMed

Schweppe, M; Geigel, J

2011-01-01

Industry has increasingly emphasized the need for "soft" or interpersonal skills development and team-building experience in the college curriculum. Here, we discuss our experiences with providing such opportunities via a collaborative project called the Virtual Theater. In this joint project between the Rochester Institute of Technology's School of Design and Department of Computer Science, the goal is to enable live performance in a virtual space with participants in different physical locales. Students work in teams, collaborating with other students in and out of their disciplines.

Safe haven laws as crime control theater.

PubMed

Hammond, Michelle; Miller, Monica K; Griffin, Timothy

2010-07-01

This article examines safe haven laws, which allow parents to legally abandon their infants. The main objective is to determine whether safe haven laws fit the criteria of crime control theater, a term used to describe public policies that produce the appearance, but not the effect, of crime control, and as such are essentially socially constructed "solutions" to socially constructed crime "problems." The analysis will apply the principles of crime control theater to safe haven laws. Specifically, the term crime control theater applies to laws that are reactionary responses to perceived criminal threats and are often widely supported as a way to address the crime in question. Such laws are attractive because they appeal to mythic narratives (i.e., saving an innocent child from a predator); however they are likely ineffective due to the complexity of the crime. These laws can have deleterious effects when policymakers make false claims of success and stunt public discourse (e.g., drawing attention away from more frequent and preventable crimes). This analysis applies these criteria to safe haven laws to determine whether such laws can be classified as crime control theater. Many qualities inherent to crime control theater are present in safe haven laws. For example, the laws are highly publicized, their intentions lack moral ambiguity, rare cases of success legitimize law enforcement and other agencies, and they appeal to the public sense of responsibility in preventing crime. Yet the goal of saving infant lives may be unattainable. These qualities make the effectiveness of the laws questionable and suggest they may be counterproductive. This analysis determined that safe haven laws are socially constructed solutions to the socially constructed problem of child abandonment. Safe haven laws are appropriately classified as crime control theater. It is imperative that further research be conducted to examine the effectiveness and collateral effects of safe haven laws

Organizational Courage: Following Through on Enabling Transformation Innovations in Theater

DTIC Science & Technology

2013-03-01

Chiefs of Staff, August 11, 2011), i. 24 John Bonin , “Army Theater Capabilities,” briefing slides with notes (Carlisle Barracks, PA: U.S. Army War...2011), C-2. 30U.S. Department of the Army, Theater Army Operations, 1-8. 31 Bonin , “Army Theater Capabilities,” Slide 41. 32 Ibid., 1-11. 29...of the Nation-a01611685069 (accessed March 11, 2013). 38 John Bonin , interview by author, Carlisle, PA, April 3, 2013; U.S. Department of the Army

Do Transsacral-transiliac Screws Across Uninjured Sacroiliac Joints Affect Pain and Functional Outcomes in Trauma Patients?

PubMed

Heydemann, John; Hartline, Braden; Gibson, Mary Elizabeth; Ambrose, Catherine G; Munz, John W; Galpin, Matthew; Achor, Timothy S; Gary, Joshua L

2016-06-01

Patients with pelvic ring displacement and instability can benefit from surgical reduction and instrumentation to stabilize the pelvis and improve functional outcomes. Current treatments include iliosacral screw or transsacral-transiliac screw, which provides greater biomechanical stability. However, controversy exists regarding the effects of placement of a screw across an uninjured sacroiliac joint for pelvis stabilization after trauma. Does transsacral-transiliac screw fixation of an uninjured sacroiliac joint increase pain and worsen functional outcomes at minimum 1-year followup compared with patients undergoing standard iliosacral screw fixation across the injured sacroiliac joint in patients who have sustained pelvic trauma? All patients between ages 18 and 84 years who sustained injuries to the pelvic ring (AO/OTA 61 A, B, C) who were surgically treated between 2011 and 2013 at an academic Level I trauma center were identified for selection. We included patients with unilateral sacroiliac disruption or sacral fractures treated with standard iliosacral screws across an injured hemipelvis and/or transsacral-transiliac screws placed in the posterior ring. Transsacral-transiliac screws were generally more likely to be used in patients with vertically unstable sacral injuries of the posterior ring as a result of previous reports of failures or in osteopenic patients. We excluded patients with bilateral posterior pelvic ring injuries, fixation with a device other than a screw, previous pelvic or acetabular fractures, associated acetabular fractures, and ankylosing spondylitis. Of the 110 patients who met study criteria, 53 (44%) were available for followup at least 12 months postinjury. Sixty patients were unable to be contacted by phone or mail and seven declined to participate in the study. Outcomes were obtained by members of the research team using the visual analog scale (VAS) pain score for both posterior sacroiliac joints, Short Musculoskeletal Functional

In-theater piracy: finding where the pirate was

NASA Astrophysics Data System (ADS)

Chupeau, Bertrand; Massoudi, Ayoub; Lefèbvre, Frédéric

2008-02-01

Pirate copies of feature films are proliferating on the Internet. DVD rip or screener recording methods involve the duplication of officially distributed media whereas 'cam' versions are illicitly captured with handheld camcorders in movie theaters. Several, complementary, multimedia forensic techniques such as copy identification, forensic tracking marks or sensor forensics can deter those clandestine recordings. In the case of camcorder capture in a theater, the image is often geometrically distorted, the main artifact being the trapezoidal effect, also known as 'keystoning', due to a capture viewing axis not being perpendicular to the screen. In this paper we propose to analyze the geometric distortions in a pirate copy to determine the camcorder viewing angle to the screen perpendicular and derive the approximate position of the pirate in the theater. The problem is first of all geometrically defined, by describing the general projection and capture setup, and by identifying unknown parameters and estimates. The estimation approach based on the identification of an eight-parameter homographic model of the 'keystoning' effect is then presented. A validation experiment based on ground truth collected in a real movie theater is reported, and the accuracy of the proposed method is assessed.

The Reserve Forces Impact on Theater Security Cooperation

DTIC Science & Technology

2013-03-01

in South America there are needs for purification is spoiled water, prophylactics, and typhoid , malaria, and yellow fever vaccines. Professions...Theater Security Cooperation (TSC) is a Phase 0 ( shaping ) instrument of regional commanders and is applied with the intent of precluding the use of...military force. The U.S. Army War College (USAWC) Theater Campaign Planning Handbook describes Phase 0 operations as “those shaping activities

A Database Design and Development Case: Home Theater Video

ERIC Educational Resources Information Center

Ballenger, Robert; Pratt, Renee

2012-01-01

This case consists of a business scenario of a small video rental store, Home Theater Video, which provides background information, a description of the functional business requirements, and sample data. The case provides sufficient information to design and develop a moderately complex database to assist Home Theater Video in solving their…

Minimalist Theater and the Classroom: Some Experiments with Shakespeare and Beckett.

ERIC Educational Resources Information Center

Homan, Sidney

1990-01-01

Argues in favor of using minimalist theater when teaching literature. Describes how minimalist theater was used to teach works by William Shakespeare and Samuel Beckett to undergraduate students. (PRA)

Pacific Theater Operations

DTIC Science & Technology

2011-01-01

Pacific theater, the 311th SC (T) is the Army’s IT service provider. They execute the activities associated with network operation , management , and...processes, and infrastructure responsible for the operation , management and health of the network under a single, administrative control entity. The...all other 311th operational entities to execute the NSC operational concept. They are primarily responsible for the technical operation

The First Afro-American Theater

ERIC Educational Resources Information Center

Molette, Carlton W., II

1970-01-01

Article focuses on the pre-Civil War black theater, and sees narrative story telling, story telling in dialogue form, persuasive speeches, sermons, song, dance, and instrumental music as part of the black theatrical heritage. (KG)

A Young Orphan Finds His "Voice" in the Theater.

ERIC Educational Resources Information Center

Morse, Richard

2001-01-01

Describes the author's experiences in Santa Cruz, Bolivia creating a theater program in an orphanage. Notes how Gueddy, a deaf boy, worked his way into the drama program and was very successful finding his "voice" in theater. Concludes that Gueddy is now the star of the orphanage, the talk of the town, and front page news in Bolivia. (SG)

"A Perfect Murder": An (Imperfect) School Theater Program Model

ERIC Educational Resources Information Center

Simon, Nicole S.; Grosso, Andrew

2009-01-01

Over the last five years, the Urban Assembly School for Law and Justice (SLJ), a new, small public high school in Brooklyn, and The Essentials, a professional theater company, have joined forces to offer a low-budget, high-quality, in-house afterschool theater program for SLJ students. Both SLJ and The Essentials were in nascent stages when the…

Using theater of the oppressed to prevent sexual violence on college campuses.

PubMed

Christensen, M Candace

2013-10-01

Using theater of the oppressed as a practice method in sexual assault prevention interventions with college students is gaining in popularity. Theater of the oppressed interventions aims to change values and norms that perpetuate the acceptability of sexual assault and teach college students how to intervene in situations where sexual violence may occur. In this review, the author reviews the literature on using theater for social change as a prevention intervention. The aim of the article is to provide a synthesis of empirical studies investigating the effects and impact of using theater for social change in prevention education. Based upon this synthesis, implications for practice, policy, and research are provided.

Gestion theatrale (Theater Management)

ERIC Educational Resources Information Center

Dubuc, Robert

1977-01-01

A comparison of American and British language of the theater. A conclusion noted is that there exists parrallel vocabulary in the United States and Great Britain. The terms studied are: director, producer, stage director, stage manager, assistant stage manager, artistic director. A glossary is appended. (Text is in French.) (AMH)

Learning from Live Theater

ERIC Educational Resources Information Center

Greene, Jay P.; Hitt, Collin; Kraybill, Anne; Bogulski, Cari A.

2015-01-01

Culturally enriching field trips matter. They produce significant benefits for students on a variety of educational outcomes that schools and communities care about. This experiment on the effects of field trips to see live theater demonstrates that seeing plays is an effective way to teach academic content; increases student tolerance by…

Adapt or Perish: Aeromedical Evacuation in the Contested Air Space of the Pacific Theater

DTIC Science & Technology

2016-08-01

AE elements and planning assistance to the theater , in intermediate supporting theaters , or in the U.S.”42 Further, AE forces are modular in design ...AIR SPACE OF THE PACIFIC THEATER by Lee O. Knoell, Captain, USAF, MSC A Research Report Submitted to the Faculty In Partial Fulfillment of...Denial (A2/AD) capabilities in the Pacific Theater . This project explores the interrelations between the Air Force Total Force, the AE community, and

Photocopy of drawing (original drawing of War Department Theater in ...

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

Photocopy of drawing (original drawing of War Department Theater in possession of MacDill Air Force Base, Civil Engineering, Tampa, Florida; 1940 architectural drawings by Construction Division, Office of the Quartermaster General)STRUCTURAL - FOUNDATIONS - MacDill Air Force Base, Base Theater, 2420 Florida Keys Avenue, Tampa, Hillsborough County, FL

Photocopy of drawing (original drawing of War Department Theater in ...

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

Photocopy of drawing (original drawing of War Department Theater in possession of MacDill Air Force Base, Civil Engineering, Tampa, Florida; 1940 architectural drawings by Construction Division, Office of the Quartermaster General) EXTERIOR ELEVATIONS - MacDill Air Force Base, Base Theater, 2420 Florida Keys Avenue, Tampa, Hillsborough County, FL

Feasibility of comparing core data from existing trauma registries in scandinavia. Reaching for a Scandinavian major trauma outcome study (MTOS).

PubMed

Ringdal, K G; Lossius, H M

2007-01-01

The organisation of trauma care in Scandinavia has several similarities, including trauma registries, but so far there are limited amount of research on efficiency and outcome. Data and results from trauma outcome studies like the US MTOS are not fully applicable to the Scandinavian trauma population. To reveal the feasibility of using data from existing trauma registries of major hospitals in Scandinavia, for a minimal common dataset, in a joint, prospective Scandinavian MTOS. We collected data points, data point definitions, and inclusion/exclusion criteria, from the major trauma registries of the Swedish trauma registry standard, three university hospitals in Denmark, one university hospital in Finland, and the Norwegian National Trauma Registry. The collected material was compared to reveal common data points, inclusion criteria, and the compatibility of data point definitions. The median number of data points was 147 (range 71-257; interquartile range = 90-205). Most registries lacked precise data definition catalogues. Only 16 data points could be considered as common, of which just a few were core trauma data. Four data points had the same data category options but were not considered having the same data point definitions. The inclusion criteria were not uniform. Trauma registries in Scandinavia have few common core data and data point definitions. There were data points for calculating the Trauma and Injury Severity Score (TRISS) but the inclusion criteria varied too much to ensure a valid comparison. A consensus process for a joint trauma core data set will be initiated by the Scandinavian Networking Group for Trauma and Emergency Management (SCANTEM) to increase research on trauma efficiency and outcome.

Theater and Psychological Development: Assessing Socio-Cognitive Complexity in the Domain of Theater

ERIC Educational Resources Information Center

Silva, José Eduardo; Ferreira, Pedro; Coimbra, Joaquim Luís; Menezes, Isabel

2017-01-01

Theater is a millenary art form that has stably maintained its minimum indispensable elements over the years. Yet, not much is known about the psychological impact of this performing art. A literature review shows a broad and sometimes contradictory spectrum of theoretical and empirical evidence. In the last few decades, however, interdisciplinary…

Implementing a Foot-Screening Clinic for University Musical Theater Students: A Pilot Program

ERIC Educational Resources Information Center

Ford, Lyndsey; Schmieg, Rose

2014-01-01

Musical theater is a unique genre within the field of the performing arts. Research of injury epidemiology and treatment efficacy is growing in the field of dance, but little is published specific to the field of musical theater. One study has reported that injury rates in musical theater are high and that injuries occur often to the foot and…

A Theater-as-Education Project Discourages Tobacco and Alcohol Use

ERIC Educational Resources Information Center

Bell-Ellison, Bethany A.; Forthofer, Melinda S.; McDermott, Robert J.; Zapata, Lauren B.; Nearns, Jodi L.; Curran, K. T.; Calkins, Susan A.; Bryant, Carol A.; McCormack Brown, Kelli R.

2009-01-01

Theater has been used as an educational tool since the Great Depression era, and it is currently considered an effective tool for health promotion and reducing risk-taking behaviors among youth. Theater projects are well suited for communicating prevention messages to youth audiences because they can depict real-life settings and characters who…

Lord Street Theater Journal: At-Risk Youth and Performance Art.

ERIC Educational Resources Information Center

Salazar, Laura Gardner

1998-01-01

Describes a theater in Port-of-Spain developed by a recovered drug user and advertising executive to provide a safe and interesting environment for recovering drug users. Discusses the methods used to engage the participants in learning about theater. Offers a chronological recounting of the class and describes participants' reactions to various…

Photocopy of drawing (original drawing of War Department Theater in ...

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

Photocopy of drawing (original drawing of War Department Theater in possession of MacDill Air Force Base, Civil Engineering, Tampa, Florida; 1940 architectural drawings by Construction Division, Office of the Quartermaster General) FIRST FLOOR AND CEILING PLAN - MacDill Air Force Base, Base Theater, 2420 Florida Keys Avenue, Tampa, Hillsborough County, FL

Photocopy of drawing (original drawing of War Department Theater in ...

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

Photocopy of drawing (original drawing of War Department Theater in possession of MacDill Air Force Base, Civil Engineering, Tampa, Florida; 1940 architectural drawings by Construction Division, Office of the Quartermaster General) FLOOR PLAN AND BENCH DETAILS - MacDill Air Force Base, Base Theater, 2420 Florida Keys Avenue, Tampa, Hillsborough County, FL

Environmental quality of the operating theaters in Campania Region: long lasting monitoring results.

PubMed

Triassi, M; Novi, C; Nardone, A; Russo, I; Montuori, P

2015-01-01

The health risk level in the operating theaters is directly correlated to the safety level offered by the healthcare facilities. This is the reason why the national Authorities released several regulations in order to monitor better environmental conditions of the operating theaters, to prevent occupational injuries and disease and to optimize working conditions. For the monitoring of environmental quality of the operating theaters following parameters are considered: quantity of supplied gases, anesthetics concentration, operating theatres volume measurement, air change rate, air conditioning system and air filtration. The objective is to minimize the risks in the operating theaters and to provide the optimal environmental working conditions. This paper reports the environmental conditions of operating rooms performed for several years in the public hospitals of the Campania Region. Investigation of environmental conditions of 162 operating theaters in Campania Region from January 2012 till July 2014 was conducted. Monitoring and analysis of physical and chemical parameters was done. The analysis of the results has been made considering specific standards suggested by national and international regulations. The study showed that 75% of the operating theaters presented normal values for microclimatic monitoring, while the 25% of the operating theaters had at least one parameter outside the limits. The monitoring of the anesthetics gases showed that in 9% of measurements of nitrous oxides and 4% of measurements of halogenated was not within the normal values.

Embodied Knowledge and Decolonization: Walking with Theater's Powerful and Risky Pedagogy

ERIC Educational Resources Information Center

Butterwick, Shauna; Selman, Jan

2012-01-01

Theater processes can powerfully connect mind, body, and emotions, providing opportunities and spaces for transformation. Based in stories from the authors' disparate but complementary practices, they focus here on facilitators' ethical responsibilities when bringing theater activities to processes of critical deconstruction of oppressive…

The Evolution of the Motion Picture Theater Business in the 1980s.

ERIC Educational Resources Information Center

Guback, Thomas

1987-01-01

Assesses the status of the movie theater business during the past seven years, which has seen major changes in production, distribution, types of theaters, seating capacity, and the general media landscape. (NKA)

Theater as a tool to educate African Americans about breast cancer.

PubMed

Livingston, Jonathan N; Smith, Nina P; Mills, Catherine; Singleton, Dorothy M; Dacons-Brock, Karen; Richardson, Ricardo; Grant, Delores; Craft, Howard; Harewood, Ken

2009-01-01

The current study examines the effectiveness of theater in educating African American women about breast cancer. Four hundred and forty-eight participants viewed a play entitled Stealing Clouds. Employing a retrospective/pre-post test design and paired sample t tests, researchers assessed the effectiveness of theater in increasing participants' knowledge about breast cancer and likelihood of participating in efforts to address and reduce breast cancer disparities. Results indicated that the play succeeded in increasing knowledge and awareness about breast cancer and intentions to improve health related behaviors. Findings suggest that theater may be an effective tool in educating African Americans about breast cancer.

The Western Pacific Theater of Operations: A Brewing Showdown

DTIC Science & Technology

2016-06-01

jet designer avoids Americas mistakes,” From War is Boring, August, 2015. 33 China’s Cyber-Theft Jet Fighter, The Wall Street Journal, 12 November...AU/ACSC/2016 AIR COMMAND AND STAFF COLLEGE DISTANCE LEARNING AIR UNIVERSITY “THE WESTERN PACIFIC THEATER OF OPERATIONS: A BREWING SHOWDOWN...in the Asia Pacific. 2 The Nature of the Problem The US has lost a modicum of dominance in portions of the Western Pacific Theater of

Command and Control for Joint Air Operations

DTIC Science & Technology

2010-01-12

systems, to include collaborative air planning tools such as the theater battle management core system ( TBMCS ). Operational level air planning occurs in...sight communications and data exchange equipment in order to respond to joint force requirements. For example, the TBMCS is often used. The use of ATO...generation and dissemination software portions of TBMCS has been standardized. This ATO feature allows the JAOC to be interoperable with other

Development of a theater-based nutrition and physical activity intervention for low-income, urban, African American adolescents.

PubMed

Jackson, Caree J; Mullis, Rebecca M; Hughes, Marilyn

2010-01-01

Childhood overweight is disproportionately worse in minority and low-income populations. Theater is a promising and effective tool for delivering health education to these underserved populations, but no known studies have examined the use of theater to promote both nutrition and physical activity to minority youth. To develop an interactive, theater-based intervention that conveys health messages to low-income, urban, African Americans and engages them in learning ways to adopt a healthy lifestyle. Community partners worked to develop a theater-based nutrition and physical activity intervention. A focus group provided urban adolescents' thoughts about their desires for the intervention. Based on input from all community partners, the group created a theater-based intervention. Researchers used a quasi-experimental (pre-/posttest) design with a community-based participatory research (CBPR) approach. Participants learned health messages through theater, dance, and music and gave feedback on the program sessions and materials. The program ended with a dinner theater performance showcasing information that students learned during the intervention. Participants received six theater-based health lessons. Learning objectives for each health education session were achieved. Each participant contributed to and performed in the final performance. All program participants were highly satisfied with the theater-based method of learning health messages. A community-academic partnership succeeded in developing a theater-based nutrition and physical activity intervention that satisfied participating adolescents.

The power of theater to promote individual recovery and social change.

PubMed

Faigin, David A; Stein, Catherine H

2010-03-01

Although theatrical activities are used in a variety of therapeutic settings, little attention has been paid to the ways that theater can enhance the recovery process and community integration for people living with psychiatric disabilities. Community-based theater involving people with psychiatric disabilities offers unique opportunities for personal growth, social connection, and advocacy efforts. This Open Forum posits that theater has the power to both facilitate individual recovery and improve the social conditions of people living with mental illness. Critical elements of theatrical activities that relate to processes of recovery and community integration are examined. Implications for future research and program development are discussed.

PERSPECTIVE VIEW OF FRONT ELEVATION OF PYTHIAN TEMPLE/NEW GRANADA THEATER ...

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

PERSPECTIVE VIEW OF FRONT ELEVATION OF PYTHIAN TEMPLE/NEW GRANADA THEATER FROM NORTHEAST. THIS 1927 STRUCTURE WAS DESIGNED BY ARCHITECT LOUIS A. BELLINGER FOR THE KNIGHTS OF PYTHIAS. IT WAS CONVERTED INTO THE NEW GRANADA THEATER DURING THE 1930S. - Pythian Temple, 2007-2013 Centre Avenue, Pittsburgh, Allegheny County, PA

Using Theater to Teach Clinical Empathy: A Pilot Study

PubMed Central

Leong, David; Anderson, Aaron; Wenzel, Richard P.

2007-01-01

Background Clinical empathy, a critical skill for the doctor–patient relationship, is infrequently taught in graduate medical education. No study has tested if clinical empathy can be taught effectively. Objective To assess whether medicine residents can learn clinical empathy techniques from theater professors. Design A controlled trial of a clinical empathy curriculum taught and assessed by 4 theater professors. Setting Virginia Commonwealth University, Richmond, Virginia, a large urban university and health system. Participants Twenty Internal Medicine residents: 14 in the intervention group, 6 in the control group. Intervention Six hours of classroom instruction and workshop time with professors of theater. Measurements Scores derived from an instrument with 6 subscores designed to measure empathy in real-time patient encounters. Baseline comparisons were made using two-sample T tests. A mixed-effects analysis of variance model was applied to test for significance between the control and intervention groups. Results The intervention group demonstrated significant improvement (p ≤ .011) across all 6 subscores between pre-intervention and post-intervention observations. Compared to the control group, the intervention group had better posttest scores in 5 of 6 subscores (p ≤ .01). Limitations The study was neither randomized nor blinded. Conclusions Collaborative efforts between the departments of theater and medicine are effective in teaching clinical empathy techniques. PMID:17486385

A Randomized Controlled Trial of a Multi-Dose Bystander Intervention Program Using Peer Education Theater

ERIC Educational Resources Information Center

McMahon, Sarah; Winter, Samantha C.; Palmer, Jane E.; Postmus, Judy L.; Peterson, N. Andrew; Zucker, Sharon; Koenick, RuthAnne

2015-01-01

This article reports findings from a longitudinal, experimental evaluation of a peer education theater program, Students Challenging Realities and Educating Against Myths (SCREAM) Theater. This study examines the impact of SCREAM Theater on a range of bystander-related outcomes (i.e. bystander intentions, bystander efficacy, perception of friend…

Evaluation of urology residents' perception of surgical theater educational environment.

PubMed

Binsaleh, Saleh; Babaeer, Abdulrahman; Rabah, Danny; Madbouly, Khaled

2015-01-01

To evaluate surgical theater learning environment perception in urology residents in Saudi Arabia and to investigate association of learning environment perception and stages of residency program, sectors of health care system, and regions of Saudi Arabia. A cross-sectional survey using the surgical theater educational environment measure (STEEM) inventory. The STEEM inventory was used to measure theater learning environment perception of urology residents in Saudi Arabia. Respondents' perception was compared regarding different residency stages, sectors of the health care system, and regions of Saudi Arabia. Internal reliability of the inventory was assessed using the Cronbach α coefficient. Correlation analysis was done using the Spearman ρ coefficient. Of 72 registered residents, 33 (45.8%) completed the questionnaire. The residents perceived their environment less than acceptable (135.9 ± 16.7, 67.95%). No significant differences in perception were found among residents of different program stages, different sectors of health care system, or different regions in Saudi Arabia. Residents from the eastern region perceived the training and teaching domain better (p = 0.025). The inventory showed a high internal consistency with a Cronbach α of 0.862. STEEM survey is an applicable and reliable instrument for assessing the learning environment and training skills of urology residency program in Saudi Arabia. Urology residents in Saudi Arabia perceived the theater learning environment as less than ideal. The perceptions of theater learning environment did not change significantly among different stages of the program, different sectors of health care system, or different training regions of Saudi Arabia assuring the uniformity of urology training all over Saudi Arabia. The training programs should address significant concerns and pay close attention to areas in surgical theater educational environment, which need development and enhancement, mainly planned fashion

Soul and Musical Theater: A Comparison of Two Vocal Styles.

PubMed

Hallqvist, Hanna; Lã, Filipa M B; Sundberg, Johan

2017-03-01

The phonatory and resonatory characteristics of nonclassical styles of singing have been rarely analyzed in voice research. Six professional singers volunteered to sing excerpts from two songs pertaining to the musical theater and to the soul styles of singing. Voice source parameters and formant frequencies were analyzed by inverse filtering tones, sung at the same fundamental frequencies in both excerpts. As compared with musical theater, the soul style was characterized by significantly higher subglottal pressure and maximum flow declination rate. Yet sound pressure level was lower, suggesting higher glottal resistance. The differences would be the effects of firmer glottal adduction and a greater frequency separation between the first formant and its closest spectrum partial in soul than in musical theater. Copyright © 2017 The Voice Foundation. Published by Elsevier Inc. All rights reserved.

Survey of health problems in musical theater students: a pilot study.

PubMed

Wanke, Eileen M; Kunath, Esther K; Koch, Franziska; Davenport, Jaqueline; Weisser, Burkhard; Groneberg, David A; Mache, Stefanie; Endres, Eva; Vitzthum, Karin

2012-12-01

Musical theater performers are the "triathletes" in the performing arts. The field requires versatility in a combination of skills including dancing, singing, and drama in a high frequency of performances. The aim of this study was to analyze and evaluate the health situation of musical theater students using a complete musical educational institute as an example (n = 37). The basis for the evaluation was a questionnaire survey (standardized F 1000). All students of the school participated (20 males, 17 females). Of the students, 62% have a part-time job for financial reasons, and 67.7% state only a "partial satisfaction" with their body. Regarding injury, 45.9% claim to sustain an orthopaedic injury up to twice a year, and 29.7% up to three or four times. A total of 49 acute injuries (1.3/student) and 42 chronic complaints (1.1/student) were stated. The lower extremity was the most common acutely injured region (65.3%), followed by the spine (16.3%) and upper extremity (14.3%). Of chronic complaints, the lumbar spine was the most commonly affected area, followed by the hip joint and pelvic area. Thirty-three and 24% of acute injuries occurred during "spins" and/or "stretching," respectively. There were various causes for physical and mental problems. The results show both parallels and differences to the relevant literature. It is shown that health hazards already arise in the education of musical performers. This provides particulars for the implementation of injury prevention measures during the theoretical and practical education of musical students.

Theaters and Auditoriums. Second Edition.

ERIC Educational Resources Information Center

Burris-Meyer, Harold; Cole, Edward C.

Facilities for the performing arts are examined as to associated problems and possible design solutions. Also included are auditoriums which may not be directly related to theater functions but have similar problems and needs. Existing facilities serve as a basis for the subsequent critical analysis of certain areas and development of optimal…

The Use of HDTV Format and the Electronic Theater in Presenting Earth Science

NASA Technical Reports Server (NTRS)

Summey, Barbara; Hasler, Arthur; Jentoft-Nilsen, Marit; Manyin, Michael; Bene, Meredith; Allen, Jesse

2000-01-01

In order to maximize the public's awareness of earth science observations, earth science data must be available in multiple media formats. This talk will focus on the use High Definition TV format in presenting earth science data, The Television (HDTV) networks are mandated to completely switch over from the current TV standard (NTSC) to HDTV in the next seven years. Museums are also beginning to use HDTV format in their displays. The Visualization Analysis Laboratory at Goddard Space Flight Center has been experimenting with the use of HDTV to present earth science data. The experimental package we have developed is called the Electronic Theater (e-theater). The e-theater is a mobile presentation system used for displaying and teaching groups about earth science and the delicate interdependence between the various earth systems. The e-theater takes advantage of a double-wide screen to show the audiences high resolution data displays. The unique architecture used in this exhibit allows several data sets to be displayed at one time, demonstrating the connections between different earth systems. The data animations are manipulated in real-time during the presentation and can be paused, moved forward, backward, looped, or zoomed into, to maximize the flexibility of the presentation. Because HDTV format is used within the e-theater, the materials generated for the e-theater are made available to the news media and museums.

Predeployment and in-theater diagnoses of American military personnel serving in Iraq.

PubMed

Larson, Gerald E; Hammer, Paul S; Conway, Terry L; Schmied, Emily A; Galarneau, Michael R; Konoske, Paula; Webb-Murphy, Jennifer A; Schmitz, Kimberly J; Edwards, Nathan; Johnson, Douglas C

2011-01-01

This purpose of this study was to determine the incidence and types of preexisting mental disorders among military personnel who received mental health services in an Iraqi war zone. The study examined psychiatric histories of 1,078 American military personnel (Marines, 65%; Army, 23%; Navy, 11%; and Air Force, <1%) deployed to Iraq and seen by in-theater mental health providers between January 2006 and February 2007. Among the 1,078 patients, the most frequent in-theater diagnoses were anxiety (24%), adjustment (23%), and mood (19%) disorders. Twenty-nine percent of the sample (N=308) had a psychiatric diagnosis in their medical records before their first encounter with mental health services in Iraq (Navy patients, 42%; Army patients, 39%; and Marine Corps patients, 23%). The mean time between last predeployment diagnosis and first in-theater mental health encounter was 21 months. For patients with a prior diagnosis, the highest rate of relapse (receipt of the same diagnosis in theater) was for attention-deficit hyperactivity disorder (57%), followed by anxiety disorders (44%)--especially posttraumatic stress disorder (PTSD) (55%)--mood disorders (38%), and adjustment disorders (32%). A significant proportion of military personnel who experienced mental health problems in a combat zone had preexisting psychiatric conditions. Because more than half of predeployment diagnoses were received in the nine months before the in-theater mental health encounter, further study may be advisable to determine whether a time-based algorithm for deployability is needed, particularly for PTSD, for which a high rate of repeat diagnosis in theater was found.

Vocal Qualities in Music Theater Voice: Perceptions of Expert Pedagogues.

PubMed

Bourne, Tracy; Kenny, Dianna

2016-01-01

To gather qualitative descriptions of music theater vocal qualities including belt, legit, and mix from expert pedagogues to better define this voice type. This is a prospective, semistructured interview. Twelve expert teachers from United States, United Kingdom, Asia, and Australia were interviewed by Skype and asked to identify characteristics of music theater vocal qualities including vocal production, physiology, esthetics, pitch range, and pedagogical techniques. Responses were compared with published studies on music theater voice. Belt and legit were generally described as distinct sounds with differing physiological and technical requirements. Teachers were concerned that belt should be taught "safely" to minimize vocal health risks. There was consensus between teachers and published research on the physiology of the glottis and vocal tract; however, teachers were not in agreement about breathing techniques. Neither were teachers in agreement about the meaning of "mix." Most participants described belt as heavily weighted, thick folds, thyroarytenoid-dominant, or chest register; however, there was no consensus on an appropriate term. Belt substyles were named and generally categorized by weightedness or tone color. Descriptions of male belt were less clear than for female belt. This survey provides an overview of expert pedagogical perspectives on the characteristics of belt, legit, and mix qualities in the music theater voice. Although teacher responses are generally in agreement with published research, there are still many controversial issues and gaps in knowledge and understanding of this vocal technique. Breathing techniques, vocal range, mix, male belt, and vocal registers require continuing investigation so that we can learn more about efficient and healthy vocal function in music theater singing. Copyright © 2016 The Voice Foundation. Published by Elsevier Inc. All rights reserved.

Image-guided laparoscopic surgery in an open MRI operating theater.

PubMed

Tsutsumi, Norifumi; Tomikawa, Morimasa; Uemura, Munenori; Akahoshi, Tomohiko; Nagao, Yoshihiro; Konishi, Kozo; Ieiri, Satoshi; Hong, Jaesung; Maehara, Yoshihiko; Hashizume, Makoto

2013-06-01

The recent development of open magnetic resonance imaging (MRI) has provided an opportunity for the next stage of image-guided surgical and interventional procedures. The purpose of this study was to evaluate the feasibility of laparoscopic surgery under the pneumoperitoneum with the system of an open MRI operating theater. Five patients underwent laparoscopic surgery with a real-time augmented reality navigation system that we previously developed in a horizontal-type 0.4-T open MRI operating theater. All procedures were performed in an open MRI operating theater. During the operations, the laparoscopic monitor clearly showed the augmented reality models of the intraperitoneal structures, such as the common bile ducts and the urinary bladder, as well as the proper positions of the prosthesis. The navigation frame rate was 8 frames per min. The mean fiducial registration error was 6.88 ± 6.18 mm in navigated cases. We were able to use magnetic resonance-incompatible surgical instruments out of the 5-Gs restriction area, as well as conventional laparoscopic surgery, and we developed a real-time augmented reality navigation system using open MRI. Laparoscopic surgery with our real-time augmented reality navigation system in the open MRI operating theater is a feasible option.

Space Weather Forecasting at the Joint Space Operations Center (JSpOC)

NASA Astrophysics Data System (ADS)

Nava, O.

2012-12-01

The Joint Space Operations Center (JSpOC) at Vandenberg Air Force Base is the command and control focal point for the operational employment of worldwide joint space forces. The JSpOC focuses on planning and executing US Strategic Command's Joint Functional Component Command for Space (JFCC SPACE) mission. Through the JSpOC, the Weather Specialty Team (WST) monitors space and terrestrial weather effects, plans and assesses weather impacts on military operations, and provides reach-back support for deployed theater solar and terrestrial needs. This presentation will detail how space weather affects the JSpOC mission set and how the scientific community can enhance the WST's capabilities and effectiveness.

An Alaskan Theater Airlift Model.

DTIC Science & Technology

1982-02-19

overt attack on American soil . In any case, such a reaotion represents the worst-case scenario In that theater forces would be denied the advantages of...NNSETNTAFE,SS(l06), USL (100), 7 TNET,THOV,1X(100) REAL A,CHKTIN INTEGER ORIC,DEST,ISCTMP,WXFLG,ALLW,T(RT,ZPTR,ZONE, * FTNFLG.WX,ZONLST(150) DATA ZNSI

Making Invisible Intersectionality Visible through Theater of the Oppressed in Teacher Education

ERIC Educational Resources Information Center

Powers, Beth; Duffy, Peter B.

2016-01-01

The arts generally and theater specifically offer effective strategies to help educators recognize and make visible the multiple student and teacher identities within classrooms. Without student and teacher agency in schools, there cannot be equitable and liberatory learning environments. Noted Brazilian theater artist and activist Augusto Boal's…

Caribbean and Central American Women's Feminist Inquiry through Theater-Based Action Research

ERIC Educational Resources Information Center

Sánchez Ares, Rocío

2015-01-01

Feminist action research interrogates gendered dynamics in the development of a collective consciousness. A group of immigrant Latina women (Latinas) from the Caribbean and Central America employed community-based theater as an instrument to mobilize diverse audiences against discriminatory practices and policies. Based on their theater work, I…

Clinical effects of joint application of β-sodium aescinate and mannitol in treating early swelling after upper limb trauma surgery.

PubMed

Wang, Bin; Yang, Ruixiang; Ju, Qing; Liu, Shaofeng; Zhang, Yongchun; Ma, Yong

2016-11-01

The aim of the present study was to examine the clinical merits of joint application of β-sodium aescinate and mannitol for the treatment of early swelling of upper limb trauma after surgery. We verified whether the expression of serum aquaporin 1 (AQP-1) was involved in swelling mechanism. A total of 102 patients with swelling after upper limb trauma surgery were enrolled into the study and divided randomly into 3 groups (n=34 cases per group). Group A was treated with β-sodium aescinate; group B was treated with with mannitol and group C was treated with both β-sodium aescinate and mannitol. The expression level of AQP-1, and clinical effects and complications before and after treatment were compared§. The time of swelling subsidence in group C was significantly shorter than that of the other two groups and differences were statistically significant (P<0.05). The recovery ratio and total efficiency in group C were significantly higher than those in other two groups and differences were statistically significant (P<0.05). Three and seven days after treatment, the AQP-1 levels in group A and group C were decreased and AQP-1 level decreased further with time. Differences of comparison within groups were statistically significant (P<0.05), although the differences of comparison between the groups showed no statistical significance (P>0.05). We also compared the AQP-1 level in group B before and after treatment, and the differences were not statistically significant (P>0.05). When the complication incidence in the 3 groups was compared, no statistical significance was detected (P>0.05). We concluded that the joint use of β-sodium aescinate and mannitol in treating early swelling after upper limb trauma surgery produced satisfactory outcomes. This might be related to reduction of the AQP-1 level.

Oral Interpretation of Literature: Readers' Theater

ERIC Educational Resources Information Center

Kennedy, Joan

2011-01-01

The pedagogical principle of experiential learning embodied in the oral interpretation of literature through Readers' Theater provides an avenue to accomplish a seemingly daunting task. Students' participation in reading, interpreting, discussing, writing, assessing, and performing their own creative responses to a literary work promotes a…

Community-Based Collaboration with High School Theater Students as Standardized Patients

PubMed Central

Marks, Alla

2007-01-01

Objectives To describe a collaborative undertaking between a private school of pharmacy (Bernard J. Dunn School of Pharmacy) and a public high school (John Handley High School) in the development, and implementation of a partnership utilizing high school theater students as standardized patients. Methods High school theater students were trained to portray patients within the Standardized Patient Assessment Laboratory. The patient encounters were videotaped and evaluated by both peer and faculty members. Quantitative and qualitative analyses of semi-structured interviews, focus groups, post-encounter surveys of students and faculty members, and encounter grades were used to evaluate the outcomes. Results Pharmacy students exhibited competence in clinical assessment skills as evidenced by high encounter grades (91.5% ± 6.8%) and 100% positive faculty feedback. The high school theater students self-reported that their improvisational skills improved through learning patient conditions and behaviors. Both schools met their mission statement and accreditation goals, including increased collaboration with the community. Conclusion This model for collaboration between a school of pharmacy and a high school using adolescents as simulated patients was successful in creating a beneficial learning experience for both the theater and pharmacy students. PMID:17533438

Photocopy of drawing (original drawing of Theater886 Seats in possession ...

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

Photocopy of drawing (original drawing of Theater-886 Seats in possession of MacDill Air Force Base, Civil Engineering, Tampa, Florida; 1947 architectural drawings by Department of the Army, Office of the Chief Engineers, Director of Military Construction Engineering Division, Washington, D.C.) FIRST FLOOR PLAN, ROOF PLAN, AND DETAILS - MacDill Air Force Base, Base Theater, 2420 Florida Keys Avenue, Tampa, Hillsborough County, FL

Vital Signs and Physiologic Derangement in Patients With Thoracic Trauma in Iraq and Afghanistan.

PubMed

Keneally, Ryan J; Szpisjak, Dale F; Hoffmann, Paul J; Park, Edward J; Albergo, Michael S

2017-11-01

Triage is the act of stratifying the need for medical attention. Effective triage must account for injury patterns and severity. Personnel making triage decisions must also consider the patients' physiologic states. Vital signs can possibly be used to assess for the presence of physiological derangements such as coagulopathy, acidosis, or a significant base deficit. Providers could use this knowledge to assist with triage at casualty collection points where laboratory studies or point of care testing may not be available. With institutional approval, data were extracted from the Joint Theater Trauma Registry for all patients with thoracic trauma between 2002 and 2012. Patients were identified by International Statistical Classification of Diseases and Related Health Problems, 9th Revision (ICD-9) codes. Heart rate (HR), systolic blood pressure (SBP), and pulse pressure were correlated with coagulopathy (international normalization ratio ≥ 1.5), acidosis (pH < 7.2) or an elevated base deficit (>6) on admission. Sensitivity, specificity, positive predictive values, negative predictive values, and odds ratios were calculated. HR > 100, SBP < 90, or pulse pressure <30 were associated with an increased risk for acidosis (odds ratio 3.06 [95% confidence interval 2.48-3.78], 4.72 [3.85-5.78], and 2.73 [2.15-3.48], respectively), coagulopathy (2.21 [1.72-2.83], 4.55 [3.57-5.80], and 2.73 [2.15-3.48], respectively), and base deficit >6 (2.17 [1.88-2.50], 3.48 [2.87-4.22], and 2.22 [1.78-2.77], respectively). HR was a moderately sensitive marker (0.74), whereas SBP was a specific marker (0.93). SBP < 90 is an effective marker for ruling in physiologic derangement after thoracic trauma. HR > 100 was associated with over twice the odds for physiologic derangement. Vital signs can be used to assess for physiologic derangement in the population studied and may help in triage. Reprint & Copyright © 2017 Association of Military Surgeons of the U.S.

Have You Heard the Word? For a Low-Budget Way to Get Kids Wild about Reading, Try Readers Theater

ERIC Educational Resources Information Center

Avi

2009-01-01

In its simplest sense, readers theater is the presentation of written work in a dramatic format. The fundamental difference between readers theater and traditional theater is that performers read their lines. With readers theater there's no memorization, and usually there are no sets or costumes. There's also little or no stage movement. It's…

[Family-Based Trauma-Focused Cognitive Behavioral Therapy with Three Siblings of a Refugee Family].

PubMed

Bohnacker, Isabelle; Goldbeck, Lutz

2017-10-01

Family-Based Trauma-Focused Cognitive Behavioral Therapy with Three Siblings of a Refugee Family The possibility and relevance of a joint trauma-therapy with siblings has yet received little attention in research and clinical practice. The following case study presents a joint family-based trauma-focused therapy process with a refugee family. All three siblings suffered from post-traumatic stress disorder (PTSD) before treatment. The treatment followed the manual of Trauma Focused Cognitive Behavioral Therapy (TF-CBT; Cohen, Mannarino, Deblinger, 2009). Measures were the short version of the Child and Adolescent Trauma Screen (CATS 7-17), as well as the Teacher's Report Form (TRF). After 18 treatment sessions together with the mother, all three children did no longer meet PTSD criteria. Benefits of the joint therapy were for all three siblings to be sharing and imitating each other's coping strategies. Furthermore, the protective factor of social support after experiencing a traumatic event became evident. The apprehension of the therapist not being sufficiently neutral towards all three siblings was not observed.

Long-term consequences of repetitive brain trauma: chronic traumatic encephalopathy.

PubMed

Stern, Robert A; Riley, David O; Daneshvar, Daniel H; Nowinski, Christopher J; Cantu, Robert C; McKee, Ann C

2011-10-01

Chronic traumatic encephalopathy (CTE) has been linked to participation in contact sports such as boxing and American football. CTE results in a progressive decline of memory and cognition, as well as depression, suicidal behavior, poor impulse control, aggressiveness, parkinsonism, and, eventually, dementia. In some individuals, it is associated with motor neuron disease, referred to as chronic traumatic encephalomyelopathy, which appears clinically similar to amyotrophic lateral sclerosis. Results of neuropathologic research has shown that CTE may be more common in former contact sports athletes than previously believed. It is believed that repetitive brain trauma, with or possibly without symptomatic concussion, is responsible for neurodegenerative changes highlighted by accumulations of hyperphosphorylated tau and TDP-43 proteins. Given the millions of youth, high school, collegiate, and professional athletes participating in contact sports that involve repetitive brain trauma, as well as military personnel exposed to repeated brain trauma from blast and other injuries in the military, CTE represents an important public health issue. Focused and intensive study of the risk factors and in vivo diagnosis of CTE will potentially allow for methods to prevent and treat these diseases. Research also will provide policy makers with the scientific knowledge to make appropriate guidelines regarding the prevention and treatment of brain trauma in all levels of athletic involvement as well as the military theater. Copyright © 2011 American Academy of Physical Medicine and Rehabilitation. Published by Elsevier Inc. All rights reserved.

The Interface of Mechanics and Nociception in Joint Pathophysiology: Insights From the Facet and Temporomandibular Joints

PubMed Central

Sperry, Megan M.; Ita, Meagan E.; Kartha, Sonia; Zhang, Sijia; Yu, Ya-Hsin; Winkelstein, Beth

2017-01-01

Chronic joint pain is a widespread problem that frequently occurs with aging and trauma. Pain occurs most often in synovial joints, the body's load bearing joints. The mechanical and molecular mechanisms contributing to synovial joint pain are reviewed using two examples, the cervical spinal facet joints and the temporomandibular joint (TMJ). Although much work has focused on the macroscale mechanics of joints in health and disease, the combined influence of tissue mechanics, molecular processes, and nociception in joint pain has only recently become a focus. Trauma and repeated loading can induce structural and biochemical changes in joints, altering their microenvironment and modifying the biomechanics of their constitutive tissues, which themselves are innervated. Peripheral pain sensors can become activated in response to changes in the joint microenvironment and relay pain signals to the spinal cord and brain where pain is processed and perceived. In some cases, pain circuitry is permanently changed, which may be a potential mechanism for sustained joint pain. However, it is most likely that alterations in both the joint microenvironment and the central nervous system (CNS) contribute to chronic pain. As such, the challenge of treating joint pain and degeneration is temporally and spatially complicated. This review summarizes anatomy, physiology, and pathophysiology of these joints and the sensory pain relays. Pain pathways are postulated to be sensitized by many factors, including degeneration and biochemical priming, with effects on thresholds for mechanical injury and/or dysfunction. Initiators of joint pain are discussed in the context of clinical challenges including the diagnosis and treatment of pain. PMID:28056123

Impact of a TeamSTEPPS Trauma Nurse Academy at a Level 1 Trauma Center.

PubMed

Peters, V Kristen; Harvey, Ellen M; Wright, Andi; Bath, Jennifer; Freeman, Dan; Collier, Bryan

2018-01-01

Nurses are crucial members of the team caring for the acutely injured trauma patient. Until recently, nurses and physicians gained an understanding of leadership and supportive roles separately. With the advent of a multidisciplinary team approach to trauma care, formal team training and simulation has transpired. Since 2007, our Level I trauma system has integrated TeamSTEPPS (Team Strategies & Tools to Enhance Performance & Patient Safety; Agency for Healthcare Research and Quality, Rockville, MD) into our clinical care, joint training of nurses and physicians, using simulations with participation of all health care providers. With the increased expectations of a well-orchestrated team and larger number of emergency nurses, our program created the Trauma Nurse Academy. This academy provides a core of experienced nurses with an advanced level of training while decreasing the variability of personnel in the trauma bay. Components of the academy include multidisciplinary didactic education, the Essentials of TeamSTEPPS, and interactive trauma bay learning, to include both equipment and drug use. Once completed, academy graduates participate in the orientation and training of General Surgery and Emergency Medicine residents' trauma bay experience and injury prevention activities. Internal and published data have demonstrated growing evidence linking trauma teamwork training to knowledge and self-confidence in clinical judgment to team performance, patient outcomes, and quality of care. Although trauma resuscitations are stressful, high risk, dynamic, and a prime environment for error, new methods of teamwork training and collaboration among trauma team members have become essential. Copyright © 2017 Emergency Nurses Association. Published by Elsevier Inc. All rights reserved.

Pain management for blunt thoracic trauma: A joint practice management guideline from the Eastern Association for the Surgery of Trauma and Trauma Anesthesiology Society.

PubMed

Galvagno, Samuel Michael; Smith, Charles E; Varon, Albert J; Hasenboehler, Erik A; Sultan, Shahnaz; Shaefer, Gregory; To, Kathleen B; Fox, Adam D; Alley, Darrell E R; Ditillo, Michael; Joseph, Bellal A; Robinson, Bryce R H; Haut, Elliot R

2016-11-01

Thoracic trauma is the second most prevalent nonintentional injury in the United States and is associated with significant morbidity. Analgesia for blunt thoracic trauma was first addressed by the Eastern Association for the Surgery of Trauma (EAST) with a practice management guideline published in 2005. Since that time, it was hypothesized that there have been advances in the analgesic management for blunt thoracic trauma. As a result, updated guidelines for this topic using the GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) framework recently adopted by EAST are presented. Five systematic reviews were conducted using multiple databases. The search retrieved articles regarding analgesia for blunt thoracic trauma from January1967 to August 2015. Critical outcomes of interest were analgesia, postoperative pulmonary complications, changes in pulmonary function tests, need for endotracheal intubation, and mortality. Important outcomes of interest examined included hospital and intensive care unit length of stay. Seventy articles were identified. Of these, 28 articles were selected to construct the guidelines. The overall risk of bias for all studies was high. The majority of included studies examined epidural analgesia. Epidural analgesia was associated with lower short-term pain scores in most studies, but the quality and quantity of evidence were very low, and no firm evidence of benefit or harm was found when this modality was compared with other analgesic interventions. The quality of evidence for paravertebral block, intrapleural analgesia, multimodal analgesia, and intercostal nerve blocks was very low as assessed by GRADE. The limitations with the available literature precluded the formulation of strong recommendations by our panel. We propose two evidence-based recommendations regarding analgesia for patients with blunt thoracic trauma. The overall risk of bias for all studies was high. The limitations with the available literature

Audit of the Functioning of the Elective Neurosurgical Operation Theater in India: A Prospective Study and Review of Literature.

PubMed

Saikia, Amrit Kumar; Sriganesh, Kamath; Ranjan, Manish; Claire, Marie; Mittal, Mohit; Pandey, Paritosh

2015-08-01

Knowledge about the utilization of the operation theater (OT) is essential to improve its efficiency. This study evaluated the neurosurgical operation theater utilization in a neurosciences teaching hospital. Data collected included OT start time, delay in start, anesthesia induction time, surgical preparation time, anesthesia recovery time, operating time, time between cases, and theater closing time. Five hundred thirty-seven surgeries were performed during the study period. The percentage of time used for anesthesia induction, actual surgical procedure, recovery from anesthesia, and theater preparation between the two cases were 8%, 70%, 6% and 5%, respectively. Fourteen percent of scheduled cases were cancelled. On 220 occasions (70.51%), theater was over-run. Late start contributed to loss of 8370 minutes (140 hours) of theater time. This study identified the proportion of time spent on each activity in the neurosurgical OT. This knowledge is likely to facilitate better planning of neurosurgical theater schedule and result in optimal utilization. Copyright © 2015 Elsevier Inc. All rights reserved.

Command and Control of Joint Air Operations. Some Lessons Learned from Four Case Studies of an Enduring Issue

DTIC Science & Technology

1991-01-01

New Zealand Air Force.4 To further complicate matters, General Douglas MacArthur, as Commander Southwest Pacific Area, and the adjoining theater...Army, Marine, and New Zealand officers and the top job was rotated fairly regularly among the services.10 By early 1943 a truly joint staff had...in joint air operations. 2C. Kenneth Allard, Command, Control, and the Common Defense, Yale University Press, New Haven, 1990. The authors strongly

Childhood trauma, combat trauma, and substance use in National Guard and reserve soldiers.

PubMed

Vest, Bonnie M; Hoopsick, Rachel A; Homish, D Lynn; Daws, Rachel C; Homish, Gregory G

2018-02-27

The goal of this work was to examine associations among childhood trauma, combat trauma, and substance use (alcohol problems, frequent heavy drinking [FHD], current cigarette smoking, and current/lifetime drug use) and the interaction effects of childhood trauma and combat exposure on those associations among National Guard/reserve soldiers. Participants (N = 248) completed an electronic survey asking questions about their military experiences, physical and mental health, and substance use. Childhood trauma and combat exposure were examined jointly in regression models, controlling for age, marital satisfaction, and number of deployments. Childhood trauma was associated with current drug use (trend level, odds ratio [OR] = 1.44, 95% confidence interval [CI]: 0.97, 2.14; P = .072) in the main effect model; however, there was not a significant interaction with combat. Combat exposure had a significant interaction with childhood trauma on alcohol problems (b = -0.56, 95% CI: -1.12, -0.01; P = .048), FHD (b = -0.27, 95% CI: -0.47, -0.08; P = .007), and lifetime drug use (OR = 1.78, 95% CI: 1.04, 3.04; P = .035). There were no associations with either of the trauma measures and current cigarette smoking. These results demonstrate that childhood and combat trauma have differential effects on alcohol use, such that combat trauma may not add to the effect on alcohol use in those with greater child maltreatment but may contribute to greater alcohol use among those with low child maltreatment. As expected, childhood and combat trauma had synergistic effects on lifetime drug use. Screening for multiple types of trauma prior to enlistment and/or deployment may help to identify at-risk individuals and allow time for early intervention to prevent future adverse outcomes.

Survey of Public Participation in the Arts: Musical Theater, Operetta, and Opera Attendees.

ERIC Educational Resources Information Center

Abreu, Dan; And Others

Research presented in this report focuses on data obtained through the 1982 and 1985 "Survey of Public Participation in the Arts" and relates to musical theater, operetta, and opera attendance. The objectives of this study were to focus on those findings which might help opera or musical theater organizations attract and understand…

Bringing Literature to Life for Urban Adolescents: Artistic, Dramatic Instruction and Live Theater

ERIC Educational Resources Information Center

Certo, Janine; Brinda, Wayne

2011-01-01

An innovative literacy/theater project implemented in two sixth-grade classrooms of a high-poverty, urban, western Pennsylvania middle school was designed to help urban teachers address aliteracy by engaging their students in the discovery of three young adult novels. The project was built on a partnership with a semiprofessional theater company…

Using Theater to Teach Social Skills: Researchers Document Improvements for Children with Autism

ERIC Educational Resources Information Center

Hartigan, Patti

2012-01-01

The idea that theater fosters social cognition has long been championed by drama therapists and some psychologists, neuropsychologists, and special educators. But the research is only now emerging, and researchers suggest that the very nature of theater makes it an inherently useful tool for children on the spectrum. Children with autism struggle…

Incorporation of Indigenous Forces in Major Theater War: Advantages, Risks and Considerations

DTIC Science & Technology

2004-05-03

USAWC STRATEGY RESEARCH PROJECT INCORPORATION OF INDIGENOUS FORCES IN MAJOR THEATER WAR: ADVANTAGES , RISKS AND CONSIDERATIONS by Ms. Priscilla... Advantages , Risks and Considerations 5a. CONTRACT NUMBER 5b. GRANT NUMBER 5c. PROGRAM ELEMENT NUMBER 6. AUTHOR(S) Priscilla Sellers 5d. PROJECT NUMBER...Std Z39-18 ii iii ABSTRACT AUTHOR: Priscilla Sellers TITLE: Incorporation of Indigenous Forces in Major Theater War: Advantages , Risks and

Learning by Heart: Intergenerational Theater Arts

ERIC Educational Resources Information Center

Gildin, Marsha; Binder, Rose O.; Chipkin, Irving; Fogelman, Vera; Goldstein, Billie; Lippel, Albert

2013-01-01

The authors of this article describe themselves as a lucky group of older adults, ranging in age from sixty to ninety-two, who participate in an intergenerational arts program at their local senior center in Flushing, Queens, one of New York City's most culturally diverse communities. In their living history theater program, run by Elders Share…

Attacking the Theater Mobile Ballistic Missile Threat

DTIC Science & Technology

1993-06-01

theater ballistic missile. The development of a long-range rocket dates back at least to 1923 when the German scientist Herman Oberth conceived of...Jeschonnek could no longer tolerate the verbal abuse he received from Reichsmarschall Hermann Goering and Field Marshal Erhard Milch. Jeschonnek

Science as Performance: Communicating and Educating through Theater, Music, and Dance

NASA Astrophysics Data System (ADS)

Schwartz, Brian B.

2010-01-01

Theater, music, dance, the literary and the visual arts can convey the joys and controversies of science. We describe a program at the Graduate Center entitled Science & the Arts which is designed to communicate to the public the excitement and wonder of science, technology, engineering and mathematics. Over the past few years there have been major successes in communicating science to the public through the arts. This is especially evident in theater, film and opera with such recent plays as Copenhagen, the Oscar winning film A Beautiful Mind and the opera Doctor Atomic at the Met. The performance series Science & the Arts has been developed and tested at the Graduate Center of the City University of New York (CUNY) in mid-Manhattan for more than nine years, see http://web.gc.cuny.edu/sciart/ . We have established working relationships with actors, playwrights, dancers, choreographers, musicians, composers, artists and scientists who work at the intersection of science and the arts. In this presentation we will illustrate many of our collaborations in theater, dance, music and art. Faculty members, professionals and students from the university, other educational institutions, museums, theaters and government laboratories as well as the public with an interest science and arts programs should find this presentation of particular interest. Supported in part by the National Science Foundation, NSF PHY-0431660.

Levels of Evidence in Orthopaedic Trauma Literature.

PubMed

Scheschuk, Joseph P; Mostello, Andrew J; Lombardi, Nicholas J; Maltenfort, Mitchell G; Freedman, Kevin B; Tjoumakaris, Fotios P

2016-07-01

To review and critically assess trends observed regarding the levels of evidence in published articles in orthopaedic traumatology literature. The Journal of Orthopaedic Trauma, Journal of Bone and Joint Surgery-American, and Clinical Orthopaedics and Related Research. All articles from the years 1998, 2003, 2008, and 2013 in The Journal of Orthopaedic Trauma (JOT) and orthopaedic trauma-related articles from The Journal of Bone and Joint Surgery-American (JBJS-A) and Clinical Orthopaedics and Related Research (CORR) were analyzed. Articles were categorized by type and ranked for level of evidence according to guidelines from the Centre for Evidence-Based Medicine. Study type and standardized level of evidence were determined for each article. Articles were subcategorized as high-level evidence (I, II), moderate-level evidence (III), and low-level evidence (IV, V). During the study period, Journal of Bone and Joint Surgery-American reduced its low-level studies from 80% to 40% (P = 0.00015), Clinical Orthopaedics and Related Research decreased its low-level studies from 70% to 27%, and Journal of Orthopaedic Trauma decreased its low-level studies from 78% to 45%. Level IV and V therapeutic, prognostic, and diagnostic studies demonstrated significant decreases during the study period (P = 0.0046, P < 0.0001, P = 0.026). The percentage of high-level studies increased from 13% to 19%; however, this was not significant (P = 0.42). There was a trend showing an increase in level I and II studies for therapeutic, prognostic, and diagnostic studies (P = 0.06). There has been a statistically significant decrease in lower level of evidence studies published in the orthopaedic traumatology literature over the past 15 years.

Hope or Hype? What is Next for Biofuels? (LBNL Science at the Theater)

ScienceCinema

Keasling, Jay; Bristow, Jim; Tringe, Susannah Green

2017-12-09

Science at the Theater: From the sun to your gas tank: A new breed of biofuels may help solve the global energy challenge and reduce the impact of fossil fuels on global warming. KTVU Channel 2 health and science editor John Fowler will moderate a panel of Lawrence Berkeley National Laboratory scientists who are developing ways to convert the solar energy stored in plants into liquid fuels. Jay Keasling is one of the foremost authorities in the field of synthetic biology. He is applying this research toward the production of advanced carbon-neutral biofuels that can replace gasoline on a gallon-for-gallon basis. Keasling is Berkeley Labs Acting Deputy Director and the Chief Executive Officer of the U.S. Department of Energys Joint BioEnergy Institute. Jim Bristow is deputy director of programs for the U.S. Department of Energy Joint Genome Institute (JGI), a national user facility in Walnut Creek, CA. He developed and implemented JGIs Community Sequencing Program, which provides large-scale DNA sequencing and analysis to advance genomics related to bioenergy and environmental characterization and cleanup. Susanna Green Tringe is a computational biologist with the U.S. Department of Energy Joint Genome Institute (JGI). She helped pioneer the field of metagenomics, a new strategy for isolating, sequencing, and characterizing DNA extracted directly from environmental samples, such as the contents of the termite gut, which yielded enzymes responsible for breakdown of wood into fuel.

The Training of Undergraduates in Theater Technology and Design: What the Industry Expects.

ERIC Educational Resources Information Center

Kaye, Stan

Because technology has changed entertainment, what was once simply a humanistic art form has turned into a large industry. Everyone from politicians to corporate executives is using theater technology to get his or her message out in the most powerful way possible. Two primary points in preparing theater graduates to enter this industry should be:…

Usefulness of Image Theater Workshops for Exploring Dilemmas in Diabetes Self-Management Among Adolescents

PubMed Central

Kupper, Frank; Peters, Louk W. H.; Stuijfzand, Sarah M.; den Besten, Heleen A. A.; van Kesteren, Nicole M. C.

2018-01-01

Diabetes treatment involves a demanding self-management regime that is particularly challenging to adolescents. There is a need for qualitative research into the specific contexts in which adolescents attempt to balance self-management demands with the needs and desires of adolescent life. This study investigates the usefulness of image theater, a participatory form of theater using the body as an expressive tool, to articulate these dilemmas in daily life contexts. We performed a qualitative analysis of two image theater workshops with 12- to 18-year-old adolescents living with diabetes. Our results show three areas of application: (a) unraveling the contextual complexity of lived experience, (b) the articulation of implicit understandings and underlying motives, and (c) the playful exploration of new behavior. We conclude that image theater is a promising method, especially with respect to the opportunities of a more contextual and action-oriented understanding of the trade-offs made in self-management provide for diabetes education and counseling. PMID:29568791

An online means of testing asymmetries in seating preference reveals a bias for airplanes and theaters.

PubMed

Nicholls, Michael E R; Thomas, Nicole A; Loetscher, Tobias

2013-08-01

The aim of this study was to investigate asymmetrical interactions between humans and their environment using online seat booking sites. Functional differences between the cerebral hemispheres affect the choices people make. For example, when asked to imagine going to a cinema, people preferentially select seats to the right We investigated whether this experimental research generalizes to online booking sites for aircraft and theaters. Occupancy rates for seats taken on the left and right sides were assessed for 100 airline flights with 12,762 available seats and 37 theater performances with 34,456 seats. On the basis of previous research, a rightward bias was predicted for aircraft and theaters. For aircraft, contrary to expectation, occupancy rate was higher for left- compared with right-side seats. For theaters, a rightward bias was observed when the theater was less than half full.The bias was not affected by the orientation of the map. For aircraft, the leftward preference could be attributable to a rightward turning bias or a "feeling" that the port seats are closer to the exit, even though they are not. For theaters, the data demonstrate that the rightward preference observed in earlier studies exists only when the theater is relatively empty. Asymmetrical seating may play an important role in the efficient assimilation of information from the environment, and this role should take this into account when designing effective human-environment interfaces.The online method of assessing seating used in the current study provides an informative and potentially powerful means of assessing asymmetries in human perception and action.

Home theater projectors: the next big thing?

NASA Astrophysics Data System (ADS)

Chinnock, Christopher B.

2002-04-01

The business presentation market has traditionally been the mainstay of the projection business, but as these users find the projectors work well at showing movies at home, interest in the home entertainment market is heating up. The idea of creating a theater environment in the home, complete with big screen projector and quality audio system, is not new. Wealthy patrons have been doing it for years. But can the concept be extended to ordinary living rooms? Many think so. Already pioneers like Sony, InFocus, Toshiba and Plus Vision are offering first generation products - and others will follow. But this market will require projectors that have different performance characteristics than those designed for data projection. In this paper, we will discuss how the requirements for a home theater projector differ from those of a data projector. We will provide updated information on who is doing what in this segment and give some insight into the growth potential.

Effect of switching off unidirectional downflow systems of operating theaters during prolonged inactivity on the period before the operating theater can safely be used.

PubMed

Traversari, A A L; Bottenheft, C; van Heumen, S P M; Goedhart, C A; Vos, M C

2017-02-01

Switching off air handling systems in operating theaters during periods of prolonged inactivity (eg, nights, weekends) can produce a substantial reduction of energy expenditure. However, little evidence is available regarding the effect of switching off the air handling system during periods of prolonged inactivity on the air quality in operating theaters during operational periods. The aim of this study is to determine the amount of time needed after restarting the ventilation system to return to a stable situation, with air quality at least equal to the situation before switching off the system. Measurements were performed in 3 operating theaters, all of them equipped with a unidirectional downflow (UDF) system. Measurements (particle counts of emitted particles with a particle size ≥0.5 µm) were taken during the start-up of the ventilation system to determine when prespecified degrees of protection were achieved. Temperature readings were taken to determine when a stable temperature difference between the periphery and the protected area was reached, signifying achievement of a stable condition. After starting up the system, the protected area achieved the required degrees of protection within 20 minutes (95% upper confidence limit). A stable temperature difference was achieved within 23 minutes (95% upper confidence limit). Both findings lie well within the period of 25 minutes normally required for preparations before the start of surgical procedures. Switching off the ventilation system during prolonged inactivity (during the night and weekend) has no negative effect on the air quality in UDF operating theaters during normal operational hours. Copyright © 2017 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

Lessons learned from modern military surgery.

PubMed

Beekley, Alec C; Starnes, Benjamin W; Sebesta, James A

2007-02-01

The era of global terrorism and asymmetric warfare heralded by the September 11, 2001 attacks on the United States have blurred the traditional lines between civilian and military trauma. The lessons learned by physicians in the theaters of war, particularly regarding the response to mass casualties, blast and fragmentation injuries, and resuscitation of casualties in austere environments, likely resonate strongly with civilian trauma surgeons in the current era. The evolution of a streamlined trauma system in the theaters of operations, the introduction of an in-theater institution review board process, and dedicated personnel to collect combat casualty data have resulted in improved data capture and realtime, on-the-scene research.

Judge upholds closing of theater that was site of high-risk sex.

PubMed

1995-05-05

New York City's decision to close a gay movie theater where inspectors found male patrons engaging in unsafe sexual activity with other men was upheld by Justice Marilyn G. Diamond of the Supreme Court in Manhattan. She rejected the theater owner's argument that the city's March 31, 1995 closure of the New David Cinema on West 54th Street violated the Constitution's guarantee of freedom of speech. The city based its action on a provision in the state health code which prohibits oral, anal or vaginal sex in commercial establishments. Despite several warnings from the city, the movie house did not follow the demands that it move forcefully to prevent high-risk sexual activity among patrons. The New David was one of two theaters and one sex club shut down by the Health Department in recent weeks, but the only one still closed at press time. Some gay activists contend the action was unjustified, since most of the sex that occurs in those establishments in consensual and involves solo or mutual masturbation. Others point out that a good deal of unsafe sex does occur. Because men often have several sexual liaisons during a single night at a theater or club, the risk of HIV transmission is magnified many-fold.

Workplace rights: a popular theater performance.

PubMed

Becker, Meryl; Rabin, Richard

2014-01-01

Theater acting can help build the social skills needed for effective communication at work and in the wider community. The following short play is about workers fighting for their rights at a textile factory in the early 20th century. It was written by an adult education teacher, performed by her students and attended by the school's students and teachers.

STARS experiential group intervention: a complex trauma treatment approach for survivors of human trafficking.

PubMed

Hopper, Elizabeth K; Azar, Naomi; Bhattacharyya, Sriya; Malebranche, Dominique A; Brennan, Kelsey E

2018-01-01

This is the abstract that was submitted online with the paper: Despite the fact that many survivors of human trafficking have experienced complex trauma, there are no established interventions designed to specifically address these impacts. Leaders in the field of complex trauma have advocated for the need for somatic approaches to intervention. This paper presents STARS Experiential Group treatment, the first structured bodybased group intervention that has been designed to address complex trauma in survivors of human trafficking. Three pilot groups were run in residential settings with adolescent and adult survivors of sex trafficking. Two adaptations were utilized, with one focusing on application of expressive arts modalities and the other incorporating theater games. Qualitative results, using thematic analysis, identified several themes related to challenges and potential benefits of these groups. Potential benefits of the STARS groups were found in the areas of Interpersonal Relationships, Regulation, and Self/ Identity, with fourteen sub-themes further describing positive impacts. Challenges within these areas are explored, to inform the development of group interventions for trafficking survivors. The results of this paper suggest that experiential, somatically-oriented group treatment shows promise as an important element of holistic intervention with trafficking survivors.

A Study of Readers Theater in Eighth Grade: Issues of Fluency, Comprehension, and Vocabulary

ERIC Educational Resources Information Center

Keehn, Susan; Harmon, Janis; Shoho, Alan

2008-01-01

This study investigated the impact of Readers Theater on eighth-grade students, the majority of whom were reading below grade level. Over six weeks of a short story unit, one class participated in Readers Theater. The comparison group of like-ability students received more traditional literary and vocabulary instruction. Quantitative measures…

40. Theater entrance and guard station, Jwing, looking southeast ...

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

40. Theater entrance and guard station, J-wing, looking southeast - Offutt Air Force Base, Strategic Air Command Headquarters & Command Center, Headquarters Building, 901 SAC Boulevard, Bellevue, Sarpy County, NE

Headspace Theater: An Innovative Method for Experiential Learning of Psychiatric Symptomatology Using Modified Role-Playing and Improvisational Theater Techniques

ERIC Educational Resources Information Center

Ballon, Bruce C.; Silver, Ivan; Fidler, Donald

2007-01-01

Objective: Headspace Theater has been developed to allow small group learning of psychiatric conditions by creating role-play situations in which participants are placed in a scenario that simulates the experience of the condition. Method: The authors conducted a literature review of role-playing techniques, interactive teaching, and experiential…

Theater in professor Charcot's galaxy.

PubMed

Poirier, Jacques; Philippon, Jacques

2013-01-01

Jean-Martin Charcot, famous professor of the Chair of Clinic for Diseases of the Nervous System at Salpêtrière Hospital in Paris, was himself an artist, surrounded by artists, and adored the theater. His close colleague Charles Brown-Séquard was ridiculed by Georges Feydeau in a brief freakish monologue recited by Coquelin Cadet, from the Comédie-Française, concerning his claims to rejuvenate himself and others with animal testicle extracts. His friend and patient Alphonse Daudet had written many novels, short stories, and plays. Léon Daudet, Alphonse Daudet's son (and friend of Jean-Baptiste Charcot, the son of the professor), after having abandoned his medical studies, became a writer whose novel Les morticoles was a cruel satire of the medical profession. Among Charcot's pupils, Alfred Binet, Gilbert Ballet, Édouard Brissaud, and Joseph Babinski were particularly involved in the theater. Gilbert Ballet wrote the foreword to La folie au théâtre (Madness in Theatre) by André de Latour. Édouard Brissaud wrote a satiric play Le chèque (The Check), and Joseph Babinski, under the pseudonym of Olaf, was the coauthor with Palau of the drama Les détraquées (The Deranged Women). However, when all is said and done, perhaps the greatest actor in his entourage was Charcot himself. Copyright © 2013 S. Karger AG, Basel.

On Politics and Puppetry: An Interview with Peter Schumann of Bread and Puppet Theater.

ERIC Educational Resources Information Center

Schumann, Peter

2001-01-01

The founder of Bread and Puppet Theater discusses the use of puppetry and theater arts to build community, educate the public about environmental and sociopolitical issues, and provide a setting for group consciousness raising; grassroots reclaiming of art as part of everyday life; and ceremony as a powerful element of performance and as part of…

All the World's a Stage: Integrating Theater and Medicine for Interprofessional Team Building in Physician and Nurse Residency Programs.

PubMed

Salam, Tabassum; Collins, Michelle; Baker, Ann-Marie

2012-01-01

To facilitate the delivery of excellent patient care, physician-nurse teams must work in a collaborative manner. We found that venues for the joint training of physician-nurse teams to foster collaboration are insufficient. We developed a novel interprofessional experience in which resident physicians and nurse residents practiced communication and collaboration skills involving a simulated alcohol withdrawal patient care scenario. Theater students portrayed the patients experiencing withdrawal. The team cared for each patient in a fully equipped and functioning hospital room in a simulation center. Together, they collaborated on interventions and a patient plan of care. After the 10-minute bedside scenario, physician and nurse educators facilitated a joint debriefing session for the physician-nurse learning team. Learners noted an improvement in their ability to identify alcohol withdrawal (44% of participants preencounter to 94% of participants postencounter) and to communicate with team members (55% of participants preencounter to 81% of participants postencounter). The learners felt the physician-nurse team training experience was exceptionally valuable for its authenticity.

Theater as a Community-Building Strategy for Women in Engineering: Theory and Practice

NASA Astrophysics Data System (ADS)

Chesler, Naomi C.; Chesler, Mark A.

Previously, the authors have suggested that peer mentoring through a caring community would improve the quality of life for female faculty members in engineering and could have a positive effect on retention and career advancement. Here, the authors present the background psychosocial literature for choosing participatory theater as a strategy to develop a caring community and report on a pilot study in which participatory theater activities were used within a workshop format for untenured female faculty members in engineering. The authors identify the key differences between participatory theater and other strategies for community building that may enhance participants' sense of commonality and the strength and utility of their community as a mentoring and support mechanism and discuss the ways in which these efforts could have a broader, longer term impact.

Utopian Performatives and the Social Imaginary: Toward a New Philosophy of Drama/Theater Education

ERIC Educational Resources Information Center

Prendergast, Monica

2011-01-01

Drama/theater education lives in the tension of being a discipline rooted in the fine arts and humanities that has been transplanted into the social science of education. This paper suggests that a more aesthetic and philosophical reflection on what drama/theater does and can do in educational settings frees us from the scientized and instrumental…

Use of interactive theater and role play to develop medical students' skills in breaking bad news.

PubMed

Skye, Eric P; Wagenschutz, Heather; Steiger, Jeffrey A; Kumagai, Arno K

2014-12-01

Creative arts have been increasingly implemented in medical education. This study investigated the use of interactive theater and role play with professional actors in teaching breaking bad news to medical students. The objectives were to explore the contexts, approaches, experiences, and reactions in giving and receiving bad news. Second-year medical students participated in a required educational session that utilized interactive theater which helps students learn about the issues of breaking bad news to a patient with cancer. Following the interactive theater piece, professional actors provided students role play experiences in small groups with breaking bad news. Anonymous evaluation surveys were given out to all second-year medical students at the conclusion of the breaking bad news session. Surveys contained quantitative and qualitative responses. Three years of evaluations were analyzed. A total of 451 (88 %) students completed the evaluations. Comments were thematically analyzed. Ninety-four percent agreed that the theater piece prompted reflection on patient-provider communications, and 89 % agreed that it stimulated discussion on complex issues with breaking bad news. The two most common themes in student comments concerned the importance of realism in the theater piece, and the value of experiencing multiple perspectives. Use of professional actors during the role play exercises enhances the realism and pushed the students out of their own "comfort zones" in ways that may more closely approximate real life clinical situations. Interactive theater can be a potentially powerful tool to teach breaking bad news during medical school.

Air Supply Operations in the China-Burma-India Theater between 1942 and 1945

DTIC Science & Technology

2010-12-10

Burma Theater ICD India China Division ICW India China Wing KMT Nationalist Chinese Party LOC Line of Communication MSR Main Supply Route ix NCAC...Theater in order to keep China in the war against Japan. Historians such as Wesley Craven, Charles Romanus, and Leo Daugherty have addressed the...the Japanese severed the line of communication ( LOC ) that supplied China and its small air force. Without that critical supply line, Lieutenant General

Air Quality Monitoring of the Post-Operative Recovery Room and Locations Surrounding Operating Theaters in a Medical Center in Taiwan

PubMed Central

Tang, Chin-Sheng; Wan, Gwo-Hwa

2013-01-01

To prevent surgical site infection (SSI), the airborne microbial concentration in operating theaters must be reduced. The air quality in operating theaters and nearby areas is also important to healthcare workers. Therefore, this study assessed air quality in the post-operative recovery room, locations surrounding the operating theater area, and operating theaters in a medical center. Temperature, relative humidity (RH), and carbon dioxide (CO2), suspended particulate matter (PM), and bacterial concentrations were monitored weekly over one year. Measurement results reveal clear differences in air quality in different operating theater areas. The post-operative recovery room had significantly higher CO2 and bacterial concentrations than other locations. Bacillus spp., Micrococcus spp., and Staphylococcus spp. bacteria often existed in the operating theater area. Furthermore, Acinetobacter spp. was the main pathogen in the post-operative recovery room (18%) and traumatic surgery room (8%). The mixed effect models reveal a strong correlation between number of people in a space and high CO2 concentration after adjusting for sampling locations. In conclusion, air quality in the post-operative recovery room and operating theaters warrants attention, and merits long-term surveillance to protect both surgical patients and healthcare workers. PMID:23573296

Air quality monitoring of the post-operative recovery room and locations surrounding operating theaters in a medical center in Taiwan.

PubMed

Tang, Chin-Sheng; Wan, Gwo-Hwa

2013-01-01

To prevent surgical site infection (SSI), the airborne microbial concentration in operating theaters must be reduced. The air quality in operating theaters and nearby areas is also important to healthcare workers. Therefore, this study assessed air quality in the post-operative recovery room, locations surrounding the operating theater area, and operating theaters in a medical center. Temperature, relative humidity (RH), and carbon dioxide (CO2), suspended particulate matter (PM), and bacterial concentrations were monitored weekly over one year. Measurement results reveal clear differences in air quality in different operating theater areas. The post-operative recovery room had significantly higher CO2 and bacterial concentrations than other locations. Bacillus spp., Micrococcus spp., and Staphylococcus spp. bacteria often existed in the operating theater area. Furthermore, Acinetobacter spp. was the main pathogen in the post-operative recovery room (18%) and traumatic surgery room (8%). The mixed effect models reveal a strong correlation between number of people in a space and high CO2 concentration after adjusting for sampling locations. In conclusion, air quality in the post-operative recovery room and operating theaters warrants attention, and merits long-term surveillance to protect both surgical patients and healthcare workers.

Safe Haven Laws as "Crime Control Theater"

ERIC Educational Resources Information Center

Hammond, Michelle; Miller, Monica K.; Griffin, Timothy

2010-01-01

Objectives: This article examines safe haven laws, which allow parents to legally abandon their infants. The main objective is to determine whether safe haven laws fit the criteria of "crime control theater", a term used to describe public policies that produce the appearance, but not the effect, of crime control, and as such are essentially…

Social capital in a regional inter-hospital network among trauma centers (trauma network): results of a qualitative study in Germany.

PubMed

Loss, Julika; Weigl, Johannes; Ernstberger, Antonio; Nerlich, Michael; Koller, Michael; Curbach, Janina

2018-02-26

As inter-hospital alliances have become increasingly popular in the healthcare sector, it is important to understand the challenges and benefits that the interaction between representatives of different hospitals entail. A prominent example of inter-hospital alliances are certified 'trauma networks', which consist of 5-30 trauma departments in a given region. Trauma networks are designed to improve trauma care by providing a coordinated response to injury, and have developed across the USA and multiple European countries since the 1960s. Their members need to interact regularly, e.g. develop joint protocols for patient transfer, or discuss patient safety. Social capital is a concept focusing on the development and benefits of relations and interactions within a network. The aim of our study was to explore how social capital is generated and used in a regional German trauma network. In this qualitative study, we performed semi-standardized face-to-face interviews with 23 senior trauma surgeons (2013-14). They were the official representatives of 23 out of 26 member hospitals of the Trauma Network Eastern Bavaria. The interviews covered the structure and functioning of the network, climate and reciprocity within the network, the development of social identity, and different resources and benefits derived from the network (e.g. facilitation of interactions, advocacy, work satisfaction). Transcripts were coded using thematic content analysis. According to the interviews, the studied trauma network became a group of surgeons with substantial bonding social capital. The surgeons perceived that the network's culture of interaction was flat, and they identified with the network due to a climate of mutual respect. They felt that the inclusive leadership helped establish a norm of reciprocity. Among the interviewed surgeons, the gain of technical information was seen as less important than the exchange of information on political aspects. The perceived resources derived from

Zoo theater's influence on affect and cognition: a case study from the Central Park Zoo in New York.

PubMed

Penn, Laura

2009-09-01

Zoo theater is used by zoos as a means to influence visitor feelings and knowledge gain about wildlife and environmental themes. This study examined whether and to what extent zoo theater fulfilled these aims by investigating its impact on affect and cognition. The study consisted of an in-depth case study at the Central Park Zoo in New York, a location that has one of the most diverse zoo theater programs in the United States. Using a multimethod approach the study explored many facets of the Central Park Zoo's extensive zoo theater program. These included performances at a main stage, at exhibits, and in the children's zoo. The study found that the extent of zoo theater's influence on affect and cognition is dependent on a combination of a variety of characteristics that include the length of a performance, audience participation, the level of structure of a performance, the presence of song and dance elements, and the scale of the productions.

In-theater hospitalizations of US and allied personnel during the 1991 Gulf War.

PubMed

Smith, Tyler C; Corbeil, Thomas E; Ryan, Margaret A K; Heller, Jack M; Gray, Gregory C

2004-06-01

The postwar morbidity of Gulf War veterans has been closely examined. However, data have not been available to evaluate morbidity suffered during the 1991 Gulf War. In this report, the authors examine archived records of hospitalizations in US military facilities in the Kuwaiti theater of operations or those medically evacuated to facilities in Europe. Using multivariable logistic regression modeling, the authors determined that service personnel at greatest odds for "in-theater" hospitalization were enlisted, female, White, Reservist, Army, and health care workers. No increase in odds was observed for oil well fire smoke exposure or possible exposure to the nerve agent hazard areas. Although these data may be incomplete, they represent the best-known data reflecting in-theater hospitalizations during the Gulf War of 1991 and show remarkable similarities in risk factors to those for postwar hospitalization.

Theater dramatizes ORT message.

PubMed

White, K

1990-04-01

The Zambian Control of Diarrheal Diseases (CDD) Program sought the assistance of 2 popular theater groups to develop a play on diarrhea including messages on using oral rehydration therapy (ORT), breast feeding, continued feeding, and using fluids. This was a more appropriate channel for promoting ORT because only 30% of the population had access to a radio and even less to a television set. The groups performed their 35-40 minute plays, complete with dancing and singing, in the local language for 40 different high density communities in Lusaka 6 times/week for 3 months. Before each play, 1 group went door to door telling the occupants that they were going to perform a play about diarrhea management, specifically ORT. If no one could come, the group described ORT for the occupants. The other group held discussions after each performance to determine what learned and to correct any misconceptions about ORT. 1 group concentrated on bottle feeding as the cause of diarrhea while the other group concentrated on poor sanitation and personal hygiene. The groups always performed in locations convenient to mothers, such as markets, outside clinics, and schools, thereby reaching an estimated 10,000 people. Men also attended the plays which was good because fathers often decide whether or not to use ORT for a sick child. Several performances were recorded and aired on local language radio programs to increase awareness of ORT. The entire 1989 campaign of the CDD Program cost $3000 while radio spots for the same period cost the program $8000-10,000. Popular theater is now being used to publicize many other health messages, such as AIDS-prevention.

Missiles for Asia The Need for Operational Analysis of U.S. Theater Ballistic Missiles in the Pacific

DTIC Science & Technology

2016-01-01

C O R P O R A T I O N Missiles for Asia? The Need for Operational Analysis of U.S. Theater Ballistic Missiles in the Pacific Jacob L. Heim • The...durability of the Intermediate-Range Nuclear Forces Treaty is in doubt. • China’s rapid military modernization could threaten U.S. forces. • Theater ...conventional land-based theater ballistic missiles (TBMs) could add to the U.S. portfolio of strike capabilities. In particular, the U.S. Army should ana- lyze

Creating Catalytic Collaborations between Theater Artists, Scientists, and Research Institutions

NASA Astrophysics Data System (ADS)

Wise, Debra

2012-02-01

Catalyst Collaborative@MIT (CC@MIT) is a collaboration between MIT and Underground Railway Theater (URT), a company with 30 years experience creating theater through interdisciplinary inquiry and engaging community. CC@MIT is dedicated to creating and presenting plays that deepen public understanding about science, while simultaneously providing artistic and emotional experiences not available in other forms of dialogue about science. CC@MIT engages audiences in thinking about themes in science of social and ethical concern; provides insight into the culture of science and the impact of that culture on society; and examines the human condition through the lens of science that intersects our lives and the lives of scientists. Original productions range from Einstein's Dreams to From Orchids to Octopi -- an evolutionary love story; classics re-framed include The Life of Galileo and Breaking the Code (about Alan Turing). CC@MIT commissions playwrights and scientists to create plays; engages audiences with scientists; performs at MIT and a professional venue near the campus; collaborates with the Cambridge Science Festival and MIT Museum; engages MIT students, as well as youth and children. Artistic Director Debra Wise will address how the collaboration developed, what opportunities are provided by collaborations between theaters and scientific research institutions, and lessons learned of value to the field.

Increasing Survivability on the Battlefield: Hemorrhage Control and the Joint Theater Trauma System

DTIC Science & Technology

2010-04-01

Francis Marlo Approved: ’Z?& L .; ff, .. ~~ . Date: 𔃻 4wr,’ I ..2V ZD I Executive Summary Title: Increasing Survivability on the Battlefield...Ray, I look forward to reading your most recent work, "FOB DOC". Tahirih Fusscas, Reference Librarian, E. R. Stitt Library, the National Naval...Pusateri, John B. Holcomb, Bijan S. Kheirabadi, Hasan B. Alam, Charles E. Wade, and Kathy L . Ryan, "Making Sense ofthe Preclinical Literature on

Data Exploration Theater 3

NASA Image and Video Library

2017-12-08

The NASA Center for Climate Simulation (NCCS) Data Exploration Theater features a 17- by 6-foot multi-screen visualization wall for engaging visitors and scientists with high-definition movies of simulation results. Here, the wall displays a 3.5-kilometer-resolution global simulation that captures numerous cloud types at groundbreaking fidelity. Credit: NASA/Pat Izzo To learn more about NCCS go to: www.nasa.gov/topics/earth/features/climate-sim-center.html NASA Goddard Space Flight Center is home to the nation's largest organization of combined scientists, engineers and technologists that build spacecraft, instruments and new technology to study the Earth, the sun, our solar system, and the universe.

Data Exploration Theater 4

NASA Image and Video Library

2017-12-08

The NASA Center for Climate Simulation (NCCS) Data Exploration Theater features a 17- by 6-foot multi-screen visualization wall for engaging visitors and scientists with high-definition movies of simulation results. Here, the wall displays a 5-kilometer-resolution global simulation that captures numerous cloud types at groundbreaking fidelity. Credit: NASA/Pat Izzo To learn more about NCCS go to: www.nasa.gov/topics/earth/features/climate-sim-center.html NASA Goddard Space Flight Center is home to the nation's largest organization of combined scientists, engineers and technologists that build spacecraft, instruments and new technology to study the Earth, the sun, our solar system, and the universe.

Data Exploration Theater 1

NASA Image and Video Library

2017-12-08

The NASA Center for Climate Simulation (NCCS) Data Exploration Theater features a 17- by 6-foot multi-screen visualization wall for engaging visitors and scientists with high-definition movies of simulation results. Here, the wall displays a 3.5-kilometer-resolution global simulation that captures numerous cloud types at groundbreaking fidelity. Credit: NASA/Pat Izzo To learn more about NCCS go to: www.nasa.gov/topics/earth/features/climate-sim-center.html NASA Goddard Space Flight Center is home to the nation's largest organization of combined scientists, engineers and technologists that build spacecraft, instruments and new technology to study the Earth, the sun, our solar system, and the universe.

Data Exploration Theater 2

NASA Image and Video Library

2017-12-08

The NASA Center for Climate Simulation (NCCS) Data Exploration Theater features a 17- by 6-foot multi-screen visualization wall for engaging visitors and scientists with high-definition movies of simulation results. Here, the wall displays a 5-kilometer-resolution global simulation that captures numerous cloud types at groundbreaking fidelity. Credit: NASA/Pat Izzo To learn more about NCCS go to: www.nasa.gov/topics/earth/features/climate-sim-center.html NASA Goddard Space Flight Center is home to the nation's largest organization of combined scientists, engineers and technologists that build spacecraft, instruments and new technology to study the Earth, the sun, our solar system, and the universe.

A Research-Based Community Theater Performance to Promote Ageing: Is It More than Just a Show?

ERIC Educational Resources Information Center

Feldman, Susan; Radermacher, Harriet; Lorains, Felicity; Haines, Terence

2011-01-01

Research-based community theater can address important life issues in a safe and entertaining environment. This study investigated using a theater performance about widowhood as a medium for facilitating older people's engagement with key life events and countering negative stereotypes. Quantitative questions incorporating semistructured…

Health and safety programs for art and theater schools.

PubMed

McCann, M

2001-01-01

A wide variety of health and safety hazards exist in schools and colleges of art and theater due to a lack of formal health and safety programs and a failure to include health and safety concerns during planning of new facilities and renovation of existing facilities. This chapter discusses the elements of a health and safety program as well as safety-related structural and equipment needs that should be in the plans for any school of art or theater. These elements include curriculum content, ventilation, storage, housekeeping, waste management, fire and explosion prevention, machine and tool safety, electrical safety, noise, heat stress, and life safety and emergency procedures and equipment. Ideally, these elements should be incorporated into the plans for any new facilities, but ongoing programs can also benefit from a review of existing health and safety programs.

Medical Readers' Theater: Relevance to Geriatrics Medical Education

ERIC Educational Resources Information Center

Shapiro, Johanna; Cho, Beverly

2011-01-01

Medical Readers' Theater (MRT) is an innovative and simple way of helping medical students to reflect on difficult-to-discuss topics in geriatrics medical education, such as aging stereotypes, disability and loss of independence, sexuality, assisted living, relationships with adult children, and end-of-life issues. The authors describe a required…

[Epidemiology of war injuries, about two conflicts: Iraq and Afghanistan].

PubMed

Pasquier, P; de Rudnicki, S; Donat, N; Auroy, Y; Merat, S

2011-11-01

Since March 2003, military operations in Iraq "Operation Iraqi Freedom" (OIF) and in Afghanistan "Operation Enduring Freedom" (OEF), have made many wounded and killed in action (KIA). This article proposes to highlight the specific epidemiology of combat casualties, met in these both non-conventional and asymmetric conflicts. Personal protective equipments, Kevlar helmet and body armor, proved their efficiency in changing features of war injuries. Health Force Services organized trauma care system in different levels, with three main objectives: immediate basic medical care in battalion aid station, forward surgery and early aeromedical evacuation. The Joint Theater Trauma Registry (JTTR), a war injury registry, provides medical data, analyzed from the combat theater to the military hospital in United States. This analysis concluded that during modern conflicts, most injuries are caused by explosive devices; injuries are more severe and interestingly more specifically the head region and extremities than the trunk. Hemorrhage is the first cause of death, leading to the concept of avoidable death. Specific databases focused on mechanisms and severity of injuries, diagnostic and treatment difficulties, outcomes can guide research programs to improve war injuries prevention and treatment. Copyright © 2011 Elsevier Masson SAS. All rights reserved.

German Literature and Culture under "Revue": Learner Autonomy and Creativity through the Theme-Based Theater Practicum

ERIC Educational Resources Information Center

Koerner, Morgan

2012-01-01

This article proposes a theatrically oriented, thematically structured course model for the upper level undergraduate German curriculum. The traditional focus on staging a single play in the German foreign language theater practicum neglects theater's potential to explore other literary genres and cultural texts and runs the danger of…

Vocal tract shapes in different singing functions used in musical theater singing-a pilot study.

PubMed

Echternach, Matthias; Popeil, Lisa; Traser, Louisa; Wienhausen, Sascha; Richter, Bernhard

2014-09-01

Singing styles in Musical Theater singing might differ in many ways from Western Classical singing. However, vocal tract adjustments are not understood in detail. Vocal tract shapes of a single professional Music Theater female subject were analyzed concerning different aspects of singing styles using dynamic real-time magnetic resonance imaging technology with a frame rate of 8 fps. The different tasks include register differences, belting, and vibrato strategies. Articulatory differences were found between head register, modal register, and belting. Also, some vibrato strategies ("jazzy" vibrato) do involve vocal tract adjustments, whereas others (classical vibrato) do not. Vocal tract shaping might contribute to the establishment of different singing functions in Musical Theater singing. Copyright © 2014 The Voice Foundation. Published by Elsevier Inc. All rights reserved.

Architectural acoustics and the heritage of theater architecture in Andalusia (Acustica arquitectonica y patrimonio teatral en Andalucia)

NASA Astrophysics Data System (ADS)

Leon, Angel Luis

2003-11-01

This thesis reports on the study of the acoustic properties of 18 theaters belonging to the Andalusian historical and architectural heritage. These theaters have undergone recent renovations to modernize and equip them appropriately. Coincident with this work, evaluations and qualification assessments with regard to their acoustic properties have been carried out for the individual theaters and for the group as a whole. Data measurements for this purpose consisted of acoustic measurements in situ, both before the renovation and after the renovation. These results have been compared with computer simulations of sound fields. Variables and parameters considered include the following: reverberation time, rapid speech transition index, back-ground noise, definition, clarity, strength, lateral efficiency, interaural cross-correlation coefficient, volume/seat ratio, volume/audience-area ratio. Based on the measurements and analysis, general conclusions are given in regard to the acoustic performance of theaters whose typology and size are comparable to those that were used in this study (between 800 and 8000 cubic meters). It is noted that these properties are comparable to those of the majority of European theaters. The results and conclusions are presented so that they should be of interest to architectural acoustics practitioners and to architects who are involved in the planning of renovation projects for theaters Thesis advisors: Juan J. Sendra and Jaime Navarro Copies of this thesis written in Spanish may be obtained by contacting the author, Angel L. Leon, E.T.S. de Arquitectura de Sevilla, Dpto. de Construcciones Arquitectonicas I, Av. Reina Mercedes, 2, 41012 Sevilla, Spain. E-mail address: leonr@us.es

Theater gateway closure: a strategic level barricade

DTIC Science & Technology

that at the strategic level the effects are based on the economic and diplomatic elements of the national power, affecting proportionally sustainment...Seven months of detrimental political implications, expensive effects on military operations, and strategic level barricades during 2011 and 2012 in...logistical planners at the strategic level can anticipate or mitigate the effects of a theater gateway closure on military operations. Through two

The Clinton plan for theater missile defenses: Costs and alternatives

DOE Office of Scientific and Technical Information (OSTI.GOV)

Mosher, D.; Hall, R.

1994-09-01

Since the Gulf War, the Department of Defense has placed a high priority on developing defenses against theater ballistic missiles (TBMs). Over the past two years the Clinton administration has redirected the focus of the Ballistic Missile Organization (BMDO, formerly the Strategic Defense Initiative Organization) away from a national missile defense system and toward the development of theater missile defenses (TMDs). But the plan put forward by the administration is expensive - as much as $50 billion through the year 2010 - and it also raises several important issues about compliance with the Anti-Ballistic Missile (ABM) Treaty. But other approachesmore » to TMD would address some of these cost and compliance concerns, so it is worthwhile to look at several alternatives and analyze their costs and effects on capability.« less

Outcomes following trauma laparotomy for hypotensive trauma patients: a UK military and civilian perspective.

PubMed

Marsden, Max; Carden, Rich; Navaratne, Lalin; Smith, Iain M; Penn-Barwell, Jowan G; Kraven, Luke M; Brohi, Karim; Tai, Nigel R M; Bowley, Douglas M

2018-05-25

The management of trauma patients has changed radically in the last decade and studies have shown overall improvements in survival. However, reduction in mortality for the many may obscure a lack of progress in some high-risk patients. We sought to examine the outcomes for hypotensive patients requiring laparotomy in UK military and civilian cohorts. We undertook a review of two prospectively maintained trauma databases; the UK Joint Theatre Trauma Registry (JTTR) for the military cohort (4th February 2003 to 21st September 2014), and the trauma registry of the Royal London Hospital MTC (1st January 2012 to 1st January 2017) for civilian patients. Adults undergoing trauma laparotomy within 90 minutes of arrival at the Emergency Department (ED) were included. Hypotension was present on arrival at the ED in 155/761 (20.4%) military patients. Mortality was higher in hypotensive casualties 25.8% vs 9.7% normotensive casualties (p<0.001). Hypotension was present on arrival at the ED in 63/176 (35.7%) civilian patients. Mortality was higher in hypotensive patients 47.6% vs 12.4% normotensive patients (p<0.001). In both cohorts of hypotensive patients neither the average injury severity, the prehospital time, the ED arrival SBP, nor mortality rate changed significantly during the study period. Despite improvements in survival after trauma for patients overall, the mortality for patients undergoing laparotomy who arrive at the Emergency Department with hypotension has not changed and appears stubbornly resistant to all efforts. Specific enquiry and research should continue to be directed at this high-risk group of patients. IV; Observational Cohort Study.

Anterior fracture dislocation of the sacroiliac joint: A case report and literature review.

PubMed

Xiao, Jianlin; Wang, Yang; Zhang, Minglei; Jiang, Rui; Zhu, Tongtong; Liu, Guangyao; Zuo, Jianlin

2017-08-09

Publications describing the diagnosis and treatment of anterior dislocation of the sacroiliac joint are scarce. We report the case a 19-year-old female at 8 weeks' gestation who presented with anterior fracture dislocation of the right sacroiliac joint, posterior fracture dislocation of the left sacroiliac joint (crescent fracture), and incomplete abortion resulting from high energy trauma. Orthopedic surgery involved standard anterior sacroiliac joint plating using an ilioinguinal approach combined with a modified Stoppa approach. Three attempts at complete abortion failed. Complete abortion was eventually achieved by dilatation and curettage two weeks after orthopedic surgery. Our findings reveal a need to improve techniques for diagnosis and treatment of anterior fracture dislocation of the sacroiliac joint, so greater attention can be paid to the rapid and effective management of associated comorbidities, and those resulting from the initial trauma.

How to Use Theater to Teach At-Risk Students

ERIC Educational Resources Information Center

Mardirosian, Gail Humphries; Lewis, Yvonne Pelletier

2009-01-01

Professors from American University and artists and educators from Imagination Stage, a children's theater and arts-education organization in nearby Bethesda, Maryland, have combined their intellectual and artistic strengths over the past 12 years to create an arts-integrated educational program for elementary and secondary schools throughout the…

Charcot joint-like changes following ankle fracture in a patient with no underlying disease: report of a rare case.

PubMed

Kumagai, Masaru; Yokota, Kiyoshi; Endoh, Toshiya; Takemoto, Hitoshi; Nagata, Kensei

2002-01-01

Charcot joint is a disease that often occurs in patients with diabetes mellitus, tabes dorsalis, syringomyelia, chronic alcoholism, leprosy, trauma, or infection after fractures and dislocations. The treatment for Charcot joint has various complications, such as skin lesions, infections, and delayed union. We present our experience with a male patient who developed Charcot joint-like changes without diabetes mellitus or any other disease after an ankle fracture due to minor trauma.

Survey of trauma registry data on tourniquet use in pediatric war casualties.

PubMed

Kragh, John F; Cooper, Arthur; Aden, James K; Dubick, Michael A; Baer, David G; Wade, Charles E; Blackbourne, Lorne H

2012-12-01

Previously, we reported on the use of emergency tourniquets to stop bleeding in war casualties, but virtually all the data were from adults. Because no pediatric-specific cohort of casualties receiving emergency tourniquets existed, we aimed to fill knowledge gaps on the care and outcomes of this group by surveying data from a trauma registry to refine device designs and clinical training. A retrospective review of data from a trauma registry yielded an observational cohort of 88 pediatric casualties at US military hospitals in theater on whom tourniquets were used from May 17, 2003, to December 25, 2009. Of the 88 casualties in the study group, 72 were male and 16 were female patients. Ages averaged 11 years (median, 11 years; range, 4-17 years). There were 7 dead and 81 survivor outcomes for a trauma survival rate of 93%. Survivor and dead casualties were similar in all independent variables measured except hospital stay duration (median, 5 days and 1 day, respectively). Six casualties (7%) had neither extremity nor external injury in that they had no lesion indicating tourniquet use. The survival rate of the present study's casualties is similar to that of 3 recent large nonpediatric-specific studies. Although current emergency tourniquets were ostensibly designed for modern adult soldiers, tourniquet makers, perhaps unknowingly, produced tourniquets that fit children. The rate of unindicated tourniquets, 7%, implied that potential users need better diagnostic training. Level 4; case series, therapeutic study.

Prehospital and emergency care research at the US Army Institute of Surgical Research: enabling the next great leap in combat casualty survival.

PubMed

Gerhardt, Robert T

2011-01-01

Minimizing preventable death continues to be a primary focus of the combat casualty care research community, and of the Army Medical Department as a whole. Toward that end, tremendous successes have been realized in resuscitative surgery, critical care, rehabilitation, preventive medicine, and in our collective ability to project effective medical care into the most austere locations throughout the globe. Innovation in the care rendered outside of theater hospitals or strategic air evacuation conveyances, however, has not kept the same pace. The US military experience in World War II, Korea, and Vietnam served as a prime source for the development of the tactics, techniques, and procedures which spawned modern civilian sector trauma care and emergency medical services. But this ascendance was driven by the dedicated medics, corpsmen, physicians, nurses, and allied health practitioners from those conflicts who left the military for the civilian sector, leaving their replacements, in many cases, to repeat the same mistakes, and to relearn hard lessons that otherwise might have been assimilated had they been effectively captured and integrated into doctrine and training. A prime example of this phenomenon is the recent acknowledgement of the "en route care gap" existing in tactical medical evacuation. The US Army Institute of Surgical Research (USAISR) and the Army emergency medicine community have made a significant commitment toward elucidating the requirements, capability gaps, and a way-forward in search of the development of an integrated prehospital combat casualty care system, nested within the Joint Theater Trauma System. This paper examines specific research programs, concept development, and collaborations with other Army, joint, and civilian center organizations which comprise the USAISR Prehospital and Emergency Care Research Program, including the Remote Damage Control Resuscitation initiative, Emergency Telemedical Direction of Role-I providers, Combat

Teaching the Surgical Craft: Surgery Residents Perception of the Operating Theater Educational Environment in a Tertiary Institution in Nigeria

PubMed Central

Ibrahim, Abdulrasheed; Delia, Ibrahim Z; Edaigbini, Sunday A; Abubakar, Amina; Dahiru, Ismail L; Lawal, Zakari Y

2013-01-01

Background: The transformation of a surgical trainee into a surgeon is strongly influenced by the quality of teaching in the operating theater. This study investigates the perceptions of residents about the educational environment of the operating theater and identifies variables that may improve the operating theater education of our trainees. Materials and Methods: Residents in the department of surgery anonymously evaluated teaching in the operating room using the operating theater education environment measure. The residents evaluated 33 variables that might have an impact on their surgical skills within the operating theater. The variables were grouped into four subscales; teaching and training, learning opportunities, operating theater atmosphere and workload/supervision/support. Differences between male and female residents and junior and senior registrars were assessed using Mann-Whitney test. Statistical analysis was completed with the statistics package for the social sciences version 17. Results: A total of 33 residents were participated in this study. Twenty nine (88%) males and 4 (12%) females. 30 (90%) were junior registrars. The mean total score was 67.5%. Operating theater atmosphere subscale had the highest score of 79.2% while workload/supervision/support subscale had the least score of 48.3%. There were significant differences between male and female resident's perception of workload/supervision/support P < 0.05; however, there was no significant differences in junior registrar versus senior registrar's perception of the education environment in all the subscales P > 0.05. Conclusion: This study has shown a satisfactory teaching environment based on the existing local realities of means, resources and tools and highlighted the need for improvement in workload/supervision/support in our institution. An acceptable learning environment in the operating theatre will produce surgeons that are technically competent to bridge the gap in the enormous

Theater of the Oppressed in an After-School Program: Middle School Students' Perspectives on Bullying and Prevention

ERIC Educational Resources Information Center

Bhukhanwala, Foram

2014-01-01

This article examines students' participation in Boalian Theater activities to role-play, rehearse, and develop strategies to use when bullied or witnessing bullying. One intention of the theater was for students to respond and to engage in perspective-taking and empathy as one of the ways of responding to bullying experiences and making sense of…

Stages of Drama: Classical to Contemporary Theater. Third Edition.

ERIC Educational Resources Information Center

Klaus, Carl H.; And Others

Organized along broadly historical lines, this comprehensive collection of outstanding plays includes 41 works from the classical Greek period to the contemporary. As an introduction to the theater, the collection is unmatched for its theatrical variety and cultural diversity. It provides: (1) a general introduction on reading and witnessing a…

Using Panorama Theater To Teach Middle School Social Studies.

ERIC Educational Resources Information Center

Chilcoat, George W.

1995-01-01

Describes how use of panorama theater to teach middle school social studies can aid in teaching the academic skills of defining a problem, locating and collecting data, organizing and designing tasks, drawing inferences, creating and building interpretations, revising and editing, and interpreting data. Presents a classroom example of a panorama…

Communication and Social Exchange Processes in Community Theater Groups

ERIC Educational Resources Information Center

Kramer, Michael W.

2005-01-01

This study explores the communication experiences of two volunteer groups involved in the production of community theater musicals. Based on social exchange theory, it examined what group members perceived to be the positive benefits (primarily meeting people and having an opportunity to perform) and the negative costs (primarily disorganization,…

DOD Needs to Improve Management and Oversight of Operations at the Theater Retrograde- Camp Arifjan, Kuwait

DTIC Science & Technology

2010-09-30

only at the TRC (includes Retro Sort), Warehouse, and Bulk Yard. 2 Theater Retrograde The Theater Retrograde consists of the TRC (includes Retro Sort...through Kuwait. Figure 1. Proper Flow of Materiel from Iraq through Kuwait Note 1: We reviewed operations at the TRC, Retro Sort, Warehouse...Materiel Processing Instructions CIIC Definition 1 Highest Sensitivity - Non-nuclear missiles and rockets , launcher tube and explosive rounds 2 Highest

Quantifying factors influencing operating theater teaching, participation, and learning opportunities for medical students in surgery.

PubMed

Ravindra, Pravisha; Fitzgerald, J Edward F; Bhangu, Aneel; Maxwell-Armstrong, Charles A

2013-01-01

Operating room experience offers a unique learning resource, potentially exposing medical students to surgical disease and treatments, use of anesthesia, basic science, team working, and communication skills. However, the alien nature of this environment to newcomers poses particular difficulties in harnessing this resource. This study aimed to assess the operating theater-based teaching and learning experiences of new medical graduates during their medical school course. A 41-item, self-administered questionnaire survey was distributed to newly qualified medical school graduates from 1 university consisting of 5 separate teaching hospitals. Results were analyzed using GraphPad Prism 5.0. Questionnaires were returned by 209 of 312 graduates (67%). Overall, 121 (59%) respondents attended ≤50% of opportunities available to attend operating theater; 47% felt they knew what was expected of them when attending and only 13% had specific learning objectives set. An interest in pursuing a surgical career was stated by 24 (12%) respondents; this group was more likely to have attended ≥50% of operating theater opportunities (p = 0.0064). Those not intending to pursue a surgical career were more likely to have been discouraged by their experiences (p = 0.0001). Active participation while scrubbed, knowing what was expected, being made to feel welcome, and being set learning objectives were all significantly positively correlated with attendance. Although female respondents felt equally welcome, in comparison with their male colleagues, they were more likely to receive negative comments (p = 0.0106). The majority of respondents (80%) stated that attendance at operating theater sessions should be a mandatory component of the curriculum. Although operating theater attendance is recognized as an important component of the medical school curriculum, overall attendance at sessions was low. Attendance could be increased by ensuring students knowing what is expected of them

Reproduction, Contestation, and Political Theater: Reflections on Three Productions.

ERIC Educational Resources Information Center

Shirley, Dennis

1986-01-01

Considers the potential of political theater to raise questions of social justice in a provocative manner for students. Describes three productions at a Swiss boarding school, in which the author served as director: a feminist "Taming of the Shrew," a student-written satirical cabaret, and Brecht's "The Good Person of Sezuan."…

Judy Collins sings at the IMAX Theater

NASA Technical Reports Server (NTRS)

1999-01-01

At the piano, singer-songwriter Judy Collins performs her original song, 'Beyond the Sky,' at the KSC Visitor Complex's Imax Theater for an audience waiting for the launch of STS-93. The song, commissioned by NASA through the Nasa Art Program, honored Eileen Collins, the first woman to command a Space Shuttle. The attendees are planning to view the launch at the Banana Creek viewing sight. Liftoff is scheduled for July 20 at 12:36 a.m. EDT.

Establishment and evaluation of a theater influenza monitoring platform.

PubMed

Wang, Jian; Yang, Hui-Suo; Deng, Bing; Shi, Meng-Jing; Li, Xiang-Da; Nian, Qing-Gong; Song, Wen-Jing; Bing, Feng; Li, Qing-Feng

2017-11-20

Influenza is an acute respiratory infectious disease with a high incidence rate in the Chinese army, which directly disturbs military training and affects soldiers' health. Influenza surveillance systems are widely used around the world and play an important role in influenza epidemic prevention and control. As a theater centers for disease prevention and control, we established an influenza monitoring platform (IMP) in 2014 to strengthen the monitoring of influenza-like illness and influenza virus infection. In this study, we introduced the constitution, influenza virus detection, and quality control for an IMP. The monitoring effect was also evaluated by comparing the monitoring data with data from national influenza surveillance systems. The experiences and problems associated with the platform also were summarized. A theater IMP was established based on 3 levels of medical units, including monitoring sites, testing laboratories and a checking laboratory. A series of measures were taken to guarantee the quality of monitoring, such as technical training, a unified process, sufficient supervision and timely communication. The platform has run smoothly for 3 monitoring years to date. In the 2014-2015 and 2016-2017 monitoring years, sample amount coincided with that obtained from the National Influenza Surveillance program. In the 2015-2016 monitoring year, due to the strict prevention and control measures, an influenza epidemic peak was avoided in monitoring units, and the monitoring data did not coincide with that of the National Influenza Surveillance program. Several problems, including insufficient attention, unreasonable administrative intervention or subordination relationships, and the necessity of detection in monitoring sites were still observed. A theater IMP was established rationally and played a deserved role in the prevention and control of influenza. However, several problems remain to be solved.

YouDash3D: exploring stereoscopic 3D gaming for 3D movie theaters

NASA Astrophysics Data System (ADS)

Schild, Jonas; Seele, Sven; Masuch, Maic

2012-03-01

Along with the success of the digitally revived stereoscopic cinema, events beyond 3D movies become attractive for movie theater operators, i.e. interactive 3D games. In this paper, we present a case that explores possible challenges and solutions for interactive 3D games to be played by a movie theater audience. We analyze the setting and showcase current issues related to lighting and interaction. Our second focus is to provide gameplay mechanics that make special use of stereoscopy, especially depth-based game design. Based on these results, we present YouDash3D, a game prototype that explores public stereoscopic gameplay in a reduced kiosk setup. It features live 3D HD video stream of a professional stereo camera rig rendered in a real-time game scene. We use the effect to place the stereoscopic effigies of players into the digital game. The game showcases how stereoscopic vision can provide for a novel depth-based game mechanic. Projected trigger zones and distributed clusters of the audience video allow for easy adaptation to larger audiences and 3D movie theater gaming.

Putting Carbon in its Place: What You Can Do (LBNL Science at the Theater)

ScienceCinema

Walker, Iain; Regnier, Cindy [LBNL, Environmental Energy Technologies Division; Miller, Jeff; Masanet, Eric

2018-06-28

Science at the Theater: Berkeley Lab scientists reveal the latest research on how to reduce your carbon footprint at home, work, and when you shop. Learn how even small choices can have a big impact. Iain Walker's research focuses on optimizing the energy use and comfort of buildings. He's a staff scientist in the Energy Performance of Buildings Group, which is part of Berkeley Lab's Environmen...tal Energy Technologies Division. He's also executive editor of Home Energy Magazine. Cindy Regnier is a Project Manager in the Environmental Energy Technologies Division at Berkeley Lab. She has over 13 years of mechanical engineering design experience, with a focus on low-energy buildings. Her projects have included several LEED Platinum buildings and the design of a 200,000 sf carbon neutral, net-zero energy science museum in San Francisco. Eric Masanet is Acting Deputy Leader of the International Energy Studies Group at Berkeley Lab. His research focuses on life-cycle assessments and energy efficiency analysis. He holds a joint research appointment in the Institute of Transportation Studies at UC Berkeley.

Pharmaceutical logistics in the European theater.

PubMed

Spain, J

1999-10-01

This article describes the responsibilities and objectives of the pharmacy officer for the U.S. Army Medical Materiel Center, Europe. Pharmacists' experiences and knowledge offer advantages in the ordering, storage, and distribution of medical materiel. Exploitation of new technology and a customer-focused attitude encourage a working environment that capitalizes on pharmaceutical expertise. The use of temperature monitors, enhanced automation opportunities, expired drug return credits, and other customer-focused initiatives exemplify pharmacists' value to military medical logistics organizations. An overview of the pharmaceutical pipeline to U.S. military and State Department customers in the European theater is provided.

EFFICACY of P188 ON LAPINE MENISCUS PRESERVATION FOLLOWING BLUNT TRAUMA

PubMed Central

Coatney, Garrett A.; Abraham, Adam C.; Fischenich, Kristine M.; Button, Keith D.; Haut, Roger C.; Haut Donahue, Tammy L.

2015-01-01

Traumatic injury to the knee leads to the development of posttraumatic osteoarthritis. The objective of this study was to characterize the effects of a single intra-articular injection of a non-ionic surfactant, Poloxamer 188 (P188), in preservation of meniscal tissue following trauma through maintenance of meniscal glycosaminoglycan (GAG) content and mechanical properties. Flemish Giant rabbits were subjected to a closed knee joint, traumatic compressive impact with the joint constrained to prevent anterior tibial translation. The contralateral limb served as an un-impacted control. Six animals (treated) received an injection of P188 in phosphate buffered saline (PBS) post trauma, and another six animals (sham) received a single injection of PBS to the impacted limb. Histological analyses for GAG was determined 6 weeks post trauma, and functional outcomes were assessed using stress relaxation micro-indentation. The impacted limbs of the sham group demonstrated a significant decrease in meniscal GAG coverage compared to non-impacted limbs (p < 0.05). GAG coverage of the impacted P188 treated limbs was not significantly different than contralateral non-impacted limbs in all regions except the medial anterior (p < 0.05). No significant changes were documented in mechanics for either the sham or treated groups compared to their respective control limbs. This suggests that a single intra-articular injection of P188 shows promise in prevention of trauma induced GAG loss. PMID:25846264

Epidemiology of moderate-to-severe penetrating versus closed traumatic brain injury in the Iraq and Afghanistan wars.

PubMed

Orman, Jean A; Geyer, Dennis; Jones, John; Schneider, Eric B; Grafman, Jordan; Pugh, Mary Jo; Dubose, Joseph

2012-12-01

US combat operations in Iraq and Afghanistan have resulted in a greater proportion of service members with head and neck wounds caused by explosions compared with that of previous wars. Although penetrating traumatic brain injury (TBI) is frequently associated with these wounds, the epidemiology of penetrating TBI from these conflicts has not been well described. The Joint Theater Trauma Registry was queried for January 2003 through December 2010 to identify all patients with moderate-to-severe brain injury with a maximum Abbreviated Injury Scale (AIS) score of the head of 3 or greater and a diagnosis of penetrating or closed TBI in accordance with the Department of Defense Traumatic Brain Injury Surveillance definition. The epidemiology of these injuries was examined, including demographics, TBI severity, overall injury severity, and surgical interventions provided. A total of 1,255 TBI patients (774 penetrating, 481 closed) meeting criteria were identified. Penetrating brain injuries were more severe, more likely to be battle related, and less likely to be isolated injuries than a group of moderate-to-severe closed TBIs within the same range of anatomic injury severity. During the 5-year period of the Iraq war with the largest numbers of TBIs (2004-2008), the numbers of penetrating TBIs exceeded closed TBIs by a ratio of 2:1. During the 3-year period of the Afghanistan war with the greatest numbers of TBIs (2008-2010), the ratio of penetrating to closed TBIs was substantially lower, approximately 1.3:1. This study represents the first comprehensive report on the epidemiology of moderate-to-severe penetrating and closed TBIs resulting from the wars in Iraq and Afghanistan using Joint Theater Trauma Registry data. With the maturing theater of conflicts, penetrating TBIs were substantially less predominant compared with closed TBIs. While this finding may reflect changes in the use of protective measures and tactics or improvements in diagnosis of closed TBIs

Understanding and Addressing the Global Need for Orthopaedic Trauma Care.

PubMed

Agarwal-Harding, Kiran J; von Keudell, Arvind; Zirkle, Lewis G; Meara, John G; Dyer, George S M

2016-11-02

➤The burden of musculoskeletal trauma is high worldwide, disproportionately affecting the poor, who have the least access to quality orthopaedic trauma care.➤Orthopaedic trauma care is essential, and must be a priority in the horizontal development of global health systems.➤The education of surgeons, nonphysician clinicians, and ancillary staff in low and middle income countries is central to improving access to and quality of care.➤Volunteer surgical missions from rich countries can sustainably expand and strengthen orthopaedic trauma care only when they serve a local need and build local capacity.➤Innovative business models may help to pay for care of the poor. Examples include reducing costs through process improvements and cross-subsidizing from profitable high-volume activities.➤Resource-poor settings may foster innovations in devices or systems with universal applicability in orthopaedics. Copyright © 2016 by The Journal of Bone and Joint Surgery, Incorporated.

Antimicrobial Prescribing Practices Following Publication of Guidelines for the Prevention of Infections Associated With Combat-Related Injuries

PubMed Central

Tribble, David R.; Lloyd, Bradley; Weintrob, Amy; Ganesan, Anuradha; Murray, Clinton K.; Li, Ping; Bradley, William; Fraser, Susan; Warkentien, Tyler; Gaskins, Lakisha J.; Seillier-Moiseiwitsch, Françoise; Millar, Eugene V.; Hospenthal, Duane R.

2018-01-01

Background Timely and limited antibiotic prophylaxis (postinjury antimicrobial therapy) targeting specific traumatic injuries is a well-recognized measure to lessen posttraumatic infection. Modern military combat injuries raise significant challenges because of complex multiple injuries and limited data derived directly from well-controlled trials to base recommendations. Expert consensus review of available evidence led to published guidance for selection and duration of antimicrobial therapy for combat-related trauma infection prevention. This analysis evaluates antibiotic-prescribing practices by military physicians in the operational theater relative to the published guidance. Methods Trauma history and infectious disease-specific inpatient care information is captured through the Joint Theater Trauma Registry along with a supplemental infectious disease module. Injury patterns are classified based on documented International Classification of Diseases-9th Revision codes with a composite assessment of each patient’s injury pattern. Antimicrobial use categorized as prophylaxis is prescribed within the first 48 hours postinjury. Adherence to published guidance is reported along with patient characteristics and injury severity to assess for potential explanations of nonadherence. Results During June to November 2009, 75% of the 610 eligible trauma patients received antimicrobial prophylaxis. Adherence to the recommended antibiotic agent on the day of injury was in the range of 46% to 50% for the most common extremity injury patterns and 10% in penetrating abdominal injuries. Antibiotics were given in 39% of patients sustaining injuries that are recommendations to not receive antimicrobial prophylaxis. Conclusions This first evaluation of combat trauma-related antibiotic prophylaxis shows adherence levels comparable or superior to reported rates in civilian settings despite the austere, frequently mass casualty environment. Areas for interval surveillance and

Analysis of Over-the-Horizon Tactical Communications in an Immature Theater

DTIC Science & Technology

2014-06-13

frequency bands, capacity, costs, and mobility, the research examines both alternate portions of the electromagnetic spectrum and rising technologies...IMMATURE THEATER, by Major Samuel Eugene Sinclair, 75 pages. This qualitative research in the field of over-the-horizon (OTH) voice communications

Teaching Resistance to Narrative: Brecht's Theater Praxis as a Response to Florian Henckel Von Donnersmarck's "Das Leben der Anderen"

ERIC Educational Resources Information Center

Koerner, Morgan

2016-01-01

This article explores the potential of Brecht's theater praxis for teaching millennial students to question dramatic narratives and rethink their own spectatorial positions, especially in regards to mainstream cinema that emphasizes character identification and plot. The article reflects on a five-day teaching unit on Brecht's theater in a senior…

Setting the Stage for Social Change: Using Live Theater to Dispel Myths About Intimate Partner Violence.

PubMed

Dill-Shackleford, Karen E; Green, Melanie C; Scharrer, Erica; Wetterer, Craig; Shackleford, Lee E

2015-08-01

Research has demonstrated the ability of fictional narratives to educate about social and health issues. Although some entertainment-education efforts have used live theater as a mechanism for social change, very few use social science methods to demonstrate exposure effects. This project used live theater to increase understanding and knowledge about intimate partner violence, a pervasive and costly social and health problem. Audiences watched either a play about abusive relationships-emphasizing psychological abuse and the role of coercion and control-or a control play. Compared with controls, those who watched the abuse play were more knowledgeable and less accepting of myths about abusive relationships in a way that mirrored play content. Although both plays were highly transporting, transportation did not explain a significant amount of variance in the attitudes toward intimate partner violence. These results provide rare evidence for theater as a tool for social change.

Theater Blood Application Was Not Effectively Developed and Implemented

DTIC Science & Technology

2015-07-17

blood product by unit; and • monitor non- Food and Drug Administration Blood Product Testing. The CONOPS document also identified over 400 specific...time of a transfusion. However, this requirement was not identified in the CONOPS document. Further, PEO DHCS officials provided a traceability ...the CONOPS document, requirements management database, and the traceability matrix increased the risk that the Theater Blood Application

"Clinical Reasoning Theater": A New Approach to Clinical Reasoning Education.

ERIC Educational Resources Information Center

Borleffs, Jan C. C.; Custers, Eugene J. F. M.; van Gijn, Jan; ten Gate, Olle Th. J.

2003-01-01

Describes a new approach to clinical reasoning education called clinical reasoning theater (CRT). With students as the audience, the doctor's clinical reasoning skills are modeled in CRT when he or she thinks aloud during conversations with the patient. Preliminary results of students' evaluations of the relevance of CRT reveal that they…

World Classics in Kazakh Theater at Early Stage of Development

ERIC Educational Resources Information Center

Sultanova, Zhanagul S.; Yeshmuratova, Anar K.; Nursultan, Yelik; Kabdiyeva, Saniya D.; Zhuasbek, Yerkin T.

2016-01-01

The research work deals with the practices and specific features of Kazakh theater, especially with the specifics of the director's decisions on performances based on European and Russian classical drama. The authors determine that the experienced directors from Russia were invited in order to influence the professional development of Kazakh…

Saving Lives on the Battlefield (Part II) - One Year Later: A Joint Theater Trauma System and Joint Trauma System Review of Prehospital Trauma Care in Combined Joint Operations Area-Afghanistan (CJOA-A)

DTIC Science & Technology

2015-01-01

medics’ aid bags? 8% 92% N/A TCCC Pain Management Are you using TCCC guidelines pain medications?4 42% 12% 46% Fentanyl 69% 31% N/A Ketamine 50% 50% N...A Wound (Combat) Pill Pack 4% 96% N/A What pain medication do your medics carry? Morphine5 92% 8% N/A Fentanyl 35% 65% N/A Ketamine 12% 88% N/A TCCC

Airborne Operations in World War II, European Theater

DTIC Science & Technology

1956-09-01

GARDEN Gee Hamilcar HANDS UP Formation usually composed of two or more elements and roughly equivalent to a squadron Forward Visual Control Post Ground...USAF HISTORICAL STUDIES: NO. 97 AIRBORNE OPERATIONS IN WORLD WAR II, EUROPEAN THEATER By Dr. John C. Warren USAF Historical Division Research Studies...OMB control number. 1. REPORT DATE SEP 1956 2. REPORT TYPE 3. DATES COVERED - 4. TITLE AND SUBTITLE Airborne Operations in World War II 5a

Performance analysis of air conditioning system and airflow simulation in an operating theater

NASA Astrophysics Data System (ADS)

Alhamid, Muhammad Idrus; Budihardjo, Rahmat

2018-02-01

The importance of maintaining performance of a hospital operating theater is to establish an adequate circulation of clean air within the room. The parameter of air distribution in a space should be based on Air Changes per Hour (ACH) to maintain a positive room pressure. The dispersion of airborne particles in the operating theater was governed by regulating the air distribution so that the operating theater meets clean room standards ie ISO 14664 and ASHRAE 170. Here, we introduced several input parameters in a simulation environment to observe the pressure distribution in the room. Input parameters were air temperature, air velocity and volumetric flow rate entering and leaving room for existing and designed condition. In the existing operating theatre, several observations were found. It was found that the outlet air velocity at the HEPA filter above the operating table was too high thus causing a turbulent airflow pattern. Moreover, the setting temperature at 19°C was found to be too low. The supply of air into the room was observed at lower than 20 ACH which is under the standard requirement. Our simulation using FloVent 8.2™ program showed that not only airflow turbulence could be reduced but also the amount of particle contamination could also be minimized.

Impact of Anemia in Critically Ill Burned Casualties Evacuated From Combat Theater via US Military Critical Care Air Transport Teams.

PubMed

Hamilton, Joshua A; Mora, Alejandra G; Chung, Kevin K; Bebarta, Vikhyat S

2015-08-01

US military Critical Care Air Transport Teams (CCATT) transport critically ill burn patients out of theater. Blood transfusion may incur adverse effects, and studies report lower hemoglobin (Hgb) value may be safe for critically ill patients. There are no studies evaluating the optimal Hgb value for critically ill burn patients prior to CCATT evacuation. The aim of the study was to determine if critically ill burn casualties with an Hgb of 10 g/dL or less, transported via CCATT, have similar clinical outcomes at 30 days as compared with patients with an Hgb of greater than 10 g/dL. We conducted an institutional review board-approved retrospective cohort study involving patients transported via CCATT. We separated our study population into two cohorts based on Hgb levels at the time of theater evacuation: Hgb ≤10 g/dL or Hgb ≥10 g/dL. We compared demographics, injury description, physiologic parameters, and clinical outcomes. Of the 140 subjects enrolled, 29 were Hgb ≤10, and 111 were Hgb ≥10. Both groups were similar in age and percent total body surface area burned. Those Hgb ≤10 had a higher injury severity score (34 ± 19.8 vs. 25 ± 16.9, P = 0.02) and were more likely to have additional trauma (50% vs. 25%, P = 0.04). Modeling revealed no persistent differences in mortality, and other clinical outcomes measured. Critical Care Air Transport Teams transport of critically ill burn patients with an Hgb of 10 g/dL or less had no significant differences in complications or mortality as compared with patients with an Hgb of greater than 10 g/dL. In this study, lower hemoglobin levels did not confer greater risk for worse outcomes.

Early osteoarthritis of the patellofemoral joint.

PubMed

Arendt, Elizabeth A; Berruto, Massimo; Filardo, Giuseppe; Ronga, Mario; Zaffagnini, Stefano; Farr, Jack; Ferrua, Paolo; Grassi, Alberto; Condello, Vincenzo

2016-06-01

Patellofemoral joint cartilage lesions are associated with a variety of clinical situations including blunt trauma, lateral patella dislocations, or as a secondary development in the setting of abnormal joint loading. There is a need for more clarity on how to best address these lesions. Most specifically, when is it necessary to surgically treat these lesions of the patella and trochlea and which technique to use? This review will focus on the spectrum of patellofemoral disease/injury and their treatment strategies, with special emphasis on cartilage damage and early osteoarthritis. Chapter sections will review the most common scenarios of cartilage damage in the patellofemoral joint, with an attempt to summarize current treatment, their outcomes, remaining challenges and unanswered questions.

Bilateral temporomandibular joint dislocation with locked mandibular impaction.

PubMed

Hynes, Sally L; Jansen, Leigh A; Brown, D Ross; Courtemanche, Douglas J; Boyle, James C

2012-02-01

Bilateral anterior temporomandibular joint dislocation is very rare, with only 2 reported cases published. In the present report, we describe a healthy 25-year-old man from Haida Gwaii, in British Columbia, Canada, who was transferred to our tertiary trauma center with life-threatening complications of a bilateral anterior temporomandibular joint dislocation with locked mandibular impaction. Copyright © 2012 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

Eusebio Vela's Mexican Hagiographies: Self-Fashioning in Eighteenth-Century Theater

ERIC Educational Resources Information Center

Post, Ben

2016-01-01

Eighteenth-century actor and playwright Eusebio Vela, long thought to be born in Mexico but actually born in Spain, dominated Mexico City's Coliseo theater for decades and has been variously interpreted as a creole patriot or as a Spanish propagandist. Vela's four extant plays, which treat the fall of Spain, Telemachus's wanderings in the…

A Theater Intervention to Promote Communication and Disclosure of Suicidal Ideation

PubMed Central

Keller, Sarah N.; Austin, C. Graham; McNeill, Vanessa

2017-01-01

Young adults from Montana have a higher rate of suicide than their national counterparts. There is a clear need for targeted interventions to address this disparity. The authors evaluate a community-based, narrative theater project designed to increase awareness and use of suicide prevention resources among eastern Montana youth. As a first step, seven group interviews with Montana young adults (n = 27) were conducted to identify current perceptions about suicide and suicide prevention. Interviews were conducted before and after subjects were exposed to a community-based theater production about suicide. Emergent thematic categories were organized using the four main constructs of the extended parallel process model. After the performance, participants expressed increased awareness of prevention resources; perceived susceptibility to the threat of suicide and depression; and self-efficacy for accessing help and assisting others. There were mixed results for perceived response efficacy. Implications and recommendations for intervention development are discussed. PMID:28824211

[Whiplash lesions and temporomandibular joint disorders].

PubMed

Gola, R; Richard, O; Guyot, L; Cheynet, F

2004-11-01

Attributing dysfunction of the temporomandibular joint (TMJ) to whiplash injury is a difficult problem to solve. TMJ disorders do not seem to be secondary to direct articular trauma but rather caused by a postural disorder of the cervical spine. Occlusal disorders and stress further complicate the picture. Four clinical cases illustrate a new hypothetical approach.

Leveraging Trauma Lessons from War to Win in a Complex Global Environment.

PubMed

Remick, Kyle N

2016-01-01

The US military has made great strides in combat casualty care since 2001. As the Army concludes combat operations in Iraq and Afghanistan, it faces new operational challenges in trauma care. The military medical community must stay ahead of the curve through sustaining current investments in combat casualty care research. This article describes lessons learned at war from a Joint Trauma System perspective in order to place in context how we should proceed in order to provide optimal care for our Warfighters in the future.

Trauma care at rural level III trauma centers in a state trauma system.

PubMed

Helling, Thomas S

2007-02-01

Although much has been written about the benefits of trauma center care, most experiences are urban with large numbers of patients. Little is known about the smaller, rural trauma centers and how they function both independently and as part of a larger trauma system. The state of Missouri has designated three levels of trauma care. The cornerstone of rural trauma care is the state-designated Level III trauma center. These centers are required to have the presence of a trauma team and trauma surgeon but do not require orthopedic or neurosurgical coverage. The purpose of this retrospective study was to determine how Level III trauma centers compared with Level I and Level II centers in the Missouri trauma system and, secondly, how trauma surgeon experience at these centers might shape future educational efforts to optimize rural trauma care. During a 2-year period in 2002 and 2003, the state trauma registry was queried on all trauma admissions for centers in the trauma system. Demographics and patient care outcomes were assessed by level of designation. Trauma admissions to the Level III centers were examined for acuity, severity, and type of injury. The experiences with chest, abdominal, and neurologic trauma were examined in detail. A total of 24,392 patients from 26 trauma centers were examined, including all eight Level III centers. Acuity and severity of injuries were higher at Level I and II centers. A total of 2,910 patients were seen at the 8 Level III centers. Overall deaths were significantly lower at Level III centers (Level I, 4% versus Level II, 4% versus Level III, 2%, p < 0.001). Numbers of patients dying within 24 hours were no different among levels of trauma care (Level I, 37% versus Level II, 30% versus Level III, 32%). Among Level III centers 45 (1.5%) patients were admitted in shock, and 48 (2%) had a Glasgow Coma Scale score <9. Twenty-six patients had a surgical head injury (7 epidural, 19 subdural hematomas). Twenty-eight patients (1%) needed

A Prospective Observation Study of Medical Toxicology Consultation in a U.S. Combat Theater.

PubMed

Maddry, Joseph K; Ng, Patrick C; Sessions, Daniel; Bebarta, Vikhyat S

2016-11-01

Since 2001, U.S. military personnel and active duty, uniformed physicians providing medical support have been deployed to Afghanistan. Medical toxicologists are among the physicians deployed. There is a paucity of information present in the literature that has documented cases treated by toxicologists in theater. This prospective observational study describes 15 male patients treated in theater by a military medical toxicologist. We performed a prospective observational study in which a medical toxicologist consulted and reported on deployed toxicology cases occurring during a 5-month deployment to Bagram, Afghanistan. Fifteen toxicology cases were collected during the 5-month period. The patients included three Afghan civilians, three U.S. civilians, and nine U.S. military personnel. Eight cases were attempts at recreational euphoria, two were self-harm attempts, two were from performance-enhancing supplements, two were accidental occupational exposures and one was alcohol withdrawal. Methanol was the most common exposure followed by dextromethorphan, supplements, opiates, and chlorine gas. In our study, we found that toxic alcohols and nonprescription medications were the most common exposures. In addition, this is the first study to describe bedside toxicology consults for U.S. combat forces in theater and the use of an observation unit for critically ill patients. Reprint & Copyright © 2016 Association of Military Surgeons of the U.S.

Effects of Collaborative Musical Theater on the Development of Social Competence

ERIC Educational Resources Information Center

Perez-Aldeguer, Santiago

2013-01-01

Introduction: This study analyzes the social competence of university students of the Music Education Teaching Degree through variables group climate, team cohesion and social skills. The need to develop good social competence was the basis to implement a project based on the musical theater applied according to the collaborative learning…

Effective and efficient learning in the operating theater with intraoperative video-enhanced surgical procedure training.

PubMed

van Det, M J; Meijerink, W J H J; Hoff, C; Middel, B; Pierie, J P E N

2013-08-01

INtraoperative Video Enhanced Surgical procedure Training (INVEST) is a new training method designed to improve the transition from basic skills training in a skills lab to procedural training in the operating theater. Traditionally, the master-apprentice model (MAM) is used for procedural training in the operating theater, but this model lacks uniformity and efficiency at the beginning of the learning curve. This study was designed to investigate the effectiveness and efficiency of INVEST compared to MAM. Ten surgical residents with no laparoscopic experience were recruited for a laparoscopic cholecystectomy training curriculum either by the MAM or with INVEST. After a uniform course in basic laparoscopic skills, each trainee performed six cholecystectomies that were digitally recorded. For 14 steps of the procedure, an observer who was blinded for the type of training determined whether the step was performed entirely by the trainee (2 points), partially by the trainee (1 point), or by the supervisor (0 points). Time measurements revealed the total procedure time and the amount of effective procedure time during which the trainee acted as the operating surgeon. Results were compared between both groups. Trainees in the INVEST group were awarded statistically significant more points (115.8 vs. 70.2; p < 0.001) and performed more steps without the interference of the supervisor (46.6 vs. 18.8; p < 0.001). Total procedure time was not lengthened by INVEST, and the part performed by trainees was significantly larger (69.9 vs. 54.1 %; p = 0.004). INVEST enhances effectiveness and training efficiency for procedural training inside the operating theater without compromising operating theater time efficiency.

A common body of care: the ethics and politics of teamwork in the operating theater are inseparable.

PubMed

Bleakley, Alan

2006-06-01

In the operating theater, the micro-politics of practice, such as interpersonal communications, are central to patient safety and are intimately tied with values as well as knowledge and skills. Team communication is a shared and distributed work activity. In an era of "professionalism," that must now encompass "interprofessionalism," a virtue ethics framework is often invoked to inform practice choices, with reference to phronesis or practical wisdom. However, such a framework is typically cast in individualistic terms as a character trait, rather than in terms of a distributed quality that may be constituted through intentionally collaborative practice, or is an emerging property of a complex, adaptive system. A virtue ethics approach is a necessary but not sufficient condition for a collaborative bioethics within the operating theater. There is also an ecological imperative-the patient's entry into the household (oikos) of the operating theater invokes the need for "hospitality" as a form of ethical practice.

TraumaNetzwerk DGU(®): optimizing patient flow and management.

PubMed

Ruchholtz, Steffen; Lewan, Ulrike; Debus, Florian; Mand, Carsten; Siebert, Hartmut; Kühne, Christian A

2014-10-01

Caring for severely injured trauma patients is challenging for all medical professionals involved both in the preclinical and in the clinical course of treatment. While the overall quality of care in Germany is high there still are significant regional differences remaining. Reasons are geographical and infrastructural differences as well as variations in personnel and equipment of the hospitals. To improve state-wide trauma care the German Trauma Society (DGU) initiated the TraumaNetzwerk DGU(®) (TNW) project. The TNW is based on five major components: (a) Whitebook for the treatment of severely injured patients; (b) evidence-based guidelines for the medical care of severe injury; (c) local auditing of participating hospitals; (d) contract of interhospital cooperation; (d) TraumaRegister DGU(®) documentation. By the end of 2013, 644 German Trauma Centres (TC) had successfully passed the audit. To that date 44 regional TNWs with a mean of 13.5 TCs had been established and certified. The TNWs cover approximately 90% of the country's surface. Of those hospitals, 2.3 were acknowledged as Supraregional TC, 5.4 as Regional TC and 6.7 as Lokal TC. Moreover, cross border TNW in cooperation with hospitals in The Netherlands, Luxembourg, Switzerland and Austria have been established. Preparing for the audit 66% of the hospitals implemented organizational changes (e.g. TraumaRegister DGU(®) documentation and interdisciplinary guidelines), while 60% introduced personnel and 21% structural (e.g. X-ray in the ER) changes. The TraumaNetzwerk DGU(®) project combines the control of common defined standards of care for all participating hospitals (top down) and the possibility of integrating regional cooperation by forming a regional TNW (bottom up). Based on the joint approach of healthcare professionals, it is possible to structure and influence the care of severely injured patients within a nationwide trauma system. Copyright © 2014 Elsevier Ltd. All rights reserved.

Behind the fence forum theater: an arts performance partnership to address lupus and environmental justice.

PubMed

Williams, Edith Marie; Anderson, Judith; Lee, Rhonda; White, Janice; Hahn-Baker, David

2009-01-01

Community-based participatory research (CBPR) is a method to improve environmental quality in communities primarily inhabited by minorities or low-income families. The Buffalo Lupus Project was a CBPR partnership formed to explore the relationship between a local waste site and high rates of lupus. The "Behind the Fence" Community Environmental Forum Theater project was able to successfully funnel the results of scientific research and ongoing activities to the community by utilizing a Forum Theater approach, image-making techniques, an interactive workshop, and energetic public performance. Filming of project activities will expand the reach of that original performance and provide other communities with a potential model for similar efforts.

When Theater Comes to Engineering Design: Oh How Creative They Can Be.

PubMed

Pfeiffer, Ferris M; Bauer, Rachel E; Borgelt, Steve; Burgoyne, Suzanne; Grant, Sheila; Hunt, Heather K; Pardoe, Jennie J; Schmidt, David C

2017-07-01

The creative process is fun, complex, and sometimes frustrating, but it is critical to the future of our nation and progress in science, technology, engineering, mathematics (STEM), as well as other fields. Thus, we set out to see if implementing methods of active learning typical to the theater department could impact the creativity of senior capstone design students in the bioengineering (BE) department. Senior bioengineering capstone design students were allowed to self-select into groups. Prior to the beginning of coursework, all students completed a validated survey measuring engineering design self-efficacy. The control and experimental groups both received standard instruction, but in addition the experimental group received 1 h per week of creativity training developed by a theater professor. Following the semester, the students again completed the self-efficacy survey. The surveys were examined to identify differences in the initial and final self-efficacy in the experimental and control groups over the course of the semester. An analysis of variance was used to compare the experimental and control groups with p < 0.05 considered significant. Students in the experimental group reported more than a twofold (4.8 (C) versus 10.9 (E)) increase of confidence. Additionally, students in the experimental group were more motivated and less anxious when engaging in engineering design following the semester of creativity instruction. The results of this pilot study indicate that there is a significant potential to improve engineering students' creative self-efficacy through the implementation of a "curriculum of creativity" which is developed using theater methods.

Using Readers Theater as a Facilitator in Elementary School English Training

ERIC Educational Resources Information Center

Lin, Ya-Fen

2015-01-01

The purpose of the study aimed to investigate the effect of the Readers Theater (RT) training on elementary school students. In particular, changes in the students' English reading comprehension before and after the RT show, comparison of the students' responses to English learning, especially English reading, the students' opinions on the RT…

The Performing Arts: Music, Dance, and Theater in the Early Years

ERIC Educational Resources Information Center

Koralek, Derry

2010-01-01

This article presents an interview with Mimi Brodsky Chenfeld, a longtime early childhood teacher, author, teacher educator, and advocate for integrating the arts with every aspect of the curriculum. In this interview, Chenfeld shares her thoughts about the performing arts: music, dance, and theater. She explains why it is important for young…

Trauma systems and the costs of trauma care.

PubMed Central

Goldfarb, M G; Bazzoli, G J; Coffey, R M

1996-01-01

OBJECTIVE. This study examines the cost of providing trauma services in trauma centers organized by publicly administered trauma systems, compared to hospitals not part of a formal trauma system. DATA SOURCES AND STUDY SETTING. Secondary administrative discharge abstracts for a national sample of severely injured trauma patients in 44 trauma centers and 60 matched control hospitals for the year 1987 were used. STUDY DESIGN. Retrospective univariate and multivariate analyses were conducted to examine the impact of formal trauma systems and trauma center designation on the costs of treating trauma patients. Key dependent variables included length of stay, charge per day per patient, and charge per hospital stay. Key impact variables were type of trauma system and level of trauma designation. Control variables included patient, hospital, and community characteristics. DATA COLLECTION/EXTRACTION METHODS. Data were selected for hospitals based on (1) a large national hospital discharge database, the Hospital Cost and Utilization Project, 1980-1987 (HCUP-2) and (2) a special survey of trauma systems and trauma designation undertaken by the Hospital Research and Educational Trust of the American Hospital Association. PRINCIPAL FINDINGS. The results show that publicly designated Level I trauma centers, which are the focal point of most trauma systems, have the highest charge per case, the highest average charge per day, and similar or longer average lengths of stay than other hospitals. These findings persist after controlling for patient injury and health status, and for demographic characteristics and hospital and community characteristics. CONCLUSIONS. Prior research shows that severely injured trauma patients have greater chances of survival when treated in specialized trauma centers. However, findings here should be of concern to the many states developing trauma systems since the high costs of Level I centers support limiting the number of centers designated at this

Moving from "optimal resources" to "optimal care" at trauma centers.

PubMed

Shafi, Shahid; Rayan, Nadine; Barnes, Sunni; Fleming, Neil; Gentilello, Larry M; Ballard, David

2012-04-01

The Trauma Quality Improvement Program has shown that risk-adjusted mortality rates at some centers are nearly 50% higher than at others. This "quality gap" may be due to different clinical practices or processes of care. We have previously shown that adoption of processes called core measures by the Joint Commission and Centers for Medicare and Medicaid Services does not improve outcomes of trauma patients. We hypothesized that improved compliance with trauma-specific clinical processes of care (POC) is associated with reduced in-hospital mortality. Records of a random sample of 1,000 patients admitted to a Level I trauma center who met Trauma Quality Improvement Program criteria (age ≥ 16 years and Abbreviated Injury Scale score 3) were retrospectively reviewed for compliance with 25 trauma-specific POC (T-POC) that were evidence-based or expert consensus panel recommendations. Multivariate regression was used to determine the relationship between T-POC compliance and in-hospital mortality, adjusted for age, gender, injury type, and severity. Median age was 41 years, 65% were men, 88% sustained a blunt injury, and mortality was 12%. Of these, 77% were eligible for at least one T-POC and 58% were eligible for two or more. There was wide variation in T-POC compliance. Every 10% increase in compliance was associated with a 14% reduction in risk-adjusted in-hospital mortality. Unlike adoption of core measures, compliance with T-POC is associated with reduced mortality in trauma patients. Trauma centers with excess in-hospital mortality may improve patient outcomes by consistently applying T-POC. These processes should be explored for potential use as Core Trauma Center Performance Measures.

Resource utilization and disability outcome assessment of combat casualties from Operation Iraqi Freedom and Operation Enduring Freedom.

PubMed

Masini, Brendan D; Waterman, Scott M; Wenke, Joseph C; Owens, Brett D; Hsu, Joseph R; Ficke, James R

2009-04-01

Injuries are common during combat operations. The high costs of extremity injuries both in resource utilization and disability are well known in the civilian sector. We hypothesized that, similarly, combat-related extremity injuries, when compared with other injures from the current conflicts in Iraq and Afghanistan, require the largest percentage of medical resources, account for the greatest number of disabled soldiers, and have greater costs of disability benefits. Descriptive epidemiologic study and cost analysis. The Department of Defense Medical Metrics (M2) database was queried for the hospital admissions and billing data of a previously published cohort of soldiers injured in Iraq and Afghanistan between October 2001 and January 2005 and identified from the Joint Theater Trauma Registry. The US Army Physical Disability Administration database was also queried for Physical Evaluation Board outcomes for these soldiers, allowing calculation of disability benefit cost. Primary body region injured was assigned using billing records that gave a primary diagnosis International Classification of Diseases Ninth Edition code, which was corroborated with Joint Theater Trauma Registry injury mechanisms and descriptions for accuracy. A total of 1333 soldiers had complete admission data and were included from 1566 battle injuries not returned to duty of 3102 total casualties. Extremity-injured patients had the longest average inpatient stay at 10.7 days, accounting for 65% of the $65.3-million total inpatient resource utilization, 64% of the 464 patients found "unfit for duty," and 64% of the $170-million total projected disability benefit costs. Extrapolation of data yields total disability costs for this conflict, approaching $2 billion. Combat-related extremity injuries require the greatest utilization of resources for inpatient treatment in the initial postinjury period, cause the greatest number of disabled soldiers, and have the greatest projected disability

Theater and Dialogue to Increase Youth's Intentions to Advocate for LGBTQQ People

ERIC Educational Resources Information Center

Wernick, Laura J.; Kulick, Alex; Dessel, Adrienne B.; Graham, Louis F.

2016-01-01

Objective: This study evaluates the effectiveness of an intervention using theater and dialogue to raise awareness about homophobia and transphobia and increase intentions to participate in macro-level change efforts around lesbian, gay, bisexual, transgender, queer, and questioning (LGBTQQ) issues. Methods: Using a pretest-posttest design, this…

"Think Differently, Get Creative": Producing Precarity in India's Corporate Theater Culture Industry

ERIC Educational Resources Information Center

Saddler, Sarah

2017-01-01

In India's rapidly developing global cities, large multinational corporations implement theater-based corporate training programs that are designed to inspire employees to be more dynamic, aspirational, and self-motivated at work. Offering a performance ethnography of a week-long "Theatre in Excellence" program hosted in Bangalore…

Enhanced Logistics Intra-theater Support Tool

DOE Office of Scientific and Technical Information (OSTI.GOV)

Van Groningen, Charles N.; Braun, Mary Duffy; Widing, Mary Ann

2004-01-27

Developed for use by Department of Defense deployment analysts to perform detailed Reception, Staging, Onward movement and Integration (RSO&I) analyses. ELIST requires: o Vehicle characteristics for ships, planes, trucks, railcars, buses, and helicopters. o Network (physical) characteristics defining the airport, seaport, road, rail, waterway and pipeline infrastructure available in a theater of operations. o Assets available for moving the personnel, equipment and supplies over the infrastructure network. o Movement requirements plan defining the deployment requirements of a military force. This includes defining each unit, its cargo (at various levels of resolution) , where it must move from and to, whatmore » modes it is required to travel by, and when it must be delivered through each phase of deployment.« less

Science as Performance: A Proactive Strategy to Communicate and Educate Through Theater, Music and Dance

NASA Astrophysics Data System (ADS)

Schwartz, Brian

2006-03-01

Theater, music, dance, the literary and the visual arts can convey the joys and controversies of science. We describe a program at the Graduate Center entitled Science as Performance which is designed to communicate to the public the excitement and wonder of science, technology, engineering and mathematics. Over the past few years there have been major successes in communicating science to the public through the arts. This is especially evident in theater and film with such recent plays as Copenhagen and the Oscar winning film A Beautiful Mind. The performance series Science and the Arts has been developed and tested at the Graduate Center of the City University of New York (CUNY) in mid-Manhattan for more than four years, see http://web.gc.cuny.edu/sciart/ . We have developed working relationships with actors, playwrights, dancers, choreographers, musicians, composers, artists and scientists who work at the intersection of science and the arts. In this presentation we will illustrate many of our collaborations in theater, dance, music and art. The response to the series has shown that the arts can make the sciences accessible, relevant, and exciting to diverse audiences in ways that provide both scientific content and significant artistic and entertainment values. The National Science Foundation has awarded a grant to the Graduate Center to help replicate similar Science and the Arts programs on other campuses by involving both their science departments and their performing arts departments. Some results of campus visits will be described. The author will also describe his involvement with producing two musical versions of a play, Einstein’s Dreams based on the novel by Alan Lightman. One production opened at the Teatro da Trindade in Lisbon, Portugal at on October 21, 2005 for a four month run and a second and different production opens at the Prince Music Theater in Philadelphia in March 2006.

Readers Theater as a Tool to Understand Difficult Concept in Economics

ERIC Educational Resources Information Center

Wulandari, Dwi; Narmaditya, Bagus Shandy

2017-01-01

Readers Theater is one of the innovative learning in an effort to increase the understanding and value students' learning processes that involve the activity of reading, writing, listening and speaking. In this type of learning, students read a manuscript of a certain literature and other students grasp the meaning of what was read and is shown by…

[Minimally invasive approaches to hip and knee joints for total joint replacement].

PubMed

Rittmeister, M; König, D P; Eysel, P; Kerschbaumer, F

2004-11-01

The manuscript features the different minimally invasive approaches to the hip for joint replacement. These include medial, anterior, anterolateral, and posterior approaches. The concept of minimally invasive hip arthroplasty makes sense if it is an integral part of a larger concept to lower postoperative morbidity. Besides minimal soft tissue trauma, this concept involves preoperative patient education, preemptive analgesia, and postoperative physiotherapy. It is our belief that minimal incision techniques for the hip are not suited for all patients and all surgeons. The different minimally invasive approaches to the knee joint for implantation of a knee arthroplasty are described and discussed. There have been no studies published yet that fulfill EBM criteria. The data so far show that minimally invasive approaches and implantation techniques for total knee replacements lead to quicker rehabilitation of patients.

Increased concentrations of bone sialoprotein in joint fluid after knee injury.

PubMed Central

Lohmander, L S; Saxne, T; Heinegård, D

1996-01-01

OBJECTIVE: To detect evidence for localised changes in bone matrix metabolism after joint trauma and in post-traumatic osteoarthritis by quantification of bone sialoprotein in joint fluid and serum after knee injury in a cross sectional study. METHODS: Samples of knee joint fluid and serum were obtained from volunteers with normal knees (n = 19), patients with rupture of the anterior cruciate ligament isolated or combined with tear of a meniscus (n = 114), and patients with isolated meniscus lesions (n = 80). Concentrations of bone sialoprotein were determined by ELISA. Concentrations of other markers of joint tissue metabolism in these samples were determined in previous investigations. RESULTS: The median concentrations of bone sialoprotein in joint fluid from healthy volunteers was 122 ng ml-1 (range 41 to 183). Concentrations of bone sialoprotein were increased in both injury groups compared with the reference group (median for cruciate ligament injury 146 ng ml-1, range 72 to 339; median for meniscus injury 166 ng ml-1, range 75 to 376). After injury, bone sialoprotein increased quickly and remained increased for six months. Bone sialoprotein in joint fluid was increased only in samples from joints with normal or nearly normal (fibrillated) cartilage, and was within reference range in joints with radiographic signs of osteoarthritis. Bone sialoprotein concentrations in joints with cruciate ligament injury were positively correlated with levels of aggrecan and cartilage oligomeric matrix protein fragments, and with levels of stromelysin-1 and tissue inhibitor of metalloproteinase-1. The ratios between the concentrations of bone sialoprotein in joint fluid and serum were > 1 in the majority of the cruciate ligament injury cases. CONCLUSIONS: The release of significant amounts of bone sialoprotein into joint fluid in connection with acute joint trauma may be associated with injury to, and active remodelling of, the cartilage-bone interface and subchondral bone

Assessment of Biomarkers Associated with Joint Injury and Subsequent Post-Traumatic Arthritis

DTIC Science & Technology

2015-10-01

osteoarthritis, articular fracture, joint injury, trauma, biomarker, inflammation, MRI , knee, mouse model, translational research. 3. OVERALL PROJECT...intervention. MRI imaging of the injured knee will be obtained to assess the articular cartilage. Degenerative changes in the cartilage and joint space...successfully enrolled patients, collected and stored biosamples, obtained all post-operative MRI scans and are continuing to obtain 18- month MRI scans for

Early Response of Mouse Joint Tissues to Noninvasive Knee Injury Suggests Treatment Targets

PubMed Central

Wu, P.; Holguin, N.; Silva, M. J.; Fu, M.; Liao, W.; Sandell, L. J.

2015-01-01

Objective Joint trauma can lead to a spectrum of acute lesions, including cartilage degradation, ligament or meniscus tears, and synovitis, all potentially associated with osteoarthritis. The goal of this study was to generate and validate a murine model of knee joint trauma following non-invasive controlled injurious compression in vivo and to investigate early molecular events. Methods The right knees of 8-week old mice were placed in a hyperflexed position and subjected to compressive joint loading at one of three peak forces (3, 6, 9 N) for 60 cycles in a single loading period and harvested at 5, 9 and 14 days post loading (n=3–5 mice for each time point and for each loading). The left knees were not loaded and served as the contralateral controls. Histological, immunohistochemical and ELISA analyses were performed to evaluate acute pathologic features in chondrocyte viability, cartilage matrix metabolism, synovial reaction, and serum COMP levels. Results Acute joint pathology was associated with increased injurious loads. All loading regimens induced chondrocyte apoptosis, cartilage matrix degradation, disruption of cartilage collagen fibril arrangement, and increased levels of serum COMP. We also observed that 6N loading induced mild synovitis by day 5 whereas at 9 N, with tearing of the anterior cruciate ligament, severe posttraumatic synovitis and ectopic cartilage formation were observed. Conclusion We have established and analyzed some early events in a murine model of knee joint trauma with different degrees of over-loading in vivo. These results suggest that immediate therapies particularly targeted to apoptosis and synovial cell proliferation could affect the acute posttraumatic reaction to potentially limit chronic consequences and osteoarthritis. PMID:24470303

Theater Security Cooperation: The Military Engagement Team. Lessons and Best Practices

DTIC Science & Technology

2017-01-01

Reproduction of this publication is welcomed and highly encouraged. Theater Security Cooperation: The Military Engagement Team FOLLOW CALL ON SOCIAL...Cooperation: The MET Table of Contents Chapter 1. Military Engagement Team 1 Chapter 2. Predeployment Training 7 Chapter 3. Engagement Planning 13...Chapter 4. Engagement Execution 19 Chapter 5. Engagement Closeout 23 Appendix A. Military Engagement Team Position Descriptions and Duties 27 Appendix

Complex Adaptive Systems: The Theater Air Control System in Desert Storm

DTIC Science & Technology

2014-05-22

insight into leverage points of effective and ineffective adaptation of the TACS. Successful adaptation indicates that increased variety or diversity of...encourages innovation and diversity of ideas. 15. SUBJECT TERMS Theater Air Control System, TACS, Complex Adaptive Systems, Adaptation, Desert Storm...increased variety or diversity of agents and purposeful behaviors are beneficial to overcoming complexity. Leaders play a key role in creating an

Cellular Therapies in Trauma and Critical Care Medicine: Forging New Frontiers.

PubMed

Pati, Shibani; Pilia, Marcello; Grimsley, Juanita M; Karanikas, Alexia T; Oyeniyi, Blessing; Holcomb, John B; Cap, Andrew P; Rasmussen, Todd E

2015-12-01

Trauma is a leading cause of death in both military and civilian populations worldwide. Although medical advances have improved the overall morbidity and mortality often associated with trauma, additional research and innovative advancements in therapeutic interventions are needed to optimize patient outcomes. Cell-based therapies present a novel opportunity to improve trauma and critical care at both the acute and chronic phases that often follow injury. Although this field is still in its infancy, animal and human studies suggest that stem cells may hold great promise for the treatment of brain and spinal cord injuries, organ injuries, and extremity injuries such as those caused by orthopedic trauma, burns, and critical limb ischemia. However, barriers in the translation of cell therapies that include regulatory obstacles, challenges in manufacturing and clinical trial design, and a lack of funding are critical areas in need of development. In 2015, the Department of Defense Combat Casualty Care Research Program held a joint military-civilian meeting as part of its effort to inform the research community about this field and allow for effective planning and programmatic decisions regarding research and development. The objective of this article is to provide a "state of the science" review regarding cellular therapies in trauma and critical care, and to provide a foundation from which the potential of this emerging field can be harnessed to mitigate outcomes in critically ill trauma patients.

Unusual exostosis formation of the subtalar joint following an inversion ankle injury.

PubMed

Cisco, R W; Shaffer, M; Kuchler, L

1993-01-01

Exostosis formation following trauma isnot uncommon to the joints of the foot and ankle. The etiology and treatment of these boney lesions is well-documented in the literature. The following is a report of an unusual exostosis of the subtalar joint following inversion ankle injury. This case is unusual in respect to the formation of an adventitious articulation, the size of the lesion, and the pathology.

Book Analysis: Command and Control of Theater Forces: Adequacy,

DTIC Science & Technology

1988-04-01

COPN R OTIC 11 AIR COMMAND AND STAFF COLLEGE STUDENT REPORT BOOK ANALYSIS: COMMA1ND AND CONTROL OF THEATER FORCES: ADEQUACY1 MA~JOR JOHN J. WRIGHT 88...brIc rNT- PA-- DTIC TAS L DIstrbA(-c & %W1.~b~ ~ Vii D~ , _ _ _ ABOUT THE AUTHOR The author is currently a student at the Air Command and Staff...College, Maxwell AFB AL. A 1973 ROTC graduate from Allegheny College, he attended undergraduate pilot training at Reese AFB TX. From 1975-1980, he was a

Characterization of craniomaxillofacial battle injuries sustained by United States service members in the current conflicts of Iraq and Afghanistan.

PubMed

Lew, Timothy A; Walker, John A; Wenke, Joseph C; Blackbourne, Lorne H; Hale, Robert G

2010-01-01

To characterize and describe the craniomaxillofacial (CMF) battlefield injuries sustained by US Service Members in Operation Iraqi Freedom and Operation Enduring Freedom. The Joint Theater Trauma Registry was queried from October 19, 2001, to December 11, 2007, for CMF battlefield injuries. The CMF injuries were identified using the "International Classification of Diseases, Ninth Revision, Clinical Modification" codes and the data compiled for battlefield injury service members. Nonbattlefield injuries, killed in action, and return to duty cases were excluded. CMF battlefield injuries were found in 2,014 of the 7,770 battlefield-injured US service members. In the 2,014 injured service members were 4,783 CMF injuries (2.4 injuries per soldier). The incidence of CMF battlefield injuries by branch of service was Army, 72%; Marines, 24%; Navy, 2%; and Air Force, 1%. The incidence of penetrating soft-tissue injuries and fractures was 58% and 27%, respectively. Of the fractures, 76% were open. The location of the facial fractures was the mandible in 36%, maxilla/zygoma in 19%, nasal in 14%, and orbit in 11%. The remaining 20% were not otherwise specified. The primary mechanism of injury involved explosive devices (84%). Of the injured US service members, 26% had injuries to the CMF region in the Operation Iraqi Freedom/Operation Enduring Freedom conflicts during a 6-year period. Multiple penetrating soft-tissue injuries and fractures caused by explosive devices were frequently seen. Increased survivability because of body armor, advanced battlefield medicine, and the increased use of explosive devices is probably related to the elevated incidence of CMF battlefield injuries. The current use of "International Classification of Diseases, Ninth Revision, Clinical Modification" codes with the Joint Theater Trauma Registry failed to characterize the severity of facial wounds.

Trauma-Focused CBT for Youth who Experience Ongoing Traumas

PubMed Central

Cohen, Judith A.; Mannarino, Anthony P.; Murray, Laura A.

2011-01-01

Many youth experience ongoing trauma exposure, such as domestic or community violence. Clinicians often ask whether evidence-based treatments containing exposure components to reduce learned fear responses to historical trauma are appropriate for these youth. Essentially the question is, if youth are desensitized to their trauma experiences, will this in some way impair their responding to current or ongoing trauma? The paper addresses practical strategies for implementing one evidence-based treatment, Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) for youth with ongoing traumas. Collaboration with local therapists and families participating in TF-CBT community and international programs elucidated effective strategies for applying TF-CBT with these youth. These strategies included: 1) enhancing safety early in treatment; 2) effectively engaging parents who experience personal ongoing trauma; and 3) during the trauma narrative and processing component focusing on a) increasing parental awareness and acceptance of the extent of the youths’ ongoing trauma experiences; b) addressing youths’ maladaptive cognitions about ongoing traumas; and c) helping youth differentiate between real danger and generalized trauma reminders. Case examples illustrate how to use these strategies in diverse clinical situations. Through these strategies TF-CBT clinicians can effectively improve outcomes for youth experiencing ongoing traumas. PMID:21855140

Diverse Student Teachers Making Sense of Difference through Engaging in Boalian Theater Approaches

ERIC Educational Resources Information Center

Bhukhanwala, Foram; Allexsaht-Snider, Martha

2012-01-01

A diverse group of student teachers in an alternative certification program participated in seminars integrating Boal's "Theater of the Oppressed" (TO) activities. Participants created images and enacted scenes that recreated interactions with their students and also rehearsed ideas for taking action in the classroom. The research,…

Spine Injuries Sustained by U.S. Military Personnel in Combat are Different From Non-Combat Spine Injuries.

PubMed

Szuflita, Nicholas S; Neal, Chris J; Rosner, Michael K; Frankowski, Ralph F; Grossman, Robert G

2016-10-01

Spine injuries are more prevalent among Iraq and Afghanistan veterans than among veterans of previous conflicts. The purpose of this investigation was to characterize the context, mode, and clinical outcomes of spine injuries sustained by U.S. military personnel in theater. Injury and clinical data from patients who sustained a spine injury in Iraq or Afghanistan between 2003 and 2008 were extracted from the Joint Theater Trauma Registry. Fischer's exact test was used to compare demographic variables between battle and nonbattle spine injuries. Two-sided t tests and univariate analyses were performed to analyze the association between injury context, mechanism, and severity with clinical outcome. A total of 307 patients sustained spine injuries in theater during the study period, and 296 had adequate data for analysis. Most injuries occurred in battle (69.6%), and these injuries were more likely to have an Injury Severity Score considered severe (44.7% vs. 20.0%; p < 0.001) or critical (13.6% vs. 5.6%; p = 0.0458). Blast was the most common mechanism of injury (42.2%) and was more likely to be blunt (81.6%) than penetrating (18.4%; p < 0.0001). Battle-associated spine injuries were most commonly caused by blasts, were more severe, and more likely to involve multiple spinal levels. Reprint & Copyright © 2016 Association of Military Surgeons of the U.S.

Assuring optimal trauma care: the role of trauma centre accreditation

PubMed Central

Simons, Richard; Kirkpatrick, Andrew

2002-01-01

Optimal care of the injured patient requires the delivery of appropriate, definitive care shortly after injury. Over the last 30 to 40 years, civilian trauma systems and trauma centres have been developed in the United States based on experience gained in military conflicts, particularly in Korea and Vietnam. A similar process is evolving in Canada. National trauma committees in the US and Canada have defined optimal resources to meet the goal of rapid, appropriate care in trauma centres. They have introduced programs (verification or accreditation) to externally audit trauma centre performance based on these guidelines. It is generally accepted that implementing trauma systems results in decreased preventable death and improved survival after trauma. What is less clear is the degree to which each facet of trauma system development contributes to this improvement. The relative importance of national performance guidelines and trauma centre audit as integral steps toward improved outcomes following injury are reviewed. Current Trauma Association of Canada guidelines for trauma centres are presented and the process of trauma centre accreditation is discussed. PMID:12174987

Hot Technology, Cool Science (LBNL Science at the Theater)

ScienceCinema

Fowler, John

2018-06-08

Great innovations start with bold ideas. Learn how Berkeley Lab scientists are devising practical solutions to everything from global warming to how you get to work. On May 11, 2009, five Berkeley Lab scientists participated in a roundtable dicussion moderated by KTVU's John Fowler on their leading-edge research. This "Science at the Theater" event, held at the Berkeley Repertory Theatre, featured technologies such as cool roofs, battery-driven transportation, a pocket-sized DNA probe, green supercomputing, and a noncontact method for restoring damaged and fragile mechanical recordings.

Childhood Personality, Betrayal Trauma, and Leukocyte Telomere Length in Adulthood: A Lifespan Perspective on Conscientiousness and Betrayal Traumas as Predictors of a Biomarker of Cellular Aging.

PubMed

Edmonds, Grant W; Hampson, Sarah E; Côté, Hélène C F; Hill, Patrick L; Klest, Bridget

2016-01-01

Conscientiousness is associated with longevity. As such, identifying the biological pathways linking personality to mortality is important. This study employs longitudinal data spanning >40 years to test prospective associations with Leukocyte Telomere Length (LTL), a potential marker of cellular aging. Because telomeres shorten over time, and are sensitive to oxidative stress, shorter LTL may reflect cumulative damage associated with negative health behaviors and past stressful events. We investigated childhood conscientiousness as a protective factor, expecting an association with longer LTL in adulthood, possibly reflecting slower LTL shortening. Potential lifespan pathways involving childhood trauma, smoking behaviors, and Body Mass Index (BMI) were explored. Childhood conscientiousness showed a small raw association with LTL ( r = .08, p = .04), although this effect did not persist when controlling for age and sex. Despite this lack of a direct effect on LTL, we detected an indirect effect operating jointly through BMI and smoking. Higher rates of childhood betrayal trauma were associated with shorter LTL. Contrary to our hypothesis that conscientiousness would buffer this effect, we found evidence for an interaction with childhood betrayal traumas where the association between childhood betrayal traumas and LTL was larger for those higher on conscientiousness in childhood.

Childhood Personality, Betrayal Trauma, and Leukocyte Telomere Length in Adulthood: A Lifespan Perspective on Conscientiousness and Betrayal Traumas as Predictors of a Biomarker of Cellular Aging

PubMed Central

Edmonds, Grant W.; Hampson, Sarah E.; Côté, Hélène C. F.; Hill, Patrick L.; Klest, Bridget

2016-01-01

Conscientiousness is associated with longevity. As such, identifying the biological pathways linking personality to mortality is important. This study employs longitudinal data spanning >40 years to test prospective associations with Leukocyte Telomere Length (LTL), a potential marker of cellular aging. Because telomeres shorten over time, and are sensitive to oxidative stress, shorter LTL may reflect cumulative damage associated with negative health behaviors and past stressful events. We investigated childhood conscientiousness as a protective factor, expecting an association with longer LTL in adulthood, possibly reflecting slower LTL shortening. Potential lifespan pathways involving childhood trauma, smoking behaviors, and Body Mass Index (BMI) were explored. Childhood conscientiousness showed a small raw association with LTL (r = .08, p = .04), although this effect did not persist when controlling for age and sex. Despite this lack of a direct effect on LTL, we detected an indirect effect operating jointly through BMI and smoking. Higher rates of childhood betrayal trauma were associated with shorter LTL. Contrary to our hypothesis that conscientiousness would buffer this effect, we found evidence for an interaction with childhood betrayal traumas where the association between childhood betrayal traumas and LTL was larger for those higher on conscientiousness in childhood. PMID:28018048

Reported vocal habits of first-year undergraduate musical theater majors in a preprofessional training program: a 10-year retrospective study.

PubMed

Donahue, Erin N; Leborgne, Wendy D; Brehm, Susan Baker; Weinrich, Barbara D

2014-05-01

Collegiate-level musical theater performance students are a specialized group of vocal performers, who rely on frequent and optimal voice use for their academic advancement and ultimate livelihood. The purpose of this study was to gather information to develop a greater understanding of vocal health and practice patterns of incoming collegiate-level musical theater performers. Data obtained from questionnaires completed by freshman musical theater majors were retrospectively analyzed to gather information about baseline vocal habits of the participants. Results of a questionnaire were obtained from incoming freshman musical theater students at the Cincinnati Conservatory of Music over a period of 10 years (2002-2011). One hundred eighty-eight participants (female = 90) (male = 98) with an average age of 18.28 years (standard deviation = 0.726) were included. Results specifying participants' self-reported vocal training and practice habits, vocal health and hygiene practices, and current vocal symptoms or contributing factors to potential voice problems are provided. Data obtained from the participants revealed that the potential for vocal problems exists in this group of performers, as over half of the subjects reported at least one current negative vocal symptom. The findings from this study provide information that may be useful for individuals who are involved in the training of vocal performers. Copyright © 2014 The Voice Foundation. Published by Mosby, Inc. All rights reserved.

A novel passive/active hybrid robot for orthopaedic trauma surgery.

PubMed

Kuang, Shaolong; Leung, Kwok-sui; Wang, Tianmiao; Hu, Lei; Chui, Elvis; Liu, Wenyong; Wang, Yu

2012-12-01

Image guided navigation systems (IGNS) have been implemented successfully in orthopaedic trauma surgery procedures because of their ability to help surgeons position and orient hand-held drills at optimal entry points. However, current IGNS cannot prevent drilling tools or instruments from slipping or deviating from the planned trajectory during the drilling process. A method is therefore needed to overcome such problems. A novel passive/active hybrid robot (the HybriDot) for positioning and supporting surgical tools and instruments while drilling and/or cutting in orthopaedic trauma surgery is presented in this paper. This new robot, consisting of a circular prismatic joint and five passive/active back-drivable joints, is designed to fulfill clinical needs. In this paper, a system configuration and three operational modes are introduced and analyzed. Workspace and layout in the operating theatre (OT) are also analyzed in order to validate the structure design. Finally, experiments to evaluate the feasibility of the robot system are described. Analysis, simulation, and experimental results show that the novel structure of the robot can provide an appropriate workspace without risk of collision within OT environments during operation. The back-drivable joint mechanism can provide surgeons with more safety and flexibility in operational modes. The mean square value of the positional accuracy of this robot is 0.811 mm, with a standard deviation (SD) of 0.361 mm; the orientation is accurate to within 2.186º, with a SD of 0.932º. Trials on actual patients undergoing surgery for distal locking of intramedullary nails were successfully conducted in one pass using the robot. This robot has the advantages of having an appropriate workspace, being well designed for human-robot cooperation, and having high accuracy, sufficient rigidity, and easy deployability within the OT for use in common orthopaedic trauma surgery tasks such as screw fixation and drilling assistance

Vascular Surgery in the Pacific Theaters of World War II: The Persistence of Ligation Amid Unique Military Medical Conditions.

PubMed

Barr, Justin; Cherry, Kenneth J; Rich, Norman M

2018-06-18

: Although multiple sources chronicle the practice of vascular surgery in the North African, Mediterranean, and European theaters of World War II, that of the Pacific campaign remains undescribed. Relying on primary source documents from the war, this article provides the first discussion of the management of vascular injuries in the island-hopping battles of the Pacific. It explains how the particular military, logistic, and geographic conditions of this theater influenced medical and surgical care, prompting a continued emphasis on ligation when surgeons in Europe had already transitioned to repairing arteries.

Cellular Therapies in Trauma and Critical Care Medicine: Forging New Frontiers

PubMed Central

Pati, Shibani; Pilia, Marcello; Grimsley, Juanita M.; Karanikas, Alexia T.; Oyeniyi, Blessing; Holcomb, John B.; Cap, Andrew P.; Rasmussen, Todd E.

2015-01-01

ABSTRACT Trauma is a leading cause of death in both military and civilian populations worldwide. Although medical advances have improved the overall morbidity and mortality often associated with trauma, additional research and innovative advancements in therapeutic interventions are needed to optimize patient outcomes. Cell-based therapies present a novel opportunity to improve trauma and critical care at both the acute and chronic phases that often follow injury. Although this field is still in its infancy, animal and human studies suggest that stem cells may hold great promise for the treatment of brain and spinal cord injuries, organ injuries, and extremity injuries such as those caused by orthopedic trauma, burns, and critical limb ischemia. However, barriers in the translation of cell therapies that include regulatory obstacles, challenges in manufacturing and clinical trial design, and a lack of funding are critical areas in need of development. In 2015, the Department of Defense Combat Casualty Care Research Program held a joint military–civilian meeting as part of its effort to inform the research community about this field and allow for effective planning and programmatic decisions regarding research and development. The objective of this article is to provide a “state of the science” review regarding cellular therapies in trauma and critical care, and to provide a foundation from which the potential of this emerging field can be harnessed to mitigate outcomes in critically ill trauma patients. PMID:26428845

A Theater-Based Approach to Primary Prevention of Sexual Behavior for Early Adolescents

ERIC Educational Resources Information Center

Lieberman, Lisa D.; Berlin, Cydelle; Palen, Lori-Ann; Ashley, Olivia Silber

2012-01-01

Early adolescence is a crucial period for preventing teen pregnancy and sexually transmitted infections. This study evaluated STAR LO, a theater-based intervention designed to affect antecedents of sexual activity among urban early adolescents (N = 1,143). Public elementary/middle schools received the intervention or served as a wait-listed…

Cogent Bodies, Self-Aware Souls: An Apologetic for Theater in Christian Higher Education

ERIC Educational Resources Information Center

Lewis, Mark; Hall, M. Elizabeth Lewis

2012-01-01

Mission statements of Christian institutions of higher education often include the purpose of forming individuals to live out their Christian commitments in larger society. This article presents the case that including theater in Christian higher education prepares students to further God's kingdom in this world after graduation--whether or not…

Systemic trauma.

PubMed

Goldsmith, Rachel E; Martin, Christina Gamache; Smith, Carly Parnitzke

2014-01-01

Substantial theoretical, empirical, and clinical work examines trauma as it relates to individual victims and perpetrators. As trauma professionals, it is necessary to acknowledge facets of institutions, cultures, and communities that contribute to trauma and subsequent outcomes. Systemic trauma-contextual features of environments and institutions that give rise to trauma, maintain it, and impact posttraumatic responses-provides a framework for considering the full range of traumatic phenomena. The current issue of the Journal of Trauma & Dissociation is composed of articles that incorporate systemic approaches to trauma. This perspective extends conceptualizations of trauma to consider the influence of environments such as schools and universities, churches and other religious institutions, the military, workplace settings, hospitals, jails, and prisons; agencies and systems such as police, foster care, immigration, federal assistance, disaster management, and the media; conflicts involving war, torture, terrorism, and refugees; dynamics of racism, sexism, discrimination, bullying, and homophobia; and issues pertaining to conceptualizations, measurement, methodology, teaching, and intervention. Although it may be challenging to expand psychological and psychiatric paradigms of trauma, a systemic trauma perspective is necessary on both scientific and ethical grounds. Furthermore, a systemic trauma perspective reflects current approaches in the fields of global health, nursing, social work, and human rights. Empirical investigations and intervention science informed by this paradigm have the potential to advance scientific inquiry, lower the incidence of a broader range of traumatic experiences, and help to alleviate personal and societal suffering.

Prehospital Interventions During Mass-Casualty Events in Afghanistan: A Case Analysis.

PubMed

Schauer, Steven G; April, Michael D; Simon, Erica; Maddry, Joseph K; Carter, Robert; Delorenzo, Robert A

2017-08-01

Mass-casualty (MASCAL) events are known to occur in the combat setting. There are very limited data at this time from the Joint Theater (Iraq and Afghanistan) wars specific to MASCAL events. The purpose of this report was to provide preliminary data for the development of prehospital planning and guidelines. Cases were identified using the Department of Defense (DoD; Virginia USA) Trauma Registry (DoDTR) and the Prehospital Trauma Registry (PHTR). These cases were identified as part of a research study evaluating Tactical Combat Casualty Care (TCCC) guidelines. Cases that were designated as or associated with denoted MASCAL events were included. Data Fifty subjects were identified during the course of this project. Explosives were the most common cause of injuries. There was a wide range of vital signs. Tourniquet placement and pressure dressings were the most common interventions, followed by analgesia administration. Oral transmucosal fentanyl citrate (OTFC) was the most common parenteral analgesic drug administered. Most were evacuated as "routine." Follow-up data were available for 36 of the subjects and 97% were discharged alive. The most common prehospital interventions were tourniquet and pressure dressing hemorrhage control, along with pain medication administration. Larger data sets are needed to guide development of MASCAL in-theater clinical practice guidelines. Schauer SG , April MD , Simon E , Maddry JK , Carter R III , Delorenzo RA . Prehospital interventions during mass-casualty events in Afghanistan: a case analysis. Prehosp Disaster Med. 2017;32(4):465-468.

Joint Theater Trauma System Implementation of Burn Resuscitation Guidelines Improves Outcomes in Severely Burned Military Casualties

DTIC Science & Technology

2007-10-01

a secure web-based portal , was established by JTTS at around the same period. Use of JPTA has allowed a near-real time picture of patient movement...video teleconference. Miltary Med. 2007;172:611–615. 6. Ivy ME, Atweh NA, Palmer, et al. Intra-abdominal hypertension and abdominal compartment...conclude that fluid volumes are unimportant. As Dr. Johannigman forecasts , these relationships will become more evident as we gather more data. With

A report of 3 soldiers returned to full duty after lumbar radiofrequency facet denervation in a theater of war.

PubMed

Dragovich, Anthony; Trainer, Robert J

2011-04-01

To provide the advanced interventional procedure of zygapophysial joint neurotomy to soldiers meeting the diagnostic criteria in a combat environment and thus reduce medical evacuations of soldiers from a theater of war. Retrospective chart review was performed on three consecutive soldiers who received neuroablation of the lumbar ZP joint. Patients received single MBB with 1 cc of 1% lidocaine at the b/l L3-L5 levels considered diagnostic if >50% analgesia was achieved concordant with duration of anesthetic.   All procedures were co-performed by the two authors at the Ibn Sina hospital in Baghdad, Iraq over a 3-month period. Three consecutive patients with >50% pain relief from diagnostic medial branch blocks were treated with radiofrequency ablation of the bilateral L3-L4 medial branch nerves and L5 posterior primary ramus. Sensory test stimulation at 50 Hz and motor stimulation at 2 Hz were performed at each level. The nerves were then lesioned at 80° Centigrade for 90 seconds after injection of lidocaine and methylprednisolone. Procedure was considered successful if patients were able to wear body armour without significant discomfort (at least 1 hour/day). Medical evacuation from Iraq was prevented and all soldiers returned to rigorous combat duties including the wearing of body armour daily. We believe to be the first to report on the use of RF nerve ablation in a war time setting and with this functional outcome. Wiley Periodicals, Inc.

The impact of specialist trauma service on major trauma mortality.

PubMed

Wong, Ting Hway; Lumsdaine, William; Hardy, Benjamin M; Lee, Keegan; Balogh, Zsolt J

2013-03-01

Trauma services throughout the world have had positive effects on trauma-related mortality. Australian trauma services are generally more consultative in nature rather than the North American model of full trauma admission service. We hypothesized that the introduction of a consultative specialist trauma service in a Level I Australian trauma center would reduce mortality of the severely injured. A 10-year retrospective study (January 1, 2002-December 31, 2011) was performed on all trauma patients admitted with an Injury Severity Score (ISS) > 15. Patients were identified from the trauma registry, and data for age, sex, mechanism of injury, ISS, survival to discharge, and length of stay were collected. Mortality was examined for patients with severe injury (ISS > 15) and patients with critical injury (ISS > 24) and compared for the three periods: 2002-2004 (without trauma specialist), 2005-2007 (with trauma specialist), and 2008-2011 (with specialist trauma service). A total of 3,869 severely injured (ISS > 15) trauma patients were identified during the 10-year period. Of these, 2,826 (73%) were male, 1,513 (39%) were critically injured (ISS > 24), and more than 97% (3,754) were the victim of blunt trauma. Overall mortality decreased from 12.4% to 9.3% (relative risk, 0.75) from period one to period three and from 25.4% to 20.3% (relative risk, 0.80) for patients with critical injury. A 0.46% per year decrease (p = 0.018) in mortality was detected (odds ratio, 0.63; p < 0.001). For critically injured (ISS > 24), the trend was (0.61% per year; odds ratio, 0.68; p = 0.039). The introduction of a specialist trauma service decreased the mortality of patients with severe injury, the model of care should be considered to implement state- and nationwide in Australia. Epidemiologic study, level III.

The Potential for Additional Channel Airlift in a Low Cargo Demand Theater

DTIC Science & Technology

2014-06-13

benefit of providing additional channel airlift in the AFRICOM Theater. Assumptions/Limitations The research problem has many variables, so the... salesman USTRANSCOM via AMC has a variety of airlift services it can offer its customers. Annex 3-17 Air Mobility Operations defines airlift as...International, 2008) Given the trouble land based travel offers the alternative for military operations is to route cargo and personnel by air. Air

The Making of "Who We Are," Now Showing at the NMAI Lelawi Theater

ERIC Educational Resources Information Center

Singer, Beverly R.

2005-01-01

"Who We Are" is among the exhibitions that premiered in September 2004 during the opening of the Smithsonian National Museum of American Indian in the U.S. capital. It is a multimedia-formatted film being shown in the distinctive circular Lelawi Theater located on the fourth floor in the museum. "Lelawi" is a Lenape (Delaware)…

Management of Open Pneumothorax in Tactical Combat Casualty Care: TCCC Guidelines Change 13-02.

PubMed

Butler, Frank K; Dubose, Joseph J; Otten, Edward J; Bennett, Donald R; Gerhardt, Robert T; Kheirabadi, Bijan S; Gross, Kriby R; Cap, Andrew P; Littlejohn, Lanny F; Edgar, Erin P; Shackelford, Stacy A; Blackbourne, Lorne H; Kotwal, Russ S; Holcomb, John B; Bailey, Jeffrey A

2013-01-01

During the recent United States Central Command (USCENTCOM) and Joint Trauma System (JTS) assessment of prehospital trauma care in Afghanistan, the deployed director of the Joint Theater Trauma System (JTTS), CAPT Donald R. Bennett, questioned why TCCC recommends treating a nonlethal injury (open pneumothorax) with an intervention (a nonvented chest seal) that could produce a lethal condition (tension pneumothorax). New research from the U.S. Army Institute of Surgical Research (USAISR) has found that, in a model of open pneumothorax treated with a chest seal in which increments of air were added to the pleural space to simulate an air leak from an injured lung, use of a vented chest seal prevented the subsequent development of a tension pneumothorax, whereas use of a nonvented chest seal did not. The updated TCCC Guideline for the battlefield management of open pneumothorax is: ?All open and/ or sucking chest wounds should be treated by immediately applying a vented chest seal to cover the defect. If a vente chest seal is not available, use a non-vented chest seal. Monitor the casualty for the potential development of a subsequent tension pneumothorax. If the casualty develops increasing hypoxia, respiratory distress, or hypotension and a tension pneumothorax is suspected, treat by burping or removing the dressing or by needle decompression.? This recommendation was approved by the required two-thirds majority of the Committee on TCCC in June 2013. 2013.

Withholding and termination of resuscitation of adult cardiopulmonary arrest secondary to trauma: resource document to the joint NAEMSP-ACSCOT position statements.

PubMed

Millin, Michael G; Galvagno, Samuel M; Khandker, Samiur R; Malki, Alisa; Bulger, Eileen M

2013-09-01

In the setting of traumatic cardiopulmonary arrest, protocols that direct emergency medical service (EMS) providers to withhold or terminate resuscitation, when clinically indicated, have the potential to decrease unnecessary use of warning lights and sirens and save valuable public health resources. Protocols to withhold resuscitation should be based on the determination that there are no obvious signs of life, the injuries are obviously incompatible with life, there is evidence of prolonged arrest, and there is a lack of organized electrocardiographic activity. Termination of resuscitation is indicated when there are no signs of life and no return of spontaneous circulation despite appropriate field EMS treatment that includes minimally interrupted cardiopulmonary resuscitation. Further research is needed to determine the appropriate duration of cardiopulmonary resuscitation before termination of resuscitation and the proper role of direct medical oversight in termination of resuscitation protocols. This article is the resource document to the position statements, jointly endorsed by the National Association of EMS Physicians and the American College of Surgeons' Committee on Trauma, on withholding and termination of resuscitation in traumatic cardiopulmonary arrest.

Trauma center staffing, infrastructure, and patient characteristics that influence trauma center need.

PubMed

Faul, Mark; Sasser, Scott M; Lairet, Julio; Mould-Millman, Nee-Kofi; Sugerman, David

2015-01-01

The most effective use of trauma center resources helps reduce morbidity and mortality, while saving costs. Identifying critical infrastructure characteristics, patient characteristics and staffing components of a trauma center associated with the proportion of patients needing major trauma care will help planners create better systems for patient care. We used the 2009 National Trauma Data Bank-Research Dataset to determine the proportion of critically injured patients requiring the resources of a trauma center within each Level I-IV trauma center (n=443). The outcome variable was defined as the portion of treated patients who were critically injured. We defined the need for critical trauma resources and interventions ("trauma center need") as death prior to hospital discharge, admission to the intensive care unit, or admission to the operating room from the emergency department as a result of acute traumatic injury. Generalized Linear Modeling (GLM) was used to determine how hospital infrastructure, staffing Levels, and patient characteristics contributed to trauma center need. Nonprofit Level I and II trauma centers were significantly associated with higher levels of trauma center need. Trauma centers that had a higher percentage of transferred patients or a lower percentage of insured patients were associated with a higher proportion of trauma center need. Hospital infrastructure characteristics, such as bed capacity and intensive care unit capacity, were not associated with trauma center need. A GLM for Level III and IV trauma centers showed that the number of trauma surgeons on staff was associated with trauma center need. Because the proportion of trauma center need is predominantly influenced by hospital type, transfer frequency, and insurance status, it is important for administrators to consider patient population characteristics of the catchment area when planning the construction of new trauma centers or when coordinating care within state or regional

Defense.gov - Special Report - Cybersecurity

Science.gov Websites

Questions Abound in Cyber Theater of Operations, Vice Chairman Says WASHINGTON, June 9, 2009 - The Defense theater of operations, the vice chairman of the Joint Chiefs of Staff said. Story Obama Announces

Incremental cost-effectiveness of trauma service improvements for road trauma casualties: experience of an Australian major trauma centre.

PubMed

Dinh, Michael M; Bein, Kendall J; Hendrie, Delia; Gabbe, Belinda; Byrne, Christopher M; Ivers, Rebecca

2016-09-01

Objective The aim of the present study was to estimate the cost-effectiveness of trauma service funding enhancements at an inner city major trauma centre. Methods The present study was a cost-effectiveness analysis using retrospective trauma registry data of all major trauma patients (injury severity score >15) presenting after road trauma between 2001 and 2012. The primary outcome was cost per life year gained associated with the intervention period (2007-12) compared with the pre-intervention period (2001-06). Incremental costs were represented by all trauma-related funding enhancements undertaken between 2007 and 2010. Risk adjustment for years of life lost was conducted using zero-inflated negative binomial regression modelling. All costs were expressed in 2012 Australian dollar values. Results In all, 876 patients were identified during the study period. The incremental cost of trauma enhancements between 2007 and 2012 totalled $7.91million, of which $2.86million (36%) was attributable to road trauma patients. After adjustment for important covariates, the odds of in-hospital mortality reduced by around half (adjusted odds ratio (OR) 0.48; 95% confidence interval (CI) 0.27, 0.82; P=0.01). The incremental cost-effectiveness ratio was A$7600 per life year gained (95% CI A$5524, $19333). Conclusion Trauma service funding enhancements that enabled a quality improvement program at a single major trauma centre were found to be cost-effective based on current international and Australian standards. What is known about this topic? Trauma quality improvement programs have been implemented across most designated trauma hospitals in an effort to improve hospital care processes and outcomes for injured patients. These involve a combination of education and training, the use of audit and key performance indicators. What does this paper add? A trauma quality improvement program initiated at an Australian Major Trauma Centre was found to be cost-effective over 12 years with

The Role of Cumulative Trauma, Betrayal, and Appraisals in Understanding Trauma Symptomatology.

PubMed

Martin, Christina Gamache; Cromer, Lisa Demarni; Deprince, Anne P; Freyd, Jennifer J

2013-03-01

Poor psychological outcomes are common among trauma survivors, yet not all survivors experience adverse sequelae. The current study examined links between cumulative trauma exposure as a function of the level of betrayal (measured by the relational closeness of the survivor and the perpetrator), trauma appraisals, gender, and trauma symptoms. Participants were 273 college students who reported experiencing at least one traumatic event on a trauma checklist. Three cumulative indices were constructed to assess the number of different types of traumas experienced that were low (LBTs), moderate (MBTs), or high in betrayal (HBTs). Greater trauma exposure was related to more symptoms of depression, dissociation, and PTSD, with exposure to HBTs contributing the most. Women were more likely to experience HBTs than men, but there were no gender differences in trauma-related symptoms. Appraisals of trauma were predictive of trauma-related symptoms over and above the effects explained by cumulative trauma at each level of betrayal. The survivor's relationship with the perpetrator, the effect of cumulative trauma, and their combined impact on trauma symptomatology are discussed.

The Role of Cumulative Trauma, Betrayal, and Appraisals in Understanding Trauma Symptomatology

PubMed Central

Martin, Christina Gamache; Cromer, Lisa DeMarni; DePrince, Anne P.; Freyd, Jennifer J.

2012-01-01

Poor psychological outcomes are common among trauma survivors, yet not all survivors experience adverse sequelae. The current study examined links between cumulative trauma exposure as a function of the level of betrayal (measured by the relational closeness of the survivor and the perpetrator), trauma appraisals, gender, and trauma symptoms. Participants were 273 college students who reported experiencing at least one traumatic event on a trauma checklist. Three cumulative indices were constructed to assess the number of different types of traumas experienced that were low (LBTs), moderate (MBTs), or high in betrayal (HBTs). Greater trauma exposure was related to more symptoms of depression, dissociation, and PTSD, with exposure to HBTs contributing the most. Women were more likely to experience HBTs than men, but there were no gender differences in trauma-related symptoms. Appraisals of trauma were predictive of trauma-related symptoms over and above the effects explained by cumulative trauma at each level of betrayal. The survivor’s relationship with the perpetrator, the effect of cumulative trauma, and their combined impact on trauma symptomatology are discussed. PMID:23542882

Preparing Global Trauma Nurses for Leadership Roles in Global Trauma Systems.

PubMed

Muñiz, Sol Angelica; Lang, Richard W; Falcon, Lisa; Garces-King, Jasmine; Willard, Suzanne; Peck, Gregory L

Trauma leads to 5.7 million annual deaths globally, accounting for 25%-33% of global unintentional deaths and 90% of the global trauma burden in low- and middle-income countries. The Lancet Commission on Global Surgery and the World Health Organization assert that emergent and essential surgical capacity building and trauma system improvement are essential to address the global burden of trauma. In response, the Rutgers Global Surgery program, the School of Nursing and Medicine, and the Robert Wood Johnson University Hospital faculty collaborated in the first Interprofessional Models in Global Injury Care and Education Symposium in June 2016. This 2-week symposium combined lectures, high-fidelity simulation, small group workshops, site visits to Level I trauma centers, and a 1-day training course from the Panamerican Trauma Society. The aim was to introduce global trauma nurses to trauma leadership and trauma system development. After completing the symposium, 10 nurses from China, Colombia, Kenya, Puerto Rico, and Uruguay were surveyed. Overall, 88.8% of participants reported high levels of satisfaction with the program and 100% stated being very satisfied with trauma lectures. Symposia, such as that developed and offered by Rutgers University, prepare nurses to address trauma within system-based care and facilitate trauma nursing leadership in their respective countries.

Utilizing Peer Education Theater for the Primary Prevention of Sexual Violence on College Campuses

ERIC Educational Resources Information Center

McMahon, Sarah; Postmus, Judy L.; Warrener, Corinne; Koenick, Ruth Anne

2014-01-01

To address the widespread problem of sexual assault, many colleges and universities are providing primary prevention education programs. Although a number of such programs exist and appear in the literature (for review see Vladutiu, Martin, & Macy, 2011), the role of peer education theater offers a unique approach. Peer education has been…

Trauma-focused CBT for youth with complex trauma

PubMed Central

Mannarino, Anthony P.; Kliethermes, Matthew; Murray, Laura A.

2013-01-01

Objectives Many youth develop complex trauma, which includes regulation problems in the domains of affect, attachment, behavior, biology, cognition, and perception. Therapists often request strategies for using evidence-based treatments (EBTs) for this population. This article describes practical strategies for applying Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) for youth with complex trauma. Methods TF-CBT treatment phases are described and modifications of timing, proportionality and application are described for youth with complex trauma. Practical applications include a) dedicating proportionally more of the model to the TF-CBT coping skills phase; b) implementing the TF-CBT Safety component early and often as needed throughout treatment; c) titrating gradual exposure more slowly as needed by individual youth; d) incorporating unifying trauma themes throughout treatment; and e) when indicated, extending the TF-CBT treatment consolidation and closure phase to include traumatic grief components and to generalize ongoing safety and trust. Results Recent data from youth with complex trauma support the use of the above TF-CBT strategies to successfully treat these youth. Conclusions The above practical strategies can be incorporated into TF-CBT to effectively treat youth with complex trauma. Practice implications Practical strategies include providing a longer coping skills phase which incorporates safety and appropriate gradual exposure; including relevant unifying themes; and allowing for an adequate treatment closure phase to enhance ongoing trust and safety. Through these strategies therapists can successfully apply TF-CBT for youth with complex trauma. PMID:22749612

Knee joint effusion following ipsilateral hip surgery.

PubMed

Christodoulou, A G; Givissis, P; Antonarakos, P D; Petsatodis, G E; Hatzokos, I; Pournaras, J D

2010-12-01

To correlate patellar reflex inhibition with sympathetic knee joint effusion. 65 women and 40 men aged 45 to 75 (mean, 65) years underwent hip surgery. The surgery entailed dynamic hip screw fixation using the lateral approach with reflection of the vastus lateralis for pertrochantric fractures (n = 49), and hip hemiarthroplasty or total hip replacement using the Watson-Jones approach (n = 38) or hip hemiarthroplasty using the posterior approach (n = 18) for subcapital femoral fractures (n = 28) or osteoarthritis (n = 28). Knee joint effusion, patellar reflex, and thigh circumference were assessed in both legs before and after surgery (at day 0.5, 2, 7, 14, 30, and 45). Time-sequence plots were used for chronological analysis, and correlation between patellar reflex inhibition and knee joint effusion was tested. In the time-sequence plot, the peak frequency of patellar reflex inhibition (on day 0.5) preceded that of the knee joint effusion and the thigh circumference increase (on day 2). Patellar reflex inhibition correlated positively with the knee joint effusion (r = 0.843, p = 0.035). These 2 factors correlated significantly for all 3 surgical approaches (p < 0.0005). All 3 approaches were associated with patellar reflex inhibition on day 0.5 (p = 0.033) and knee joint effusion on day 2 (p = 0.051). Surgical trauma of the thigh may cause patellar reflex inhibition and subsequently knee joint effusion.

Improving joint pain and function in osteoarthritis.

PubMed

Owens, Claire; Conaghan, Philip G

2016-12-01

Osteoarthritis has become a major chronic pain condition. It affects more than 10% of adults and accounts for almost 10% of health service resources. The impact of osteoarthritis is amplified by underuse of effective muscle strengthening exercises and a focus on often less effective and poorly tolerated analgesic therapies. Although traditionally considered to be primarily a disease of cartilage, there is now ample evidence that typical clinical osteoarthritis involves multiple tissue pathologies. Increased BMI is associated with a higher incidence of knee osteoarthritis. Anatomical abnormalities such as valgus alignment or previous joint trauma including meniscectomy, anterior cruciate ligament rupture and fracture through the joint are also associated with increased incidence of osteoarthritis. Pain is the main presenting symptom. However, we still have a poor understanding of the causes of pain in osteoarthritis. In patients aged 45 or over the diagnosis should be made clinically without investigations if the patient has activity-related joint pain in addition to early morning joint stiffness lasting less than 30 minutes. Muscle strengthening and aerobic exercise have been shown to improve joint pain and function. Weight loss not only improves joint pain and function but has a myriad of other health benefits, reducing the incidence of lifestyle associated diseases such as cardiovascular disease and type 2 diabetes, and mechanical stress on the joints.

Pediatric trauma at an adult trauma center.

PubMed

Siram, Suryanarayana; Oyetunji, Tolulope A; Khoury, Amal L; Walker, Sonya R; Bolorunduro, Oluwaseyi B; Chang, David C; Greene, Wendy R; Cornwell, Edward E; Frederick, Wayne A I

2010-08-01

Accidental traumatic injury is the number 1 cause of morbidity and mortality in the pediatric population. In this study, we aim to prove that certain pediatric patients can be treated with good outcomes at an adult level 1 trauma center. Retrospective analysis using the Howard University Hospital trauma registry identified 71 patients treated at Howard University Hospital between the ages of 1 and 17 years old. Specific variables were identified and collected for each patient. The majority of pediatric traumas treated at Howard University Hospital between June 2004 and May 2005 had high survival rates (93%). The patients who did not survive (7%) included 3 patients who were dead on arrival and 2 who died shortly after arrival to the hospital. Certain pediatric populations who present with minor and/or isolated injuries can be treated in an adult level 1 trauma center with similar outcomes to treatment in a pediatric level 1 trauma center.

Trauma Fact Sheet

MedlinePlus

... News & Meetings Science Education About NIGMS NIGMS Home > Science Education > Physical Trauma Physical Trauma Tagline (Optional) Middle/Main Content Area PDF Version (420 KB) Other Fact Sheets What is physical trauma? Physical trauma is ...

Pediatric Thoracic Trauma in Iraq and Afghanistan.

PubMed

Keneally, Ryan J; Shields, Cynthia H; Hsu, Albert; Prior, Howard I; Creamer, Kevin M

2018-04-06

The objective of this study is to review available data on pediatric thoracic trauma seen at U.S. military treatment facilities in Iraq and Afghanistan and describe the scope of injuries, patterns seen, and associated mortality. The results were compared with adults injured in Iraq and Afghanistan and other reports of pediatric thoracic trauma in the literature. The investigators received approval from the Uniformed Services University of the Health Sciences' institutional review board before the study. The Joint Theatre Trauma Registry was queried for all patients with an ICD-9 code for thoracic trauma. Two-tailed Student's t-test, Mann-Whitney rank sum, χ2, ANOVA, or multiple logistic regression was used as indicated. There were 955 patients under the age of 18 yr, just over 12% of all thoracic trauma. Penetrating injuries were common (73.6%), including gunshot wounds. The most common pediatric diagnoses were contusions (45%), pneumothorax (40%), and rib and/or sternal fractures (18%). The overall mortality for children was 15.2% compared with 13.8% and 9% for civilian adults and Coalition members with thoracic trauma, respectively. Mortality was inversely related to age among pediatric patients. Children under 2 yr of age had the highest mortality (25.1%). Patients under 12 yr of age were more likely to die than those between 12 and 18 (OR 2.02, 95% CI 1.27-3.22) yr. Thoracic vascular injuries and cardiac injuries resulted in the highest mortality among pediatric patients. The presence of a hemothorax was independently associated with an increased risk for mortality (OR 1.78, 95% CI 1.06-2.99) as was a concomitant head injury (OR 2.17, 95% CI 1.33-3.54). There was a 2.7% incidence of burns among pediatric patients with a high associated mortality (46.2%). Nearly one-half of all the children identified required a transfusion (47%). Penetrating injuries predominated and these children commonly required a transfusion. Mortality was inversely related to age

[The Academy of Trauma Surgery (AUC). Service provider and management organization of the DGU].

PubMed

Sturm, J A; Hoffmann, R

2016-02-01

At the beginning of this century the German Trauma Society (DGU) became extensively active with an initiative on quality promotion, development of quality assurance and transparency regarding treatment of the severely injured. A white book on "Medical care of the severely injured" was published, focusing on the requirements on structural quality and especially procedural quality. The impact of the white book was immense and a trauma network with approved trauma centers, structured and graded for their individual trauma care performance, was developed. In order to monitor and document the required quality of care, a registry was needed. Furthermore, for cooperation within the trauma networks innovative methods for digital transfer of radiological images and patient documents became necessary. Finally, the auditing criteria for trauma centers had and still have to be completed with advanced medical education and training programs. In order to realize the implementation of such a broad spectrum of economically relevant and increasingly complex activities the Academy of Trauma Surgery (AUC) was established as a subsidiary of the DGU in 2004. The AUC currently has four divisions: 1) networks and health care structures, 2) registries and research management, 3) telemedicine, 4) medical education and training, all of which serve the goal of the initiative. The AUC is a full service provider and management organization in compliance with the statutes of the DGU. According to these statutes the business operations of the AUC also cover projects for numerous groups of patients, projects for the joint society the German Society for Orthopedics and Trauma (DGOU) as well as other medical institutions. This article describes the success stories of the trauma network (TraumaNetzwerk DGU®), the TraumaRegister DGU®, the telecooperation platform TKmed®, the new and fast-growing orthogeriatric center initiative (AltersTraumaZentrum DGU®) and the division of medical education and

Acts of Reciprocity: Analyzing Social Exchange in a University Theater for Social Change Project

ERIC Educational Resources Information Center

Cloeren, Nicole Birgit

2010-01-01

In this study I sought to understand the complexities of the processes of reciprocity within a theater for social change service-learning project. My sample included three university students, one university faculty member, four high school students, one high school principal, and one high school teacher. As a participant- observer, I conducted an…

Guidelines and Criteria to Assess Singing and Music Training in Baccalaureate Music Theater Programs

ERIC Educational Resources Information Center

Fleming-DeBerger, Rachelle

2011-01-01

Within the last twenty years there have been a growing number of prospective students interested in pursuing musical theater (MT) training in colleges and universities throughout the United States. To meet this demand, the number of schools offering baccalaureate MT degrees has also grown. However, information on how to assess the music and…

The Blue Glow from the Back Row: Live Theater and the Wireless Teen

ERIC Educational Resources Information Center

Richardson, John M.

2012-01-01

Every year the author and his colleagues take their grade 12 English students to see four plays at one of Canada's major theaters. Chatting about the series on the last day of class, his students asked him if he had seen "the blue glow from the back row." Laughing at his bewilderment, they told him that during the performances so many…

What's Right with Kansas? (LBNL Science at the Theater)

ScienceCinema

Fuller, Merrian; Jackson, Nancy

2018-06-20

On Monday, Oct. 3 at 7 p.m. in Berkeley's Repertory Theater, the Lab presented "What's Right with Kansas," an evening of conversation with the Kansas-based Climate and Energy Project's founder and board chair, Nancy Jackson, and Berkeley Lab scientist Merrian Fuller, an electricity-market, policy and consumer behavior expert. Berkeley Lab will also debut its video "Common Ground," which showcases how CEP has become a Kansas mainstay and an inspiration to environmental organizations across the country. In a state rife with climate-change skepticism, CEP has changed behavior, and some minds, by employing rural values of thrift, independence, conservation, and friendly competition to promote energy efficiency.

Arthrodesis of the thumb interphalangeal joint and finger distal interphalangeal joints with a headless compression screw.

PubMed

Cox, Christopher; Earp, Brandon E; Floyd, W Emerson; Blazar, Philip E

2014-01-01

To study the results of using a small, headless compression screw (AcuTwist) for thumb interphalangeal (IP) joint and finger distal interphalangeal (DIP) joint arthrodeses. Between November 2007 and January 2012, 48 primary arthrodeses of the thumb IP joint or DIP joint in the other digits were performed in 29 consecutive patients with AcuTwist devices. Indications for arthrodesis included 19 cases of osteoarthritis in 25 fingers, 3 cases of lupus in 9 fingers, 2 cases of post-traumatic osteoarthritis in 2 fingers, and 1 case and finger each of acute trauma, neuromuscular disorder, postinfectious osteoarthritis, boutonniere deformity, and Dupuytren contracture. Charts were reviewed for clinical data, and radiographs were assessed for alignment and healing. Age averaged 59 years and follow-up averaged 12 months (range, 2-50 mo). Union occurred in 43 out of 46 fingers (94%). There were no cases of nail deformity, wound complications, tip hypersensitivity, or clinically notable malalignment. Three arthrodeses failed to fuse, including 2 asymptomatic nonunions and 1 fixation loss requiring revision with autograft. The complication rate was 9%. Distal digital joint arthrodesis with the AcuTwist resulted in a fusion rate of 94% with a complication rate of 9%. Our rate of fusion compares favorably with prior series using other methods of fixation. Therapeutic IV. Copyright © 2014 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

Simultaneous Middle Third Clavicle Fracture and Type 3 Acromioclavicular Joint Dislocation; A Case Report

PubMed Central

Solooki, Saeed; Azad, Ali

2014-01-01

Simultaneous middle third clavicle fracture and acromioclavicular joint dislocation is a rare combination injury, as a result of high-energy trauma. We report a patient with a middle third clavicle fracture and ipsilateral grade three-acromioclavicular joint dislocation, which is a rare combination. The patient wanted to get back to work as soon as possible, so the fracture was fixed with reconstruction plate after open reduction and plate contouring; and acromioclavicular joint dislocation was reduced and fixed with two full threaded cancellous screws. One screw was inserted through the plate to the coracoid process. Clinical and radiographic finding revealed complete union of clavicle fracture and anatomical reduction of acromioclavicular joint with pain free full joint range of motion one year after operation. PMID:25207318

NASA/NOAA: Earth Science Electronic Theater 1999

NASA Technical Reports Server (NTRS)

Hasler, A. Fritz

1999-01-01

The Electronic Theater (E-theater) presents visualizations which span the period from the original Suomi/Hasler animations of the first ATS-1 GEO weather satellite images in 1966 to the latest 1999 NASA Earth Science Vision for the next 25 years. Hot off the SGI-Onyx Graphics-Supercomputer are NASA's visualizations of Hurricanes Mitch, Georges, Fran and Linda. These storms have been recently featured on the covers of National Geographic, Time, Newsweek and Popular Science. Highlights will be shown from the NASA hurricane visualization resource video tape that has been used repeatedly this season on National and International network TV. Results will be presented from a new paper on automatic wind measurements in Hurricane Luis from 1-min GOES images that appeared in the November BAMS. The visualizations are produced by the NASA Goddard Visualization and Analysis Laboratory (VAL/912), and Scientific Visualization Studio (SVS/930), as well as other Goddard and NASA groups using NASA, NOAA, ESA, and NASDA Earth science datasets. Visualizations will be shown from the Earth Science E-Theater 1999 recently presented in Tokyo, Paris, Munich, Sydney, Melbourne, Honolulu, Washington, New York, and Dallas. The presentation Jan 11-14 at the AMS meeting in Dallas used a 4-CPU SGI/CRAY Onyx Infinite Reality Super Graphics Workstation with 8 GB RAM and a Terabyte Disk at 3840 X 1024 resolution with triple synchronized BarcoReality 9200 projectors on a 60ft wide screen. Visualizations will also be featured from the new Earth Today Exhibit which was opened by Vice President Gore on July 2, 1998 at the Smithsonian Air & Space museum in Washington, as well as those presented for possible use at the American Museum of Natural History (NYC), Disney EPCOT, and other venues. New methods are demonstrated for visualizing, interpreting, comparing, organizing and analyzing immense HyperImage remote sensing datasets and three dimensional numerical model results. We call the data from many

Tympanic plate fractures in temporal bone trauma: prevalence and associated injuries.

PubMed

Wood, C P; Hunt, C H; Bergen, D C; Carlson, M L; Diehn, F E; Schwartz, K M; McKenzie, G A; Morreale, R F; Lane, J I

2014-01-01

The prevalence of tympanic plate fractures, which are associated with an increased risk of external auditory canal stenosis following temporal bone trauma, is unknown. A review of posttraumatic high-resolution CT temporal bone examinations was performed to determine the prevalence of tympanic plate fractures and to identify any associated temporal bone injuries. A retrospective review was performed to evaluate patients with head trauma who underwent emergent high-resolution CT examinations of the temporal bone from July 2006 to March 2012. Fractures were identified and assessed for orientation; involvement of the tympanic plate, scutum, bony labyrinth, facial nerve canal, and temporomandibular joint; and ossicular chain disruption. Thirty-nine patients (41.3 ± 17.2 years of age) had a total of 46 temporal bone fractures (7 bilateral). Tympanic plate fractures were identified in 27 (58.7%) of these 46 fractures. Ossicular disruption occurred in 17 (37.0%). Fractures involving the scutum occurred in 25 (54.4%). None of the 46 fractured temporal bones had a mandibular condyle dislocation or fracture. Of the 27 cases of tympanic plate fractures, 14 (51.8%) had ossicular disruption (P = .016) and 18 (66.6%) had a fracture of the scutum (P = .044). Temporomandibular joint gas was seen in 15 (33%) but was not statistically associated with tympanic plate fracture (P = .21). Tympanic plate fractures are commonly seen on high-resolution CT performed for evaluation of temporal bone trauma. It is important to recognize these fractures to avoid the preventable complication of external auditory canal stenosis and the potential for conductive hearing loss due to a fracture involving the scutum or ossicular chain.

The role of the trauma nurse leader in a pediatric trauma center.

PubMed

Wurster, Lee Ann; Coffey, Carla; Haley, Kathy; Covert, Julia

2009-01-01

The trauma nurse leader role was developed by a group of trauma surgeons, hospital administrators, and emergency department and trauma leaders at Nationwide Children's Hospital who recognized the need for the development of a core group of nurses who provided expert trauma care. The intent was to provide an experienced group of nurses who could identify and resolve issues in the trauma room. Through increased education, exposure, mentoring, and professional development, the trauma nurse leader role has become an essential part of the specialized pediatric trauma care provided at Nationwide Children's Hospital.

The trauma ecosystem: The impact and economics of new trauma centers on a mature statewide trauma system.

PubMed

Ciesla, David J; Pracht, Etienne E; Leitz, Pablo T; Spain, David A; Staudenmayer, Kristan L; Tepas, Joseph J

2017-06-01

Florida serves as a model for the study of trauma system performance. Between 2010 and 2104, 5 new trauma centers were opened alongside 20 existing centers. The purpose of this study was to explore the impact of trauma system expansion on system triage performance and trauma center patients' profiles. A statewide data set was queried for all injury-related discharges from adult acute care hospitals using International Classification of Diseases, Ninth Revision (ICD-9) codes for 2010 and 2014. The data set, inclusion criteria, and definitions of high-risk injury were chosen to match those used by the Florida Department of Health in its trauma registry. Hospitals were classified as existing Level I (E1) or Level II (E2) trauma centers and new E2 (N2) centers. Five N2 centers were established 11.6 to 85.3 miles from existing centers. Field and overall trauma system triage of high-risk patients was less accurate with increased overtriage and no change in undertriage. Annual volume at N2 centers increased but did not change at E1 and E2 centers. In 2014, Patients at E1 and E2 centers were slightly older and less severely injured, while those at N2 centers were substantially younger and more severely injured than in 2010. The injured patient-payer mix changed with a decrease in self-pay and commercial patients and an increase in government-sponsored patients at E1 and E2 centers and an increase in self-pay and commercial patients with a decrease in government-sponsored patients at N2 centers. Designation of new trauma centers in a mature system was associated with a change in established trauma center demographics and economics without an improvement in trauma system triage performance. These findings suggest that the health of an entire trauma system network must be considered in the design and implementation of a regional trauma system. Therapeutic/care management study, level IV; epidemiological, level IV.

Preparing University Educators for Hot Moments: Theater for Educational Development about Difference, Power, and Privilege

ERIC Educational Resources Information Center

Harlap, Yael

2014-01-01

A "hot moment" is an emotion-laden moment of conflict or tension that threatens to derail teaching and learning. In this study, an educational development workshop used interactive theater depicting a hot moment to prepare university instructors for diverse classrooms. Participants in three workshops wrote short reflections, both before…

Understanding Producers' Intentions and Viewers' Learning Outcomes in a Science Museum Theater Play on Evolution

ERIC Educational Resources Information Center

Peleg, R.; Baram-Tsabari, A.

2016-01-01

Science museums often introduce plays to liven up exhibits, attract visitors to specific exhibitions, and help visitors to "digest" difficult content. Most previous research has concentrated on viewers' learning outcomes. This study uses performance and spectator analyses from the field of theater studies to explore the link between…

Dramatic action: A theater-based paradigm for analyzing human interactions

PubMed Central

Raindel, Noa; Alon, Uri

2018-01-01

Existing approaches to describe social interactions consider emotional states or use ad-hoc descriptors for microanalysis of interactions. Such descriptors are different in each context thereby limiting comparisons, and can also mix facets of meaning such as emotional states, short term tactics and long-term goals. To develop a systematic set of concepts for second-by-second social interactions, we suggest a complementary approach based on practices employed in theater. Theater uses the concept of dramatic action, the effort that one makes to change the psychological state of another. Unlike states (e.g. emotions), dramatic actions aim to change states; unlike long-term goals or motivations, dramatic actions can last seconds. We defined a set of 22 basic dramatic action verbs using a lexical approach, such as ‘to threaten’–the effort to incite fear, and ‘to encourage’–the effort to inspire hope or confidence. We developed a set of visual cartoon stimuli for these basic dramatic actions, and find that people can reliably and reproducibly assign dramatic action verbs to these stimuli. We show that each dramatic action can be carried out with different emotions, indicating that the two constructs are distinct. We characterized a principal valence axis of dramatic actions. Finally, we re-analyzed three widely-used interaction coding systems in terms of dramatic actions, to suggest that dramatic actions might serve as a common vocabulary across research contexts. This study thus operationalizes and tests dramatic action as a potentially useful concept for research on social interaction, and in particular on influence tactics. PMID:29518101

Play Well With Others: Improvisational Theater and Collaboration in the Homeland Security Environment

DTIC Science & Technology

2013-09-01

AND COLLABORATION IN THE HOMELAND SECURITY ENVIRONMENT 5. FUNDING NUMBERS 6. AUTHOR(S) Andrew J. Phelps 7. PERFORMING ORGANIZATION NAME(S) AND...ADDRESS(ES) Naval Postgraduate School Monterey, CA 93943-5000 8. PERFORMING ORGANIZATION REPORT NUMBER 9. SPONSORING /MONITORING AGENCY NAME(S...collaboration is important, but we are not told how to collaborate. Improvisational theater, on the other hand, is built on collaboration among performers to

Trauma-Focused CBT for Youth Who Experience Ongoing Traumas

ERIC Educational Resources Information Center

Cohen, Judith A.; Mannarino, Anthony P.; Murray, Laura K.

2011-01-01

Many youth experience ongoing trauma exposure, such as domestic or community violence. Clinicians often ask whether evidence-based treatments containing exposure components to reduce learned fear responses to historical trauma are appropriate for these youth. Essentially the question is, if youth are desensitized to their trauma experiences, will…

[Mental interiority in the early-modern age. The "Cartesian theater"].

PubMed

Gillot, Pascale

2010-01-01

This paper looks into the notion of mental interiority in the early-modern age and, more specifically, into the Cartesian conception of the mind as an "inner theater". The main claim emphasizes a close connexion at work between the representative theory of the mind, associated with internalism, on the one hand, and a "neuropsychological" view on the other hand. Cartesian mentalism, in so far as it is based upon a disjunction between representation and resemblance, can therefore not be separated from the general project, already at work in the Dioptrique, of an intra-cerebral localization of the mental.

Facial trauma.

PubMed

Peeters, N; Lemkens, P; Leach, R; Gemels B; Schepers, S; Lemmens, W

Facial trauma. Patients with facial trauma must be assessed in a systematic way so as to avoid missing any injury. Severe and disfiguring facial injuries can be distracting. However, clinicians must first focus on the basics of trauma care, following the Advanced Trauma Life Support (ATLS) system of care. Maxillofacial trauma occurs in a significant number of severely injured patients. Life- and sight-threatening injuries must be excluded during the primary and secondary surveys. Special attention must be paid to sight-threatening injuries in stabilized patients through early referral to an appropriate specialist or the early initiation of emergency care treatment. The gold standard for the radiographic evaluation of facial injuries is computed tomography (CT) imaging. Nasal fractures are the most frequent isolated facial fractures. Isolated nasal fractures are principally diagnosed through history and clinical examination. Closed reduction is the most frequently performed treatment for isolated nasal fractures, with a fractured nasal septum as a predictor of failure. Ear, nose and throat surgeons, maxillofacial surgeons and ophthalmologists must all develop an adequate treatment plan for patients with complex maxillofacial trauma.

Moving social work norms via theater for senior farmers.

PubMed

Reed, Deborah B; Claunch, Deborah T

2017-02-01

Senior farmers have a 2.6-fold risk of fatal injury compared to their younger counterparts. Usual educational interventions have resulted in limited success in reducing injury. An innovative strategy, didactic readers theater, was piloted. Farmers' stories provided the foundation for the scripts. The approach incorporated adult learning strategies based on Ajzen's Theory of Planned Behavior. The intervention was marketed as a "dinner theater" to farm couples. Three short socio-novels (plays) were presented by local farmers who served as actors. Following each play participants completed a reaction form and participated in a short discussion about the play's content. One week later a phone survey was completed that tapped further reaction to the content and behavior changes. Thirty-three farm household individuals (including 16 couples) participated. Participants expressed favorable reaction to the intervention. Within one week post intervention, 42% had made safety changes and 67% were "thinking about/intending" to make changes. The use of real stories contributed to the success of this intervention. Farmers identified with the stories and began to think and talk about the impact that aging exerts on their health and safety. Interaction among the group identified work modifications which empowered the farmers to make positive changes in their own work behavior. Educational interventions with farmers have met with limited success in reducing farm-related injuries. Moreover, few interventions have utilized the family unit. This novel program, incorporating local organizations and using limited financial resources, resulted in swift behavior changes. Total Worker Health includes not only the worker, but also the family. Interventions that include family units should be considered when possible. This format is effective, easily adapted to local issues, can be delivered using existing infrastructure, and is acceptable to the farm community. It is currently being tested

NASA/NOAA Electronic Theater: An Hour of Spectacular Visualization

NASA Technical Reports Server (NTRS)

Hasier, A. F.

2004-01-01

The NASA/NOAA Electronic Theater presents Earth science observations and visualizations from space in a historical perspective. Fly in from outer space to Utah, Logan and the USU Agriculture Station. Compare zooms through the Cosmos to the sites of the 2004 Summer and 2002 Winter Olympic games using 1 m IKONOS "Spy Satellite" data. Contrast the 1972 Apollo 17 "Blue Marble" image of the Earth with the latest US and International global satellite images that allow us to view our Planet from any vantage point. See the latest spectacular images h m NASA/NOAA remote sensing missions like Terra, GOES, TRMM, SeaWiF!3,& Landsat 7, of storms & fires like Hurricanes Charlie & Isabel and the LA/San Diego Fire Storms of 2003. See how High Definition Television (HDTV) is revolutionizing the way we do science communication. Take the pulse of the planet on a daily, annual and 30-year time scale. See daily thunderstorms, the annual greening of the northern hemisphere land masses and oceans, fires in Africa, dust storms in Iraq, and carbon monoxide exhaust from global burning. See visualizations featured on Newsweek, TIME, National Geographic, Popular Science covers & National & International Network TV. Spectacular new global visualizations of the observed and simulated atmosphere & oceans are shown. See the currents and vortexes in the oceans that bring up the nutrients to feed tiny plankton and draw the fish, whales and fishermen. See the how the Ocean blooms in response to El Nino/La Nina climate changes. The E-theater will be presented using the latest High Definition TV and video projection technology on a large screen. See the global city lights, and the great NE US blackout of August 2003 observed by the "night-vision" DMSP satellite.

Vascularised knee joint transplantation in man: the first two years experience.

PubMed

Kirschner, M H; Brauns, L; Gonschorek, O; Bühren, V; Hofmann, G O

2000-04-01

To describe our early experience with a new technique for restoring destroyed knee joints to give reasonable functional results. Observational clinical trial. Level-1-Trauma centre, Germany. 5 patients with large bone defects of the knee and loss of the extensor apparatus caused either by serious injury alone, or infection after serious injury. Transplantation of fresh and perfused knee joints with a vascular pedicle from multiorgan donors under immunosuppression. Ability to walk, need to remove one transplanted joint. Four patients are able to walk, the range of movement being from 50 degrees-120 degrees. The first patient additionally had to be provided with a total knee joint arthroplasty. In the third patient the graft became infected and had to be removed. She finally had an arthrodesis and bone lengthening by the Ilizarov technique. Transplantation of the knee joint may be an alternative to bone lengthening or amputation for patients with total loss of the extensor apparatus.

76 FR 41696 - Presumptive Service Connection for Diseases Associated With Service in the Southwest Asia Theater...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-07-15

... DEPARTMENT OF VETERANS AFFAIRS 38 CFR Part 3 RIN 2900-AN83 Presumptive Service Connection for Diseases Associated With Service in the Southwest Asia Theater of Operations During the Persian Gulf War: Functional Gastrointestinal Disorders AGENCY: Department of Veterans Affairs. ACTION: Final rule. SUMMARY...

Special Operations Forces (SOF): An Integral Part of the Theater Operating System

DTIC Science & Technology

1994-02-08

Special Operations Forces (SOF) Operati’c-al MOUC Theater Operating Syst,:- Opelrational Fires G-eration Desert Sh.eld/;e sert Stormi Ccc.Tnd & cnrtrcl~ It...INTRODUCTION The classroom at the College of Naval Command & Staff was filled with field grade Army officers. The day’s lesson, part of the Army’s...service component SOF units; readers are inviter’ to turn to the many field manuals and publications which describe the characteristics of special

Trajectory tracking and backfitting techniques against theater ballistic missiles

NASA Astrophysics Data System (ADS)

Hutchins, Robert G.; Britt, Patrick T.

1999-10-01

Since the SCUD launches in the Gulf War, theater ballistic missile (TBM) systems have become a growing concern for the US military. Detection, fast track initiation, backfitting for launch point determination, and tracking and engagement during boost phase or shortly after booster cutoff are goals that grow in importance with the proliferation of weapons of mass destruction. This paper focuses on track initiation and backfitting techniques, as well as extending some earlier results on tracking a TBM during boost phase cutoff. Results indicate that Kalman techniques are superior to third order polynomial extrapolations in estimating the launch point, and that some knowledge of missile parameters, especially thrust, is extremely helpful in track initiation.

Upper ankle joint space detection on low contrast intraoperative fluoroscopic C-arm projections

NASA Astrophysics Data System (ADS)

Thomas, Sarina; Schnetzke, Marc; Brehler, Michael; Swartman, Benedict; Vetter, Sven; Franke, Jochen; Grützner, Paul A.; Meinzer, Hans-Peter; Nolden, Marco

2017-03-01

Intraoperative mobile C-arm fluoroscopy is widely used for interventional verification in trauma surgery, high flexibility combined with low cost being the main advantages of the method. However, the lack of global device-to- patient orientation is challenging, when comparing the acquired data to other intrapatient datasets. In upper ankle joint fracture reduction accompanied with an unstable syndesmosis, a comparison to the unfractured contralateral site is helpful for verification of the reduction result. To reduce dose and operation time, our approach aims at the comparison of single projections of the unfractured ankle with volumetric images of the reduced fracture. For precise assessment, a pre-alignment of both datasets is a crucial step. We propose a contour extraction pipeline to estimate the joint space location for a prealignment of fluoroscopic C-arm projections containing the upper ankle joint. A quadtree-based hierarchical variance comparison extracts potential feature points and a Hough transform is applied to identify bone shaft lines together with the tibiotalar joint space. By using this information we can define the coarse orientation of the projections independent from the ankle pose during acquisition in order to align those images to the volume of the fractured ankle. The proposed method was evaluated on thirteen cadaveric datasets consisting of 100 projections each with manually adjusted image planes by three trauma surgeons. The results show that the method can be used to detect the joint space orientation. The correlation between angle deviation and anatomical projection direction gives valuable input on the acquisition direction for future clinical experiments.

Correlating weather and trauma admissions at a level I trauma center.

PubMed

Rising, William R; O'Daniel, Joseph A; Roberts, Craig S

2006-05-01

Popular emergency room wisdom touts higher temperatures, snowfall, weekends, and evenings as variables that increase trauma admissions. This study analyzed the possible correlation between trauma admissions and specific weather variables, and between trauma admissions and time of day or season. Trauma admission data from a Level I trauma center database from July 1, 1996 to January 31, 2002 was downloaded and linked with local weather data from the Archives of the National Oceanic and Atmospheric Administration website, and then analyzed. There were 8,269 trauma admissions over a total of 48,984 hours for an average of one admission every 6 hours. Daily high temperature and precipitation were valid predictors of trauma admission volume, with a 5.25% increase in hourly incidents for each 10-degree difference in temperature, and a 60% to 78% increase in the incident rate for each inch of precipitation in the previous 3 hours. Weather and seasonal variations affect admissions at a Level I trauma center. Data from this study could be useful for determining staffing requirements and resource allocation.

The epidemiology of vascular injury in the wars in Iraq and Afghanistan.

PubMed

White, Joseph M; Stannard, Adam; Burkhardt, Gabriel E; Eastridge, Brian J; Blackbourne, Lorne H; Rasmussen, Todd E

2011-06-01

Blood vessel trauma leading to hemorrhage or ischemia presents a significant cause of morbidity and mortality after battlefield injury. The objective of this study is to characterize the epidemiology of vascular injury in the wars of Iraq and Afghanistan, including categorization of anatomic patterns, mechanism, and management of casualties. The Joint Theater Trauma Registry was interrogated (2002-2009) for vascular injury in US troops to identify specific injury (group 1) and operative intervention (group 2) groups. Battle-related injuries (nonreturn to duty) were used as the denominator to establish injury rates. Mechanism of injury was compared between theaters of war and the management strategies of ligation versus revascularization (repair and interposition grafting) reported. Group 1 included 1570 Troops injured in Iraq (OIF) (n = 1390) and Afghanistan (OEF) (n = 180). Mechanism included explosive (73%), gunshot (27%), and other (<1%) with explosive more common in OIF than OEF (P < 0.05). During this period, 13,076 battle-related injuries occurred resulting in a specific rate of 12% (1570 of 13,076), which was higher in OIF than OEF (12.5% vs 9% respectively; P < 0.05). Of group 1, 60% (n = 940) sustained injury to major or proximal vessels and 40% (n = 630) to minor or distal vessels (unknown vessel, n = 27). Group 2 (operative) comprised 1212 troops defining an operative rate of 9% (1212 of 13,076) and included ligation (n = 660; 54%) or repair (n = 552; 46%). Peak rates in OIF and OEF occurred in November 2004 (15%) and August 2009 (11%), respectively and correlated with combat operational tempo. The rate of vascular injury in modern combat is 5 times that reported in previous wars and varies according to theater of war, mechanism of injury and operational tempo. Methods of reconstruction are now applied to nearly half of the vascular injuries and should be a focus of training for combat surgery. Selective ligation of vascular injury remains an important

The Impact of Criteria-Referenced Formative Assessment on Fifth-Grade Students' Theater Arts Achievement

ERIC Educational Resources Information Center

Chen, Fei; Andrade, Heidi

2018-01-01

The purpose of this study was to examine the effects of criteria-referenced formative assessment (CRFA) on students' achievement in theater arts. The role of type of task in differentiating the treatment-achievement relationship was explored. The analytical sample included 520 fifth-grade students from 13 schools in New York City. Schools were…

Abdominal Trauma Revisited.

PubMed

Feliciano, David V

2017-11-01

Although abdominal trauma has been described since antiquity, formal laparotomies for trauma were not performed until the 1800s. Even with the introduction of general anesthesia in the United States during the years 1842 to 1846, laparotomies for abdominal trauma were not performed during the Civil War. The first laparotomy for an abdominal gunshot wound in the United States was finally performed in New York City in 1884. An aggressive operative approach to all forms of abdominal trauma till the establishment of formal trauma centers (where data were analyzed) resulted in extraordinarily high rates of nontherapeutic laparotomies from the 1880s to the 1960s. More selective operative approaches to patients with abdominal stab wounds (1960s), blunt trauma (1970s), and gunshot wounds (1990s) were then developed. Current adjuncts to the diagnosis of abdominal trauma when serial physical examinations are unreliable include the following: 1) diagnostic peritoneal tap/lavage, 2) surgeon-performed ultrasound examination; 3) contrast-enhanced CT of the abdomen and pelvis; and 4) diagnostic laparoscopy. Operative techniques for injuries to the liver, spleen, duodenum, and pancreas have been refined considerably since World War II. These need to be emphasized repeatedly in an era when fewer patients undergo laparotomy for abdominal trauma. Finally, abdominal trauma damage control is a valuable operative approach in patients with physiologic exhaustion and multiple injuries.

Traumas of the middle skull base with TMJ involvement. Case report.

PubMed

Bottini, D J; Gnoni, G; De Angelis, B; Savo, P; Trimarco, A; Cervelli, G; Cervelli, V

2006-03-01

The authors report their experience with temporomandibular joint (TMJ) traumas involving breakage of the roof of the glenoid cavity, an infrequent event that occurs in those cases in which, as a result of the condylar neck not fracturing, the traumatic energy is transmitted to the middle skull base. As the literature contains no valid series for establishing standardized protocols for the treatment of these fractures, we propose our own orthopedic-functional approach. The patient observed by us had suffered a cranio-facial trauma and presented the classical symptoms and signs of TMJ traumas and complete bilateral Bell paralysis. He was subjected to a CAT scan and then to 2-stage treatment consisting of functional rest with liquid diet followed by physiotherapy. An almost total recovery in TMJ function was observed after 1 month. At 1-year follow-up the facial paralysis had resolved completely. On the basis of our experience, breakages of the glenoid cavity can be compared, in terms of treatment procedure, to intracapsular fractures of the TMJ with surgery confined to cases of ankylosis sequelae. To avoid the onset of ankylosis careful control of clinical, functional and radiological follow-up is required.

Geriatric trauma.

PubMed

Adams, Sasha D; Holcomb, John B

2015-12-01

The landscape of trauma is changing due to an aging population. Geriatric patients represent an increasing number and proportion of trauma admissions and deaths. This review explores recent literature on geriatric trauma, including triage criteria, assessment of frailty, fall-related injury, treatment of head injury complicated by coagulopathy, goals of care, and the need for ongoing education of all surgeons in the care of the elderly. Early identification of high-risk geriatric patients is imperative to initiate early resuscitative efforts. Geriatric patients are typically undertriaged because of their baseline frailty being underappreciated; however, centers that see more geriatric patients do better. Rapid reversal of anticoagulation is important in preventing progression of brain injury. Anticipation of difficult disposition necessitates early involvement of physical therapy for rehabilitation and case management for appropriate placement. Optimal care of geriatric trauma patients will be based on the well established tenets of trauma resuscitation and injury repair, but with distinct elements that address the physiological and anatomical challenges presented by geriatric patients.

International trauma teleconference: evaluating trauma care and facilitating quality improvement.

PubMed

Parra, Michael W; Castillo, Roberto C; Rodas, Edgar B; Suarez-Becerra, Jose M; Puentes-Manosalva, Fabian E; Wendt, Luke M

2013-09-01

Evaluation, development, and implementation of trauma systems in Latin America are challenging undertakings as no model is currently in place that can be easily replicated throughout the region. The use of teleconferencing has been essential in overcoming other challenges in the medical field and improving medical care. This article describes the use of international videoconferencing in the field of trauma and critical care as a tool to evaluate differences in care based on local resources, as well as facilitating quality improvement and system development in Latin America. In February 2009, the International Trauma and Critical Care Improvement Project was created and held monthly teleconferences between U.S. trauma surgeons and Latin American general surgeons, emergency physicians, and intensivists. In-depth discussions and prospective evaluations of each case presented were conducted by all participants based on resources available. Care rendered was divided in four stages: (1) pre-hospital setting, (2) emergency room or trauma room, (3) operating room, and (4) subsequent postoperative care. Furthermore, the participating institutions completed an electronic survey of trauma resources based on World Health Organization/International Association for Trauma and Surgical Intensive Care guidelines. During a 17-month period, 15 cases in total were presented from a Level I and a Level II U.S. hospital (n=3) and five Latin American hospitals (n=12). Presentations followed the Advanced Trauma Life Support sequence in all U.S. cases but in only 3 of the 12 Latin American cases. The following deficiencies were observed in cases presented from Latin America: pre-hospital communication was nonexistent in all cases; pre-hospital services were absent in 60% of cases presented; lack of trauma team structure was evident in the emergency departments; during the initial evaluation and resuscitation, the Advanced Trauma Life Support protocol was followed one time and the Clinical

Exploring Learning through Audience Interaction in Virtual Reality Dome Theaters

NASA Astrophysics Data System (ADS)

Apostolellis, Panagiotis; Daradoumis, Thanasis

Informal learning in public spaces like museums, science centers and planetariums is increasingly popular during the last years. Recent advancements in large-scale displays allowed contemporary technology-enhanced museums to get equipped with digital domes, some with real-time capabilities like Virtual Reality systems. By conducting extensive literature review we have come to the conclusion that little to no research has been carried out on the leaning outcomes that the combination of VR and audience interaction can provide in the immersive environments of dome theaters. Thus, we propose that audience collaboration in immersive virtual reality environments presents a promising approach to support effective learning in groups of school aged children.

Prevalence and pattern of glenohumeral injuries among acute high-grade acromioclavicular joint instabilities.

PubMed

Pauly, Stephan; Kraus, Natascha; Greiner, Stefan; Scheibel, Markus

2013-06-01

With increasing numbers of arthroscopically assisted acromioclavicular (AC) joint stabilization procedures has come an increase in reports of concomitant glenohumeral injuries among AC joint separations. The aim of the present study was to evaluate the prevalence, pattern, and cause of glenohumeral pathologies among a large patient population with acute high-grade AC joint instability. A total of 125 patients (13 women, 112 men) with high-grade AC joint dislocation (6 Rockwood II; 119 Rockwood V) underwent diagnostic glenohumeral arthroscopy before AC joint repair. Pathologic lesions were evaluated for acute or degenerative origin and, if considered relevant, treated all-arthroscopically. Concomitant glenohumeral pathologies were found in 38 of 125 patients (30.4%). Analysis of pathogenesis distinguished different patterns of accompanying injuries: acute intra-articular lesions, related to the recent shoulder trauma, were found in 9 patients (7.2%), degenerative lesions, considered to be unrelated to the recent trauma, were found in 18 (14.4%), and 11 (8.8%) had an unclear traumatic correlation (intermediate group). Within the acute and the degenerative group, affected structures were predominantly partial, articular-sided tears of the anterosuperior rotator cuff, including instabilities of the pulley complex, followed by pathologies of the long head of the biceps and superior labrum anteroposterior lesions. The intermediate group presented mainly with articular-sided partial tears of the subscapularis tendon. This prospective study showed a high prevalence (30%) of concomitant glenohumeral pathologies, of which some indicate additional surgical therapy and could be missed by an isolated open AC repair. Hence, the arthroscopic approach for AC joint stabilization allows for the diagnosis and treatment of associated intra-articular pathologies. Copyright © 2013 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Mosby, Inc. All rights reserved.

L2 Reading Research and Pedagogical Considerations in the Teaching of French and Francophone Theater

ERIC Educational Resources Information Center

Edwards, Carole; Taylor, Alan M.

2012-01-01

Little research on improving second language (L2) reading comprehension of French and francophone theater has been conducted. This study provides insight into enhancing L2 comprehension of drama by combining L2 research with examples from L'accent grave by Jacques Prevert, Ton beau capitaine by Simone Schwarz-Bart (1987), Un Touareg s'est marie a…

Effects of war exposure on Air Force personnel’s mental health, job burnout and other organizational related outcomes

PubMed Central

Vinokur, Amiram D.; Pierce, Penny F.; Lewandowski-Romps, Lisa; Hobfoll, Stevan E.; Galea, Sandro

2011-01-01

Longitudinal data from a stratified representative sample of U.S. Air Force personnel (N = 1009) deployed to the wars in Iraq, Afghanistan, and other locations were analyzed in this study. Using structural equation models, we examined the effects of war exposure on traumatic experiences, Post Traumatic Stress (PTS) symptoms, resource loss, and on subsequent functioning, perceived health, and on job and organizationally relevant outcomes. The job and organizational outcomes included job burnout, job involvement, job strain, job satisfaction, work-family conflict, organizational commitment, deployment readiness, and intention to reenlist. We found that deployment to the theater of the war increased risk of exposure to trauma, which in turn, predicted elevated PTS symptoms and resource loss. PTS symptoms predicted later loss of resources and deterioration in perceived health and functioning. In turn, resource loss predicted negative job and organizational outcomes. Exposure to trauma fully mediated the effects of deployment to the theater of war on PTS symptoms and resource loss and had additional significant indirect effects on several job and organizational relevant outcomes. For returning veterans, deployment to the theater of war, exposure to trauma, PTS symptoms, and resource loss represents a ‘cascading’ chain of events that over time results in a decline of health and functioning as well as in adverse job and organizationally relevant outcomes that may affect organizational effectiveness. PMID:21280941

Cardiac Trauma.

PubMed

Gosavi, Sucheta; Tyroch, Alan H; Mukherjee, Debabrata

2016-11-01

Cardiac trauma is a leading cause of death in the United States and occurs mostly due to motor vehicle accidents. Blunt cardiac trauma and penetrating chest injuries are most common, and both can lead to aortic injuries. Timely diagnosis and early management are the key to improve mortality. Cardiac computed tomography and cardiac ultrasound are the 2 most important diagnostic modalities. Mortality related to cardiac trauma remains high despite improvement in diagnosis and management.

Interobserver Variability in Injury Severity Scoring After Combat Trauma: Different Perspectives, Different Values?

PubMed

Smith, Iain M; Naumann, David N; Guyver, Paul; Bishop, Jonathan; Davies, Simon; Lundy, Jonathan B; Bowley, Douglas M

2015-01-01

Anatomic measures of injury burden provide key information for studies of prehospital and in-hospital trauma care. The military version of the Abbreviated Injury Scale [AIS(M)] is used to score injuries in deployed military hospitals. Estimates of total trauma burden are derived from this. These scores are used for categorization of patients, assessment of care quality, and research studies. Scoring is normally performed retrospectively from chart review. We compared data recorded in the UK Joint Theatre Trauma Registry (JTTR) and scores calculated independently at the time of surgery by the operating surgeons to assess the concordance between surgeons and trauma nurse coordinators in assigning injury severity scores. Trauma casualties treated at a deployed Role 3 hospital were assigned AIS(M) scores by surgeons between 24 September 2012 and 16 October 2012. JTTR records from the same period were retrieved. The AIS(M), Injury Severity Score (ISS), and New Injury Severity Score (NISS) were compared between datasets. Among 32 matched casualties, 214 injuries were recorded in the JTTR, whereas surgeons noted 212. Percentage agreement for number of injuries was 19%. Surgeons scored 75 injuries as "serious" or greater compared with 68 in the JTTR. Percentage agreement for the maximum AIS(M), ISS, and NISS assigned to cases was 66%, 34%, and 28%, respectively, although the distributions of scores were not statistically different (median ISS: surgeons: 20 [interquartile range (IQR), 9-28] versus JTTR: 17.5 [IQR, 9-31.5], p = .7; median NISS: surgeons: 27 [IQR, 12-42] versus JTTR: 25.5 [IQR, 11.5-41], p = .7). There are discrepancies in the recording of AIS(M) between surgeons directly involved in the care of trauma casualties and trauma nurse coordinators working by retrospective chart review. Increased accuracy might be achieved by actively collaborating in this process. 2015.

Embodied Theater Ecology: Illuminating the Gap through Bridging Depth Psychology's Encounter with Performative Inquiry

ERIC Educational Resources Information Center

Frantzich, Kirsten; Fels, Lynn

2018-01-01

This article presents a new approach to psychological practice that dwells within the somatic, expressive, imaginal, poetic, narrative, and performative. Embodied Theater Ecology (ETE) as a form of Performative Inquiry is introduced and presented. This approach involves the performative unfolding of unlanguaged stories that lie at the heart of our…

Multidisciplinary trauma team care in Kandahar, Afghanistan: current injury patterns and care practices.

PubMed

Beckett, Andrew; Pelletier, Pierre; Mamczak, Christiaan; Benfield, Rodd; Elster, Eric

2012-12-01

Multidisciplinary trauma care systems have been shown to improve patient outcomes. Medical care in support of the global war on terror has provided opportunities to refine these systems. We report on the multidisciplinary trauma care system at the Role III Hospital at Kandahar Airfield, Afghanistan. We reviewed the Joint Trauma System Registry, Kandahar database from 1 October 2009 to 31 December 2010 and extracted data regarding patient demographics, clinical variables and outcomes. We also queried the operating room records from 1 January 2009 to 31 December 2010. In the study period of 1 October 2009 to 31 December 2010, 2599 patients presented to the trauma bay, with the most common source of injury being from Improvised Explosive Device (IED) blasts (915), followed by gunshot wounds (GSW) (327). Importantly, 19 patients with triple amputations as a result of injuries from IEDs were seen. 127 patients were massively transfused. The in-hospital mortality was 4.45%. From 1 January 2010 to 31 December 2010, 4106.24 operating room hours were logged to complete 1914 patient cases. The mean number of procedures per case in 2009 was 1.27, compared to 3.11 in 2010. Multinational, multidisciplinary care is required for the large number of severely injured patients seen at Kandahar Airfield. Multidisciplinary trauma care in Kandahar is effective and can be readily employed in combat hospitals in Afghanistan and serve as a model for civilian centres. Published by Elsevier Ltd.

Trauma-induced insomnia: A novel model for trauma and sleep research.

PubMed

Sinha, Smit S

2016-02-01

Traumatic events have been increasingly recognized as important precipitants of clinically significant insomnia. Trauma is an extreme form of stressful life event that generates a sustained neurobiological response triggering the onset and maintenance of insomnia. Trauma may disrupt the normal sleep-wake regulatory mechanism by sensitizing the central nervous system's arousal centers, leading to pronounced central and physiological hyperarousal. The central concept of hyperarousal has been linked to both the pathogenesis of insomnia and to the neurobiological changes in the aftermath of traumatic events, and may be a neurobiological commonality underlying trauma and insomnia. This paper presents evidence for trauma-induced insomnia and advances a model of it as an important nosological and neurobiological entity. Trauma-induced insomnia may occur in the absence of full-blown posttraumatic stress disorder (PTSD), and may also be a precursor of subsequent PTSD development. Converging lines of evidence from the neuroscience of insomnia with the neurobiology and psychophysiology of stress, fear, trauma and PTSD will be integrated to advance understanding of the condition. Preclinical and clinical stress and fear paradigms have informed the neurobiological pathways mediating the production of insomnia by trauma. Elucidating the underlying neurobiological substrates can establish novel biological markers to identify persons at risk for the condition, and help optimize treatment of the trauma-insomnia interface. Early identification and treatment of trauma-induced insomnia may prevent the development of PTSD, as well as other important sequelae such as depression, substance dependence, and other medical conditions. Copyright © 2015 Elsevier Ltd. All rights reserved.

[Chest trauma].

PubMed

Freixinet Gilart, Jorge; Ramírez Gil, María Elena; Gallardo Valera, Gregorio; Moreno Casado, Paula

2011-01-01

Chest trauma is a frequent problem arising from lesions caused by domestic and occupational activities and especially road traffic accidents. These injuries can be analyzed from distinct points of view, ranging from consideration of the most severe injuries, especially in the context of multiple trauma, to the specific characteristics of blunt and open trauma. In the present article, these injuries are discussed according to the involvement of the various thoracic structures. Rib fractures are the most frequent chest injuries and their diagnosis and treatment is straightforward, although these injuries can be severe if more than three ribs are affected and when there is major associated morbidity. Lung contusion is the most common visceral lesion. These injuries are usually found in severe chest trauma and are often associated with other thoracic and intrathoracic lesions. Treatment is based on general support measures. Pleural complications, such as hemothorax and pneumothorax, are also frequent. Their diagnosis is also straightforward and treatment is based on pleural drainage. This article also analyzes other complex situations, notably airway trauma, which is usually very severe in blunt chest trauma and less severe and even suitable for conservative treatment in iatrogenic injury due to tracheal intubation. Rupture of the diaphragm usually causes a diaphragmatic hernia. Treatment is always surgical. Myocardial contusions should be suspected in anterior chest trauma and in sternal fractures. Treatment is conservative. Other chest injuries, such as those of the great thoracic and esophageal vessels, are less frequent but are especially severe. Copyright © 2011 Sociedad Española de Neumología y Cirugía Torácica. Published by Elsevier Espana. All rights reserved.

The impact of patient volume on surgical trauma training in a Scandinavian trauma centre.

PubMed

Gaarder, Christine; Skaga, Nils Oddvar; Eken, Torsten; Pillgram-Larsen, Johan; Buanes, Trond; Naess, Paal Aksel

2005-11-01

Some of the problems faced in trauma surgery are increasing non-operative management of abdominal injuries, decreasing work hours and increasing sub-specialisation. We wanted to document the experience of trauma team leaders at the largest trauma centre in Norway, hypothesising that the patient volume would be inadequate to secure optimal trauma care. Patients registered in the hospital based Trauma Registry during the 2-year period from 1 August 2000 to 31 July 2002 were included. Of a total of 1667 patients registered, 645 patients (39%) had an Injury Severity Score (ISS)>15. Abdominal injuries were diagnosed in 205 patients with a median ISS of 30. An average trauma team leader assessed a total of 119 trauma cases a year (46 patients with ISS>15) and participated in 10 trauma laparotomies. Although the total number of trauma cases seems adequate, the experience of the trauma team leaders with challenging abdominal injuries is limited. With increasing sub-specialisation and general surgery vanishing, fewer surgical specialties provide operative competence in dealing with complicated torso trauma. A system of additional education and quality assurance measures is a prerequisite of high quality, and has consequently been introduced in our institution.

Counterproliferation strategy: The influence of technology, budget, and arms control on theater missile defenses. Strategic research project

DOE Office of Scientific and Technical Information (OSTI.GOV)

Parlier, G.H.

1996-05-20

This paper describes the historical evolution of the theater missile threat during World War II and the Persian Gulf War, and analyzes current technological challenges, budgetary pressures, and arms control restraints which constrain the development and deployment of effective theater missile defenses. The impact of these trends on strategic concepts as outlined in the National Military Strategy and their implications for attaining national policy objectives is assessed. A systems approach is used to described analyze, and evaluate the effectiveness of emerging counterproliferation strategy within the framework of an ends-ways-means strategy formulation paradigm. I conclude that current trends will lead tomore » a self-deterring strategy: resources are inadequate to support the ways we intend to achieve our national objectives. Recommendations are made to eliminate unacceptable risk and enhance the concept of `extended conventional deterrence` consistent with U.S. national values and security interests for our role in a new world order.« less

Prevalence of interpersonal trauma exposure and trauma-related disorders in severe mental illness.

PubMed

Mauritz, Maria W; Goossens, Peter J J; Draijer, Nel; van Achterberg, Theo

2013-01-01

Interpersonal trauma exposure and trauma-related disorders in people with severe mental illness (SMI) are often not recognized in clinical practice. To substantiate the prevalence of interpersonal trauma exposure and trauma-related disorders in people with SMI. We conducted a systematic review of four databases (1980-2010) and then described and analysed 33 studies in terms of primary diagnosis and instruments used to measure trauma exposure and trauma-related disorders. Population-weighted mean prevalence rates in SMI were physical abuse 47% (range 25-72%), sexual abuse 37% (range 24-49%), and posttraumatic stress disorder (PTSD) 30% (range 20-47%). Compared to men, women showed a higher prevalence of sexual abuse in schizophrenia spectrum disorder, bipolar disorder, and mixed diagnosis groups labelled as having SMI. Prevalence rates of interpersonal trauma and trauma-related disorders were significantly higher in SMI than in the general population. Emotional abuse and neglect, physical neglect, complex PTSD, and dissociative disorders have been scarcely examined in SMI.

Trauma-Focused CBT for Youth with Complex Trauma

ERIC Educational Resources Information Center

Cohen, Judith A.; Mannarino, Anthony P.; Kliethermes, Matthew; Murray, Laura A.

2012-01-01

Objectives: Many youth develop complex trauma, which includes regulation problems in the domains of affect, attachment, behavior, biology, cognition, and perception. Therapists often request strategies for using evidence-based treatments (EBTs) for this population. This article describes practical strategies for applying Trauma-Focused Cognitive…

Transcriptomic analysis of synovial extracellular RNA following knee trauma: A pilot study.

PubMed

Griswold, Anthony J; Perez, Jose; Nuytemans, Karen; Strong, Thomas A; Wang, Liyong; Vance, Danica D; Ennis, Hayley; Smith, Marvin K; Best, Thomas M; Vance, Jeffery M; Pericak-Vance, Margaret A; Kaplan, Lee D

2018-06-01

Traumatic knee injuries often result in damage to articular cartilage and other joint structures. Such trauma is a strong risk factor for the future development and progression of osteoarthritis (OA). The molecular mechanisms and signaling pathways modulating response to knee joint trauma remain unclear. Moreover, investigations of biomarkers influencing responses have been targeted rather than broad, unbiased discovery studies. Herein, we characterize the complete complement of extracellular RNA (exRNA) in the synovial fluid of 14 subjects following knee injury. Fluid was collected during surgery from the injured knees, and from the contralateral knee in a subset, undergoing surgical repair of the ACL and/or meniscal repair/debridement. Arthroscopic grading of chondral damage in four knee compartments was performed using the Outerbridge classification. exRNA was extracted and subjected to massively parallel total RNA sequencing. Differential abundance of RNA was calculated between the subject cohorts of injured and non-injured knee, average Outerbridge score ≥0.5 and less, and chronic and acute injury duration defined as ≤4 months till surgery or longer. Overall, expression of several thousand genes was identified in the synovial fluid. Furthermore, differential expression analysis suggests a role of exRNA fragments of matrix metalloproteinases and skeletal muscle fiber genes in the response to traumatic injury. Together, these data suggest that high-throughput approaches can indicate exRNA molecular signatures following knee trauma. Future studies are required to more fully characterize the biological roles of these exRNA and the cadence of their respective release that may lead to translational treatment options for post-traumatic OA. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 36:1659-1665, 2018. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc.

Major trauma: the unseen financial burden to trauma centres, a descriptive multicentre analysis.

PubMed

Curtis, Kate; Lam, Mary; Mitchell, Rebecca; Dickson, Cara; McDonnell, Karon

2014-02-01

This research examines the existing funding model for in-hospital trauma patient episodes in New South Wales (NSW), Australia and identifies factors that cause above-average treatment costs. Accurate information on the treatment costs of injury is needed to guide health-funding strategy and prevent inadvertent underfunding of specialist trauma centres, which treat a high trauma casemix. Admitted trauma patient data provided by 12 trauma centres were linked with financial data for 2008-09. Actual costs incurred by each hospital were compared with state-wide Australian Refined Diagnostic Related Groups (AR-DRG) average costs. Patient episodes where actual cost was higher than AR-DRG cost allocation were examined. There were 16693 patients at a total cost of AU$178.7million. The total costs incurred by trauma centres were $14.7million above the NSW peer-group average cost estimates. There were 10 AR-DRG where the total cost variance was greater than $500000. The AR-DRG with the largest proportion of patients were the upper limb injury categories, many of whom had multiple body regions injured and/or a traumatic brain injury (P<0.001). AR-DRG classifications do not adequately describe the trauma patient episode and are not commensurate with the expense of trauma treatment. A revision of AR-DRG used for trauma is needed. WHAT IS KNOWN ABOUT THIS TOPIC? Severely injured trauma patients often have multiple injuries, in more than one body region and the determination of appropriate AR-DRG can be difficult. Pilot research suggests that the AR-DRG do not accurately represent the care that is required for these patients. WHAT DOES THIS PAPER ADD? This is the first multicentre analysis of treatment costs and coding variance for major trauma in Australia. This research identifies the limitations of the current AR-DRGS and those that are particularly problematic. The value of linking trauma registry and financial data within each trauma centre is demonstrated. WHAT ARE THE

What Do Students Learn when We Teach Peace? A Qualitative Assessment of a Theater Peace Program

ERIC Educational Resources Information Center

Duckworth, Cheryl Lynn; Allen, Barb; Williams, Teri Triguba

2012-01-01

This is a qualitative assessment of a theater arts peace education program for high-school students. We present the results of qualitative interviews with students who participated in a peace education program. They tell us in their own words what they believe they learned. Given that most peace education evaluation is quantitative or focuses on…

Trauma deaths in a mature urban trauma system: is "trimodal" distribution a valid concept?

PubMed

Demetriades, Demetrios; Kimbrell, Brian; Salim, Ali; Velmahos, George; Rhee, Peter; Preston, Christy; Gruzinski, Ginger; Chan, Linda

2005-09-01

Trimodal distribution of trauma deaths, described more than 20 years ago, is still widely taught in the design of trauma systems. The purpose of this study was to examine the applicability of this trimodal distribution in a modern trauma system. A study of trauma registry and emergency medical services records of trauma deaths in the County of Los Angeles was conducted over a 3-year period. The times from injury to death were analyzed according to mechanism of injury and body area (head, chest, abdomen, extremities) with severe trauma (abbreviated injury score [AIS] >/= 4). During the study period there were 4,151 trauma deaths. Penetrating trauma accounted for 50.0% of these deaths. The most commonly injured body area with critical trauma (AIS >/= 4) was the head (32.0%), followed by chest (20.8%), abdomen (11.5%), and extremities (1.8%). Time from injury to death was available in 2,944 of these trauma deaths. Overall, there were two distinct peaks of deaths: the first peak (50.2% of deaths) occurred within the first hour of injury. The second peak occurred 1 to 6 hours after admission (18.3% of deaths). Only 7.6% of deaths were late (>1 week), during the third peak of the classic trimodal distribution. Temporal distribution of deaths in penetrating trauma was very different from blunt trauma and did not follow the classic trimodal distribution. Other significant independent factors associated with time of death were chest AIS and head AIS. Temporal distribution of deaths as a result of severe head trauma did not follow any pattern and did not resemble classic trimodal distribution at all. The classic "trimodal" distribution of deaths does not apply in our trauma system. Temporal distribution of deaths is influenced by the mechanism of injury, age of the patient, and body area with severe trauma. Knowledge of the time of distribution of deaths might help in allocating trauma resources and focusing research effort.

Pulsed Radiofrequency Application for the Treatment of Pain Secondary to Sacroiliac Joint Metastases.

PubMed

Yi, Yu Ri; Lee, Na Rea; Kwon, Young Suk; Jang, Ji Su; Lim, So Young

2016-01-01

Sacroiliac (SI) joint pain can result from degeneration, infection, malignancy, and trauma. Patients with metastatic bone pain who do not respond to conventional treatment may need more aggressive neuroinvasive approaches. Recently, pulsed radiofrequency (PRF) neuromodulation has emerged as a promising treatment alternative for refractory cases of SI joint pain. Nevertheless, there is no report on the treatment of pain arising from SI joint metastases with PRF. We are reporting about a 63-year-old woman suffering from buttock pain due to breast cancer metastases in the SI joint. We treated this patient with PRF neuromodulation of the L4-S3 primary dorsal rami and lateral branches using a rotating curved needle technique. The patient tolerated the procedures well, without any complications. She experienced about 70% reduction in pain, and pain relief was sustained for 10 months. This result suggests that PRF neuromodulation is a safe, effective treatment for pain from SI joint metastases.

[Clinical applications of sternoclavicular hook plate for the treatment of sternoclavicular joint dislocation].

PubMed

Chen, Fang-Hu; Zhao, Xiao-Ping; Zheng, Wen-Biao; Zeng, Han-Bing; Ran, Bo; Huang, Hui; Wang, Hai-Bao

2013-05-01

To observe the clinical therapeutic effects of sternoclavicular hook plate for the treatment of sternoclavicular joint dislocation. From June 2010 to June 2012, 7 patients with sternoclavicular joint dislocation were treated with sternoclavicular hook plate fixation. Among the 7 patients, 5 patients were male and 2 patients were female, and the average age was 42.3 years, ranging from 38 to 54 years. The course of the disease ranged from 1 to 4 weeks. All the patients had trauma history. The clinical manifestations included: obvious swelling and pain of sternoclavicular joint, restricted shoulder joint activity. The sternoclavicular joint dislocation was proved by preoperative X-ray and CT. The postoperative curative effect was evaluated according to Rockwood scoring method. According to Rockwood scoring method, the excellent results obtained in 6 cases, good in 1. There were no complications such as internal fixation loosening or broken, second dislocation, pain in the sternoclavicular joint, and deformity. The function of shoulder joint was good, and the limb activity was free and no pain appeared. The sternoclavicular hook plate for the treatment of sternoclavicular joint dislocation has follow advantages: simple procedure, stable fixation, definite therapeutic effects.

[First aid and management of multiple trauma: in-hospital trauma care].

PubMed

Boschin, Matthias; Vordemvenne, Thomas

2012-11-01

Injuries remain the leading cause of death in children and young adults. Management of multiple trauma patients has improved in recent years by quality initiatives (trauma network, S3 guideline "Polytrauma"). On this basis, strong links with preclinical management, structured treatment algorithms, training standards (ATLS®), clear diagnostic rules and an established risk- and quality management are the important factors of a modern emergency room trauma care. We describe the organizational components that lead to successful management of trauma in hospital. © Georg Thieme Verlag Stuttgart · New York.

Cool Cities, Cool Planet (LBNL Science at the Theater)

ScienceCinema

Rosenfeld, Arthur; Pomerantz, Melvin; Levinson, Ronnen

2018-06-14

Science at the Theater: Berkeley Lab scientists discuss how cool roofs can cool your building, your city ... and our planet. Arthur Rosenfeld, Professor of Physics Emeritus at UC Berkeley, founded the Berkeley Lab Center for Building Science in 1974. He served on the California Energy Commission from 2000 to 2010 and is commonly referred to as California's godfather of energy efficiency. Melvin Pomerantz is a member of the Heat Island Group at Berkeley Lab. Trained as a physicist at UC Berkeley, he specializes in research on making cooler pavements and evaluating their effects. Ronnen Levinson is a staff scientist at Berkeley Lab and the acting leader of its Heat Island Group. He has developed cool roofing and paving materials and helped bring cool roof requirements into building energy efficiency standards.

Neuromuscular prehabilitation to prevent osteoarthritis after a traumatic joint injury.

PubMed

Tenforde, Adam S; Shull, Pete B; Fredericson, Michael

2012-05-01

Post-traumatic osteoarthritis (PTOA) is a process resulting from direct forces applied to a joint that cause injury and degenerative changes. An estimated 12% of all symptomatic osteoarthritis (OA) of the hip, knee, and ankle can be attributed to a post-traumatic cause. Neuromuscular prehabilitation is the process of improving neuromuscular function to prevent development of PTOA after an initial traumatic joint injury. Prehabilitation strategies include restoration of normative movement patterns that have been altered as the result of traumatic injury, along with neuromuscular exercises and gait retraining to prevent the development of OA after an injury occurs. A review of the current literature shows that no studies have been performed to evaluate methods of neuromuscular prehabilitation to prevent PTOA after a joint injury. Instead, current research has focused on management strategies after knee injuries, the value of exercise in the management of OA, and neuromuscular exercises after total knee arthroplasty. Recent work in gait retraining that alters knee joint loading holds promise for preventing the development of PTOA after joint trauma. Future research should evaluate methods of neuromuscular prehabilitation strategies in relationship to the outcome of PTOA after joint injury. Copyright © 2012 American Academy of Physical Medicine and Rehabilitation. Published by Elsevier Inc. All rights reserved.

Temporal distribution of trauma deaths: quality of trauma care in a developing country.

PubMed

Masella, Cesar Augusto; Pinho, Vitor Ferreira; Costa Passos, Afonso Dinis; Spencer Netto, Fernando A C; Rizoli, Sandro; Scarpelini, Sandro

2008-09-01

Examination of the epidemiology and timing of trauma deaths has been deemed a useful method to evaluate the quality of trauma care. The purpose of this study was to evaluate the quality of trauma care in a regional trauma system and in a university hospital in Brazil by comparing the timing of deaths in the studied prehospital and in-hospital settings to those published for trauma systems in other areas. We analyzed the National Health Minister's System of Deaths Information for the prehospital mortality and we retrospectively collected the demographics, timelines, and trauma severity scores of all in-hospital patients who died after admission through the Emergency Unit of Hospital das Clinicas de Ribeirao Preto between 2000 and 2001. During the study period, there were 787 trauma fatalities in the city: 448 (56.9%) died in the prehospital setting and 339 (43.1%) died after being admitted to a medical facility. In 2 years, 238 trauma deaths occurred in the studied hospital, and we found a complete clinical set of data for 224 of these patients. The majority of deaths in the prehospital setting were caused by penetrating injuries (66.7%), whereas in-hospital mortality was mainly because of blunt traumas (59.1%). The largest number of in-hospital deaths occurred beyond 72 hours of stay (107 patients-47%). The region studied showed some deficiencies in prehospital and in-hospitals settings, in particular in the critical care and short-term follow-up of trauma patients when compared with the literature. Particularly, the late mortality may be related to training and human resources deficiency. Based on the timeline of trauma deaths, we can suggest that the studied region needs improvements in the prehospital trauma system and in hospital critical care.

Trauma and emergency surgery: an evolutionary direction for trauma surgeons.

PubMed

Scherer, Lynette A; Battistella, Felix D

2004-01-01

The success of nonoperative management of injuries has diminished the operative experience of trauma surgeons. To enhance operative experience, our trauma surgeons began caring for all general surgery emergencies. Our objective was to characterize and compare the experience of our trauma surgeons with that of our general surgeons. We reviewed records to determine case diversity, complexity, time of operation, need for intensive care unit care, and payor mix for patients treated by the trauma and emergency surgery (TES) surgeons and elective practice general surgery (ELEC) surgeons over a 1-year period. TES and ELEC surgeons performed 253 +/- 83 and 234 +/- 40 operations per surgeon, respectively (p = 0.59). TES surgeons admitted more patients and performed more after-hours operations than their ELEC colleagues. Both groups had a mix of cases that was diverse and complex. Combining the care of patients with trauma and general surgery emergencies resulted in a breadth and scope of practice for TES surgeons that compared well with that of ELEC surgeons.

Prevalence of interpersonal trauma exposure and trauma-related disorders in severe mental illness

PubMed Central

Mauritz, Maria W.; Goossens, Peter J. J.; Draijer, Nel; van Achterberg, Theo

2013-01-01

Background Interpersonal trauma exposure and trauma-related disorders in people with severe mental illness (SMI) are often not recognized in clinical practice. Objective To substantiate the prevalence of interpersonal trauma exposure and trauma-related disorders in people with SMI. Methods We conducted a systematic review of four databases (1980–2010) and then described and analysed 33 studies in terms of primary diagnosis and instruments used to measure trauma exposure and trauma-related disorders. Results Population-weighted mean prevalence rates in SMI were physical abuse 47% (range 25–72%), sexual abuse 37% (range 24–49%), and posttraumatic stress disorder (PTSD) 30% (range 20–47%). Compared to men, women showed a higher prevalence of sexual abuse in schizophrenia spectrum disorder, bipolar disorder, and mixed diagnosis groups labelled as having SMI. Conclusions Prevalence rates of interpersonal trauma and trauma-related disorders were significantly higher in SMI than in the general population. Emotional abuse and neglect, physical neglect, complex PTSD, and dissociative disorders have been scarcely examined in SMI. PMID:23577228

The US Strategic Logistics Plan In The CBI Theater And Its Contemporary Significance

DTIC Science & Technology

2016-05-26

SUBJECT TERMS CBI Theater, Logistics, Lend-Lease Aid, LOC Network, Ledo Road, Burma Road, The Hump, AMMISCA 16. SECURITY CLASSIFICATION OF: a...19 Stilwell versus Chennault………………………………………………….………………………….......26 Efficiency of the LOC Network... LOC Line of Communication NATO North Atlantic Treaty Organization SLOC Sea Line of Communication SME Subject Matter Expert SOS Services of Supply SPOD

[Orthopedic and trauma surgery in the German DRG system. Recent developments].

PubMed

Franz, D; Schemmann, F; Selter, D D; Wirtz, D C; Roeder, N; Siebert, H; Mahlke, L

2012-07-01

Orthopedics and trauma surgery are subject to continuous medical advancement. The correct and performance-based case allocation by German diagnosis-related groups (G-DRG) is a major challenge. This article analyzes and assesses current developments in orthopedics and trauma surgery in the areas of coding of diagnoses and medical procedures and the development of the 2012 G-DRG system. The relevant diagnoses, medical procedures and G-DRGs in the versions 2011 and 2012 were analyzed based on the publications of the German DRG Institute (InEK) and the German Institute of Medical Documentation and Information (DIMDI). Changes were made for the International Classification of Diseases (ICD) coding of complex cases with medical complications, the procedure coding for spinal surgery and for hand and foot surgery. The G-DRG structures were modified for endoprosthetic surgery on ankle, shoulder and elbow joints. The definition of modular structured endoprostheses was clarified. The G-DRG system for orthopedic and trauma surgery appears to be largely consolidated. The current phase of the evolution of the G-DRG system is primarily aimed at developing most exact descriptions and definitions of the content and mutual delimitation of operation and procedures coding (OPS). This is an essential prerequisite for a correct and performance-based case allocation in the G-DRG system.

A Requirements Analysis for an Integrated Maintenance Information System Application Into Theater Air Control System Maintenance

DTIC Science & Technology

1994-09-01

133 v List of Tables Table Page 1. Line Item Changes in Proposed Ground TACS SSS Matrix...39 2. Percentage of Line Item Changes in Proposed SSS Matrix for G round T A C S...modified to meet Theater Air Control System requirements. The small amount of changes required to modify the aircraft matrix in order to satisfy ground

A Joint Force Medical Command is Required to Fix Combat Casualty Care

DTIC Science & Technology

2017-10-05

that poses an operations security risk. Author: ☒ PA: ☒ 13. SUPPLEMENTARY NOTES Word Count: 10,665 14. ABSTRACT The Military Health System...15. SUBJECT TERMS Military Health System, Joint Trauma System, Defense Health Agency, PROFIS 16. SECURITY CLASSIFICATION OF: 17...The Military Health System (MHS) is required to provide medical operational forces for military and contingency operations while also providing

Assessment of Biomarkers Associated with Joint Injury and Subsequent Post-Traumatic Arthritis

DTIC Science & Technology

2015-10-01

Post-traumatic arthritis, post-traumatic osteoarthritis, articular fracture, joint injury, trauma, biomarker, inflammation, MRI , knee, mouse model...will be collected prior to or at surgical intervention. MRI imaging of the injured knee will be obtained to assess the articular cartilage...and the development of PTA. We have successfully enrolled patients, collected and stored biosamples, obtained all post-operative MRI scans and are

Assessment of Biomarkers Associated with Joint Injury and Subsequent Post Traumatic Arthritis

DTIC Science & Technology

2015-10-01

arthritis, post-traumatic osteoarthritis, articular fracture, joint injury, trauma, biomarker, inflammation, MRI , knee, mouse model, translational...prior to or at surgical intervention. MRI imaging of the injured knee will be obtained to assess the articular cartilage. Degenerative changes in...development of PTA. We have successfully enrolled patients, collected and stored biosamples, obtained all post-operative MRI scans and are continuing to

Trauma-Informed Care in the Massachusetts Child Trauma Project.

PubMed

Bartlett, Jessica Dym; Barto, Beth; Griffin, Jessica L; Fraser, Jenifer Goldman; Hodgdon, Hilary; Bodian, Ruth

2016-05-01

Child maltreatment is a serious public health concern, and its detrimental effects can be compounded by traumatic experiences associated with the child welfare (CW) system. Trauma-informed care (TIC) is a promising strategy for addressing traumatized children's needs, but research on the impact of TIC in CW is limited. This study examines initial findings of the Massachusetts Child Trauma Project, a statewide TIC initiative in the CW system and mental health network. After 1 year of implementation, Trauma-Informed Leadership Teams in CW offices emerged as key structures for TIC systems integration, and mental health providers' participation in evidence-based treatment (EBT) learning collaboratives was linked to improvements in trauma-informed individual and agency practices. After approximately 6 months of EBT treatment, children had fewer posttraumatic symptoms and behavior problems compared to baseline. Barriers to TIC that emerged included scarce resources for trauma-related work in the CW agency and few mental providers providing EBTs to young children. Future research might explore variations in TIC across service system components as well as the potential for differential effects across EBT models disseminated through TIC. © The Author(s) 2015.

Enlisting Madison Avenue: The Marketing Approach to Earning Popular Support in Theaters of Operation

DTIC Science & Technology

2007-01-01

equivalent size: 7 Philip Kotler and Gary Armstrong, Principles of Marketing, 11th ed., Upper Saddle River, N.J.: Pearson Education, 2006, p. 196. 8...researchers Philip Kotler , Ned Roberto, and Nancy Lee.146 To illus- trate the application of these steps in an operational theater, we utilize a...2003, p. 18. Kotler , Philip , and Gary Armstrong, Principles of Marketing, 11th ed., Upper Saddle River, N.J.: Pearson Education, 2006. 200

Physical and nutrition statuses of geriatric patients after trauma-related hospitalization: Data from the Korean National Health and Nutrition Examination Survey 2013-2015.

PubMed

Cho, Hang Joo; Hong, Tae Hwa; Kim, Maru

2018-03-01

Population aging is associated with increasing numbers of geriatric trauma patients, and various studies have evaluated their short-term outcomes, assessment, and treatment. However, there is insufficient information regarding their long-term outcomes. This study evaluated the physical and nutritional statuses of geriatric patients after trauma-related hospitalization.Data regarding physical and nutritional status were obtained from the Korean National Health and Nutrition Examination Survey VI (2013-2015).A total of 21,069 individuals participated in the survey, including 5650 geriatric individuals. After excluding individuals with missing data, 3731 cases were included in the analyses. The average age was 68 years, and most individuals were women (n = 2055, 55.08%). There were 94 patients had been hospitalized because of trauma. Trauma-related hospitalization among geriatric patients was significantly associated with reduced strength exercise (23.56% vs 12.99%, P = .043), activity limitations caused by joint pain (0.65% vs 3.31%, P = .028), self-care problems (8.00% vs 16.77%, P = .008), pain or discomfort (29.48% vs 40.51%, P = .024), hypercholesterolemia (27.37% vs 39.36%, P = .037), and mastication discomfort (39.98% vs 57.85% P = .005). The adjusted analyses revealed that trauma-related hospitalization was independently associated with activity limitations caused by joint pain (odds ratio [OR]: 5.04, 95% confidence interval [CI]: 1.29-19.67, P = .020), self-care problems (OR: 2.24, 95% CI: 1.11-4.53, P = .025), pain or discomfort (OR: 1.77, 95% CI: 1.08-2.89, P = .023), and mastication discomfort (OR: 2.06, 95% CI: 1.22-3.46, P = .007).Medical staff should be aware that geriatric patients have relatively poor physical and nutritional statuses after trauma-related hospitalization, and manage these patients accordingly.

Imaging of Combat-Related Thoracic Trauma - Review of Penetrating Trauma.

PubMed

Lichtenberger, John P; Kim, Andrew M; Fisher, Dane; Tatum, Peter S; Neubauer, Brian; Peterson, P Gabriel; Carter, Brett W

2018-03-01

Combat-related thoracic trauma is a significant contributor to morbidity and mortality of the casualties from Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF). Penetrating, blunt, and blast injuries were the most common mechanisms of trauma. Imaging plays a key role in the management of combat-related thoracic trauma casualties. This review discusses the imaging manifestations of thoracic injuries from penetrating trauma, emphasizing epidemiology and diagnostic clues seen during OEF and OIF. The assessment of radiologic findings in patients who suffer from combat-related thoracic trauma is the basis of this review article. The imaging modalities for this study include multi-detector computed tomography and chest radiography. High-velocity penetrating projectile injuries appear as hemorrhage and re-expansion pulmonary edema from the temporary cavity and a linear, blood-filled track from the permanent cavity. In cases where the projectile passes totally through the body, entrance wounds at the skin surface and tracks through the subcutaneous tissues may be the only indications of penetrating trauma. When assessing vascular injury, special attention should be paid to the right hilum in contrast-enhanced multi-detector computed tomography, as contrast is concentrated in the superior vena cava and superior cavoatrial junction may obscure small fragments. Additionally, CT angiography may show vessel disruption or extravasation of contrast distal to normal vessel location in addition to intraluminal filling defects and pseudo-aneurysms. Tension pneumopericardium may rarely complicate penetrating or blunt chest trauma. On imaging, distension of the pericardial sack by pneumopericardium and compression of the heart support the diagnosis of tension. On multi-detector computed tomography in the acute trauma setting, fluid in the pleural space should be considered hemothorax, particularly when Hounsfield units are above 35. Acutely, extravasated blood will

Feasibility Study and Demonstration Project for Joint Military/Civilian Trauma Institute with a Burn Center

DTIC Science & Technology

2008-10-01

Standard Form 298 (Rev. 8-98) Prescribed by ANSI Std. Z39.18 3 Table of Contents ...Protocols and Restrictive Blood Transfusion Strategies on Glucose Measurement in American Burn Association ( ABA ) Verified Burn 13 Centers. Journal...civilian experts in trauma care as well as policy makers and include: CAPT (Ret) Frank Butler, Col (Ret) Donald Jenkins, COL (Ret) John Holcomb, Dr. Basil

[Modern concepts of trauma care and multiple trauma management in oral and maxillofacial region].

PubMed

Tan, Yinghui

2015-06-01

Multiple trauma management requires the application of modem trauma care theories. Optimal treatment results can be achieved by reinforcing cooperation and stipulating a treatment plan together with other disciplines. Based on modem theories in trauma care and our understanding of the theoretical points, this paper analyzes the injury assessment strategies and methods in oral and maxillofacial multiple trauma management. Moreover, this paper discusses operating time and other influencing factors as well as proposed definitive surgical timing and indications in comprehensive management of oral and maxillofacial multiple trauma patients associated with injuries in other body parts. We hope that this paper can help stomatological physicians deepen their understanding of modem trauma care theories and improve their capacity and results in the treatment of oral and maxillofacial multiple trauma.

Trauma: the seductive hypothesis.

PubMed

Reisner, Steven

2003-01-01

In much of contemporary culture, "trauma" signifies not so much terrible experience as a particular context for understanding and responding to a terrible experience. In therapy, in the media, and in international interventions, the traumatized are seen not simply as people who suffer and so are deserving of concern and aid; they are seen also as people who suffer for us, who are given special dispensation. They are treated with awe if they tell a certain kind of trauma story, and are ignored or vilified if they tell another. Trauma has become not simply a story of pain and its treatment, but a host of sub-stories involving the commodification of altruism, the justification of violence and revenge, the entry point into "true experience," and the place where voyeurism and witnessing intersect. Trauma is today the stuff not only of suffering but of fantasy. Historically, trauma theory and treatment have shown a tension, exemplified in the writings of Freud and Janet, between those who view trauma as formative and those who view it as exceptional. The latter view, that trauma confers exceptional status deserving of special privilege, has gained ground in recent years and has helped to shape the way charitable dollars are distributed, how the traumatized are presented in the media, how governments justify and carry out international responses to trauma, and how therapists attend to their traumatized patients. This response to trauma reflects an underlying, unarticulated belief system derived from narcissism; indeed, trauma has increasingly become the venue, in society and in treatment, where narcissism is permitted to prevail.

A case of pachydermodactyly in a seventeen year old associated with repetitive minor trauma.

PubMed

Abdelrahman, W; Walsh, M Y; Smyth, A; Alderice, D

2016-08-15

A boy presented initially to a Rheumatology clinic with a three year history of asymptomatic swelling of the third to fourth proximal interphalangeal (PIP) joints bilaterally. A presumptive diagnosis of seronegative arthritis was made. Sulfasalazine was commenced without improvement and resulted in mood disturbance. Blood tests including ESR, lupus anticoagulant, rheumatoid factor and CCP antibodies were unremarkable. Hand radiographs were normal. MRI showed oedema within soft tissues around PIP joints. His care was transferred to the Rheumatology unit in our hospital and the rheumatological diagnosis was revised; sulfasalazine was stopped and skin biopsy organised. Onward referral to Dermatology was made. Examination revealed symmetrical swelling and thickening of soft tissues on PIP joints with no evidence of joint synovitis. He denied habitual behaviour but was noted to rub his fingers subconsciously. With this as a cause of repetitive minor trauma, a clinical diagnosis of pachydermodactyly was made. Skin biopsy was supportive showing a dermis with coarse collagen. Pachydermodactyly is rare. This case highlights the importance of prompt recognition to avoid invasive and excessive diagnostic procedures as well as unnecessary immunosuppression.

Distraction for proximal interphalangeal joint contractures: long-term results.

PubMed

Houshian, Shirzad; Jing, Shan Shan; Kazemian, Gholam Hussein; Emami-Moghaddam-Tehrani, Mohammad

2013-10-01

To report the medium- to long-term outcomes of joint distraction using a unilateral external fixator in the treatment of chronic post-traumatic proximal interphalangaeal (PIP) joint contractures. Between September 2001 and October 2011, 94 consecutive patients (98 PIP joints) with a mean age of 43 years (range, 17-69 y) were treated with external fixation for chronic flexion deformity of the PIP joint from trauma. The average time from injury to surgery was 48 months (range, 6-84 mo), and the duration of joint distraction was 10 days (range, 7-22 d). Patients were followed for a mean period of 54 months (range, 12-72 mo). The average gain in joint flexion was 25° and in joint extension was 40°. The mean improvement in the active range of movement was 67° (range. 30°-90°). There was no loss of motion on the latest follow-up. Patients younger than 40 years fared slightly better than those older than 40 years. Two patients developed swelling, pain, and erythema during treatment, which resolved upon temporarily stopping the distraction process. There were 12 cases of superficial pin-site infections, which were managed conservatively without serious complications or adverse outcome. External fixation is a simple and effective treatment modality for chronic traumatic PIP joint contractures with good predictable medium- to long-term results. Careful patient selection and monitoring are required. Copyright © 2013 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

Trauma facilities in Denmark - a nationwide cross-sectional benchmark study of facilities and trauma care organisation.

PubMed

Weile, Jesper; Nielsen, Klaus; Primdahl, Stine C; Frederiksen, Christian A; Laursen, Christian B; Sloth, Erik; Mølgaard, Ole; Knudsen, Lars; Kirkegaard, Hans

2018-03-27

Trauma is a leading cause of death among adults aged < 44 years, and optimal care is a challenge. Evidence supports the centralization of trauma facilities and the use multidisciplinary trauma teams. Because knowledge is sparse on the existing distribution of trauma facilities and the organisation of trauma care in Denmark, the aim of this study was to identify all Danish facilities that care for traumatized patients and to investigate the diversity in organization of trauma management. We conducted a systematic observational cross-sectional study. First, all hospitals in Denmark were identified via online services and clarifying phone calls to each facility. Second, all trauma care manuals on all facilities that receive traumatized patients were gathered. Third, anesthesiologists and orthopedic surgeons on call at all trauma facilities were contacted via telephone for structured interviews. A total of 22 facilities in Denmark were found to receive traumatized patients. All facilities used a trauma care manual and all had a multidisciplinary trauma team. The study found three different trauma team activation criteria and nine different compositions of teams who participate in trauma care. Training was heterogeneous and, beyond the major trauma centers, databases were only maintained in a few facilities. The study established an inventory of the existing Danish facilities that receive traumatized patients. The trauma team activation criteria and the trauma teams were heterogeneous in both size and composition. A national database for traumatized patients, research on nationwide trauma team activation criteria, and team composition guidelines are all called for.

[Staple fixation for the treatment of hamate metacarpal joint injury].

PubMed

Tang, Yang-Hua; Zeng, Lin-Ru; Huang, Zhong-Ming; Yue, Zhen-Shuang; Xin, Da-Wei; Xu, Can-Da

2014-03-01

To investigate the effcacy of the staple fixation for the treatment of hamate metacarpal joint injury. From May 2009 to November 2012,16 patients with hamate metacarpal joint injury were treated with staple fixation including 10 males and 6 females with an average age of 33.6 years old ranging from 21 to 57 years. Among them, 11 cases were on the fourth or fifth metacarpal base dislocation without fractures, 5 cases were the fourth or fifth metacarpal base dislocation with avulsion fractures of the back of hamatum. Regular X-ray review was used to observe the fracture healing, joint replacement and position of staple fixation. The function of carpometacarpal joint and metacarpophalangeal joint were evaluated according to ASIA (TAM) system evaluation method. All incision were healed well with no infection. All patients were followed up from 16 to 24 months with an average of (10.0 +/- 2.7) months. No dislocation recurred, the position of internal fixator was good,no broken nail and screw withdrawal were occurred. Five patients with avulsion fracture of the back of hamatum achieved bone healing. The function of carpometacarpal joint and metacarpophalangeal was excellent in 10 cases,good in 5 cases, moderate in 1 case. The application of the staple for the treatment of hamatometacarpal joint injury has the advantages of simple operation, small trauma, reliable fixation, early postoperative function exercise and other advantages, which is the ideal operation mode for hamatometacarpal joint injury.

Getting Teachers in on the Act: Evaluation of a Theater- and Classroom-Based Youth Violence Prevention Program

ERIC Educational Resources Information Center

Zucker, Marla; Spinazzola, Joseph; Pollack, Amie Alley; Pepe, Lauren; Barry, Stephanie; Zhang, Lynda; van der Kolk, Bessel

2010-01-01

This study replicated and extended our previous evaluation of Urban Improv (UI), a theater-based youth violence prevention (YVP) program developed for urban youth. It assessed the replicability of positive program impacts when implemented by nonprogram originators, as well as the utility of a comprehensive version of the UI program that included a…

Subtalar joint arthroscopy for sinus tarsi syndrome: a review of 29 cases.

PubMed

Oloff, L M; Schulhofer, S D; Bocko, A P

2001-01-01

Twenty-nine consecutive patients who underwent diagnostic or therapeutic subtalar joint arthroscopy for sinus tarsi syndrome were retrospectively reviewed. The mean length of follow-up was 18 months. There was a history of trauma in 86% of the patients, with an inversion sprain being the most common predisposing injury (63%). All patients had a primary preoperative diagnosis of sinus tarsi syndrome. Magnetic resonance imaging was useful in identifying subtalar joint chronic synovitis and/or fibrosis in all 26 patients who were imaged. Subtalar joint synovectomy was the most common procedure performed. Twelve patients had 15 additional operative procedures. One patient required an arthrotomy secondary to arthrofibrosis. There were no postoperative complications. The mean return to full activity was 4 months. The mean postoperative AOFAS Ankle-Hindfoot Scale score was 85 points. Subtalar joint arthroscopy has proven to be a relatively safe and effective diagnostic and therapeutic technique in the management of sinus tarsi syndrome.

Computer-assisted trauma care prototype.

PubMed

Holzman, T G; Griffith, A; Hunter, W G; Allen, T; Simpson, R J

1995-01-01

Each year, civilian accidental injury results in 150,000 deaths and 400,000 permanent disabilities in the United States alone. The timely creation of and access to dynamically updated trauma patient information at the point of injury is critical to improving the state of care. Such information is often non-existent, incomplete, or inaccurate, resulting in less than adequate treatment by medics and the loss of precious time by medical personnel at the hospital or battalion aid station as they attempt to reassess and treat the patient. The Trauma Care Information Management System (TCIMS) is a prototype system for facilitating information flow and patient processing decisions in the difficult circumstances of civilian and military trauma care activities. The program is jointly supported by the United States Advanced Research Projects Agency (ARPA) and a consortium of universities, medical centers, and private companies. The authors' focus has been the human-computer interface for the system. We are attempting to make TCIMS powerful in the functions it delivers to its users in the field while also making it easy to understand and operate. To develop such a usable system, an approach known as user-centered design is being followed. Medical personnel themselves are collaborating with the authors in its needs analysis, design, and evaluation. Specifically, the prototype being demonstrated was designed through observation of actual civilian trauma care episodes, military trauma care exercises onboard a hospital ship, interviews with civilian and military trauma care providers, repeated evaluation of evolving prototypes by potential users, and study of the literature on trauma care and human factors engineering. This presentation at MedInfo '95 is still another avenue for soliciting guidance from medical information system experts and users. The outcome of this process is a system that provides the functions trauma care personnel desire in a manner that can be easily and

[Abdominal trauma].

PubMed

Sido, B; Grenacher, L; Friess, H; Büchler, M W

2005-09-01

Blunt abdominal trauma is much more frequent than penetrating abdominal trauma in Europe. As a consequence of improved quality of computed tomography, even complex liver injuries are increasingly being treated conservatively. However, missed hollow viscus injuries still remain a problem, as they considerably increase mortality in multiply injured patients. Laparoscopy decreases the rate of unnecessary laparotomies in perforating abdominal trauma and helps to diagnose injuries of solid organs and the diaphragm. However, the sensitivity in detecting hollow viscus injuries is low and the role of laparoscopy in blunt abdominal injury has not been defined. If intra-abdominal bleeding is difficult to control in hemodynamically unstable patients, damage control surgery with packing of the liver, total splenectomy, and provisional closure of hollow viscus injuries is of importance. Definitive surgical treatment follows hemodynamic stabilization and restoration of hemostasis. Injuries of the duodenum and pancreas after blunt abdominal trauma are often associated with other intra-abdominal injuries and the treatment depends on their location and severity.

The Cultural Value of Older People's Experiences of Theater-making: A Review.

PubMed

Bernard, Miriam; Rickett, Michelle

2017-04-01

Although a number of existing reviews document the health and social benefits of arts participation by older people, there are none which focus specifically on theater and drama. This article presents the findings of a study conducted as part of the UK's Arts and Humanities Research Council "Cultural Value Project." The 2-year (2013-2015) "Cultural Value Project" sought to make a major contribution to how we think about the value of arts and culture to individuals and to society. It made 72 awards: 19 critical reviews of existing bodies of research, 46 research development awards to carry out new research, and 7 expert workshop awards to facilitate discussions among academics and practitioners. Together, these awards explored the components of cultural value and the ways in which cultural value is evidenced and evaluated. Following an extensive search of academic databases and E-mail requests via relevant organizations and networks, 77 publications formed the basis for our own critical review. Our findings highlight the benefits and value of older people's theater and drama participation on health and well-being, group relationships, learning and creativity, and draw attention to the importance of the esthetic value and quality of older people's drama. Despite the recent surge of interest in this field (a third of the reviewed literature was published between 2010 and 2014), we suggest that there are multiple areas for further research. © The Author 2016. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

The 2014 Academic College of Emergency Experts in India's INDO-US Joint Working Group (JWG) White Paper on “Developing Trauma Sciences and Injury Care in India”

PubMed Central

Pal, Ranabir; Agarwal, Amit; Galwankar, Sagar; Swaroop, Mamta; Stawicki, Stanislaw P; Rajaram, Laxminarayan; Paladino, Lorenzo; Aggarwal, Praveen; Bhoi, Sanjeev; Dwivedi, Sankalp; Menon, Geetha; Misra, MC; Kalra, OP; Singh, Ajai; Radjou, Angeline Neetha; Joshi, Anuja

2014-01-01

It is encouraging to see the much needed shift in the understanding and recognition of the concept of “burden of disease” in the context of traumatic injury. Equally important is understanding that the impact of trauma burden rivals that of nontraumatic morbidities. Subsequently, this paradigm shift reinstates the appeal for timely interventions as the standard for management of traumatic emergencies. Emergency trauma care in India has been disorganized due to inadequate sensitivity toward patients affected by trauma as well as the haphazard, nonuniform acceptance of standardization as the norm. Some of the major hospitals across various regions in the country do have trauma care units, but even those lack protocols to ensure that all trauma cases are handled by those units, largely owing to lack of structured referral system. As a first step to reform the state of trauma care in the country, a detailed overview is needed to gain insight into the prevailing reality. The objectives of this paper are to thus weave a foundation based on the statistical and qualitative burden of trauma in the country; the available infrastructure of trauma care centers equipped to deal with trauma; the need and scope of standardized protocols for intervention; and most importantly, the application of these in shaping educational initiatives in advancing emergency trauma care in the country. PMID:25024939

Focused abdominal sonography for trauma (FAST) in blunt paediatric abdominal trauma.

PubMed

Faruque, Ahmad Vaqas; Qazi, Saqib Hamid; Khan, Muhammad Arif Mateen; Akhtar, Wassem; Majeed, Amina

2013-03-01

To evaluate the role of focussed abdominal sonography for trauma in blunt paediatric abdominal trauma patients, and to see if the role of computed tomography scan could be limited to only those cases in which sonography was positive. The retrospective study covered 10 years, from January 1,2000 to December 31,2009, and was conducted at the Department of Radiology and Department of Emergency Medicine, Aga Khan University Hospital, Karachi. It comprised cases of 174 children from birth to 14 years who had presented with blunt abdominal trauma and had focussed abdominal sonography for trauma done at the hospital. The findings were correlated with computed tomography scan of the abdomen and clinical follow-up. Sensitivity, specificity, positive predictive value, negative predictive value and accuracy of focussed abdominal sonography for trauma were calculated for blunt abdominal trauma. SPSS 17 was used for statistical analysis. Of the total 174 cases, 31 (17.81%) were later confirmed by abdominal scan. Of these 31 children, sonography had been positive in 29 (93.54%) children. In 21 (67.74%) of the 31 children, sonograpy had been true positive; 8 (25%) (8/31) were false positive; and 2 (6%) (2/31) were false negative. There were 6 (19.3%) children in which sonography was positive and converted to laparotomy. There was no significant difference on account of gender (p>0.356). Focussed abdominal sonography for trauma in the study had sensitivity of 91%, specificity of 95%, positive predictive value of 73%, and negative predictive value of 73% with accuracy of 94%. All patients who had negative sonography were discharged later, and had no complication on clinical follow-up. Focussed abdominal sonography for trauma is a fairly reliable mode to assess blunt abdominal trauma in children. It is a useful tool to pick high-grade solid and hollow viscous injury. The results suggest that the role of computed tomography scan can be limited to those cases in which focussed

Establishing Theater Command and Control In a Coalition of Nations: Requirements for U.S. Doctrine

DTIC Science & Technology

1992-05-01

difficult and time consuming to establish effective coalition relations . Given the above, US doctrine for coalition theater C2 must go beyond the...make a disproportionate effort to do so. Related to the shared cultural heritage Is a common religious history. Both nations were predominantly Judeo...Inhibited. 6 The language difference too was substantial. The Korean language, Hangul, Is related to Chinese, but with Its own alphabet, one that bears no

A novel prospective approach to evaluate trauma recidivism: the concept of the past trauma history.

PubMed

McCoy, Andrew M; Como, John J; Greene, Gregory; Laskey, Sara L; Claridge, Jeffrey A

2013-07-01

The purpose of this study was to determine the incidence and burden of trauma recidivism at a regional Level 1 trauma center by incorporating the concept of the past trauma history (PTHx) into the general trauma history. All trauma patients who met prehospital trauma criteria and activated the trauma team during a 13-month period were asked about their PTHx, that is, their history of injury in the previous 5 years. A recidivist presented more than once for separate severe injuries. Recurrent recidivists presented multiple times during the study period. Of the 4,971 trauma activations during the study period, 1,246 (25.2%) were identified as recidivists. Recidivists were 75% male, 62% white, 36% unemployed, 26% uninsured, and 90% unmarried. The recidivism rate among admitted patients was 23.4% compared with 29.3% in those discharged from the emergency department. The highest recidivism rates were noted in patients who reported alcohol or illegal drug use on the day of injury and in victims of interpersonal violence (IPV), defined as those who sustained gunshot wounds, stab wounds, or assaults, Those involved in IPV were more likely to have been involved in IPV at the previous trauma than those with other trauma mechanisms. Key risk factors for recidivism among all patients were male sex and single marital status. Seventy-three patients (1.5%) were recurrent recidivists, representing 157 unique encounters. This is the highest trauma recidivism rate reported on a large population of all consecutive trauma activations at a regional Level 1 trauma center. These data illustrate the tremendous burden of recidivism in the modern era, more than previously recognized. Efforts specifically targeting those involved in IPV may reduce recidivism rates. Incorporating the concept of the PTHx into the general history of the trauma patient is feasible and provides valuable information to the provider. Prognostic study, level II.

The value of trauma registries.

PubMed

Moore, Lynne; Clark, David E

2008-06-01

Trauma registries are databases that document acute care delivered to patients hospitalised with injuries. They are designed to provide information that can be used to improve the efficiency and quality of trauma care. Indeed, the combination of trauma registry data at regional or national levels can produce very large databases that allow unprecedented opportunities for the evaluation of patient outcomes and inter-hospital comparisons. However, the creation and upkeep of trauma registries requires a substantial investment of money, time and effort, data quality is an important challenge and aggregated trauma data sets rarely represent a population-based sample of trauma. In addition, trauma hospitalisations are already routinely documented in administrative hospital discharge databases. The present review aims to provide evidence that trauma registry data can be used to improve the care dispensed to victims of injury in ways that could not be achieved with information from administrative databases alone. In addition, we will define the structure and purpose of contemporary trauma registries, acknowledge their limitations, and discuss possible ways to make them more useful.

Evaluation of massive transfusion protocol practices by type of trauma at a level I trauma center.

PubMed

Givergis, Roshan; Munnangi, Swapna; Fayaz M Fomani, Katayoun; Boutin, Anthony; Zapata, Luis Carlos; Angus, Ld George

2018-04-18

To evaluate massive transfusion protocol practices by trauma type at a level I trauma center. A retrospective analysis was performed on a sample of 76 trauma patients with MTP activation between March 2010 and January 2015 at a regional trauma center. Patient demographics, transfusion practices, and clinical outcomes were compared by type of trauma sustained. Penetrating trauma patients who required MTP activation were significantly younger, had lower injury severity score (ISS), higher probability of survival (POS), decreased mortality, and higher Glasgow Coma scale (GCS) compared to blunt trauma patients. Overall, the mortality rate was 38.16%. The most common injury sustained among blunt trauma patients was head injury (36.21%), whereas the majority of the penetrating trauma patients sustained abdominal injuries (55.56%). Although the admission coagulation parameters and timing of coagulopathy were not significantly different between the two groups of patients, a significantly higher proportion of penetrating trauma patients received high plasma content therapy relative to blunt trauma patients (p < 0.01). Despite the use of the same MTP for all injured patients requiring massive transfusion, significant differences existed between blunt trauma patients and penetrating trauma patients. These differences in transfusion characteristics and outcomes following MTP activation underscore the complexity of implementing MTPs and warrant vigilant transfusion practices to improve outcomes in trauma patients. Copyright © 2018 Daping Hospital and the Research Institute of Surgery of the Third Military Medical University. Production and hosting by Elsevier B.V. All rights reserved.

Disaster preparedness of Canadian trauma centres: the perspective of medical directors of trauma

PubMed Central

Gomez, David; Haas, Barbara; Ahmed, Najma; Tien, Homer; Nathens, Avery

2011-01-01

Background Owing to their constant readiness to treat injured patients, trauma centres are essential to regional responses to mass casualty incidents (MCIs). Reviews of recent MCIs suggest that trauma centre preparedness has frequently been limited. We set out to evaluate Canadian trauma centre preparedness and the extent of their integration into a regional response to MCIs. Methods We conducted a survey of Canadian level-1 trauma centres (n = 29) to characterize their existing disaster-response plans and to identify areas where pre-paredness could be improved. The survey was directed to the medical director of trauma at each centre. Descriptive statistics were used to analyze responses. Results Twenty-three (79%) trauma centres in 5 provinces responded. Whereas most (83%) reported the presence of a committee dedicated to disaster preparedness, only half of the medical directors of trauma were members of these committees. Almost half (43%) the institutions had not run any disaster drill in the previous 2 years. Only 70% of trauma centres used communications assets designed to function during MCIs. Additionally, more than half of the trauma directors (59%) did not know if their institutions had the ability to sustain operations for at least 72 hours during MCIs. Conclusion The results of this study suggest important opportunities to better prepare Canadian trauma centers to respond to an MCI. The main areas identified for potential improvement include the need for the standardization of MCI planning and response at a regional level and the implementation of strategies such as stockpiling of resources and novel communication strategies to avoid functional collapse during an MCI. PMID:21251427

A Survey of Teaching Artists in Dance and Theater: Implications for Preparation, Curriculum, and Professional Degree Programs

ERIC Educational Resources Information Center

Anderson, Mary Elizabeth; Risner, Doug

2012-01-01

This study investigates teaching artists whose work is rooted in dance and theater. Although the term remains both ambiguous and debated, teaching artists provide a good deal of arts education delivery in P-12 and afterschool programs throughout the United States. Based on survey data from a range of teaching artists across the nation (N = 133),…

Freedom to Experiment: The Coherence and Complexity of Federico García Lorca's Puppet Theater

ERIC Educational Resources Information Center

Polansky, Susan G.

2014-01-01

Federico García Lorca's appropriation of the puppet play genre reveals that at the same time he was reaching into deep roots of popular tradition, he also was seeking opportunity to innovate and break free from limitations imposed by the commercial theater scene of the first decades of the twentieth century. Tracing the trajectory of…

Development and validation of a brief trauma screening measure for children: The Child Trauma Screen.

PubMed

Lang, Jason M; Connell, Christian M

2017-05-01

Childhood exposure to trauma, including violence and abuse, is a major public health concern that has resulted in increased efforts to promote trauma-informed child-serving systems. Trauma screening is an important component of such trauma-informed systems, yet widespread use of trauma screening is rare in part due to the lack of brief, validated trauma screening measures for children. We describe development and validation of the Child Trauma Screen (CTS), a 10-item screening measure of trauma exposure and posttraumatic stress disorder (PTSD) symptoms for children consistent with the DSM-5 definition of PTSD. Study 1 describes measure development incorporating analysis to derive items based on existing measures from 1,065 children and caregivers together with stakeholder input to finalize item selection. Study 2 describes validation of the CTS with a clinical sample of 74 children and their caregivers. Results support the CTS as an empirically derived, reliable measure to screen children for trauma exposure and PTSD symptoms with strong convergent, divergent, and criterion validity. The CTS is a promising measure for rapidly and reliably screening children for trauma exposure and PTSD symptoms. Future research is needed to confirm validation and to examine feasibility and utility of its use across various child-serving systems. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

Hepatic trauma: a 21-year experience.

PubMed

Zago, Thiago Messias; Pereira, Bruno Monteiro; Nascimento, Bartolomeu; Alves, Maria Silveira Carvalho; Calderan, Thiago Rodrigues Araujo; Fraga, Gustavo Pereira

2013-01-01

To evaluate the epidemiological aspects, behavior, morbidity and treatment outcomes for liver trauma. We conducted a retrospective study of patients over 13 years of age admitted to a university hospital from 1990 to 2010, submitted to surgery or nonoperative management (NOM). 748 patients were admitted with liver trauma. The most common mechanism of injury was penetrating trauma (461 cases, 61.6%), blunt trauma occurring in 287 patients (38.4%). According to the degree of liver injury (AAST-OIS) in blunt trauma we predominantly observed Grades I and II and in penetrating trauma, Grade III. NOM was performed in 25.7% of patients with blunt injury. As for surgical procedures, suturing was performed more frequently (41.2%). The liver-related morbidity was 16.7%. The survival rate for patients with liver trauma was 73.5% for blunt and 84.2% for penetrating trauma. Mortality in complex trauma was 45.9%. trauma remains more common in younger populations and in males. There was a reduction of penetrating liver trauma. NOM proved safe and effective, and often has been used to treat patients with penetrating liver trauma. Morbidity was high and mortality was higher in victims of blunt trauma and complex liver injuries.

Pancreatic trauma.

PubMed

Lahiri, R; Bhattacharya, S

2013-05-01

Pancreatic trauma occurs in approximately 4% of all patients sustaining abdominal injuries. The pancreas has an intimate relationship with the major upper abdominal vessels, and there is significant morbidity and mortality associated with severe pancreatic injury. Immediate resuscitation and investigations are essential to delineate the nature of the injury, and to plan further management. If main pancreatic duct injuries are identified, specialised input from a tertiary hepatopancreaticobiliary (HPB) team is advised. A comprehensive online literature search was performed using PubMed. Relevant articles from international journals were selected. The search terms used were: 'pancreatic trauma', 'pancreatic duct injury', 'radiology AND pancreas injury', 'diagnosis of pancreatic trauma', and 'management AND surgery'. Articles that were not published in English were excluded. All articles used were selected on relevance to this review and read by both authors. Pancreatic trauma is rare and associated with injury to other upper abdominal viscera. Patients present with non-specific abdominal findings and serum amylase is of little use in diagnosis. Computed tomography is effective in diagnosing pancreatic injury but not duct disruption, which is most easily seen on endoscopic retrograde cholangiopancreaticography or operative pancreatography. If pancreatic injury is suspected, inspection of the entire pancreas and duodenum is required to ensure full evaluation at laparotomy. The operative management of pancreatic injury depends on the grade of injury found at laparotomy. The most important prognostic factor is main duct disruption and, if found, reconstructive options should be determined by an experienced HPB surgeon. The diagnosis of pancreatic trauma requires a high index of suspicion and detailed imaging studies. Grading pancreatic injury is important to guide operative management. The most important prognostic factor is pancreatic duct disruption and in these cases

OOSTT: a Resource for Analyzing the Organizational Structures of Trauma Centers and Trauma Systems

PubMed Central

Utecht, Joseph; Judkins, John; Otte, J. Neil; Colvin, Terra; Rogers, Nicholas; Rose, Robert; Alvi, Maria; Hicks, Amanda; Ball, Jane; Bowman, Stephen M.; Maxson, Robert T.; Nabaweesi, Rosemary; Pradhan, Rohit; Sanddal, Nels D.; Tudoreanu, M. Eduard; Winchell, Robert J.; Brochhausen, Mathias

2017-01-01

Organizational structures of healthcare organizations has increasingly become a focus of medical research. In the CAFÉ project we aim to provide a web-service enabling ontology-driven comparison of the organizational characteristics of trauma centers and trauma systems. Trauma remains one of the biggest challenges to healthcare systems worldwide. Research has demonstrated that coordinated efforts like trauma systems and trauma centers are key components of addressing this challenge. Evaluation and comparison of these organizations is essential. However, this research challenge is frequently compounded by the lack of a shared terminology and the lack of effective information technology solutions for assessing and comparing these organizations. In this paper we present the Ontology of Organizational Structures of Trauma systems and Trauma centers (OOSTT) that provides the ontological foundation to CAFÉ's web-based questionnaire infrastructure. We present the usage of the ontology in relation to the questionnaire and provide the methods that were used to create the ontology. PMID:28217041

Specific Trauma Subtypes Improve the Predictive Validity of the Harvard Trauma Questionnaire in Iraqi Refugees

PubMed Central

Arnetz, Bengt B.; Broadbridge, Carissa L.; Jamil, Hikmet; Lumley, Mark A.; Pole, Nnamdi; Barkho, Evone; Fakhouri, Monty; Talia, Yousif Rofa; Arnetz, Judith E.

2014-01-01

Background Trauma exposure contributes to poor mental health among refugees, and exposure often is measured using a cumulative index of items from the Harvard Trauma Questionnaire (HTQ). Few studies, however, have asked whether trauma subtypes derived from the HTQ could be superior to this cumulative index in predicting mental health outcomes. Methods A community sample of recently arrived Iraqi refugees (N = 298) completed the HTQ and measures of posttraumatic stress disorder (PTSD) and depression symptoms. Results Principal components analysis of HTQ items revealed a 5-component subtype model of trauma that accounted for more item variance than a 1-component solution. These trauma subtypes also accounted for more variance in PTSD and depression symptoms (12% and 10%, respectively) than did the cumulative trauma index (7% and 3%, respectively). Discussion Trauma subtypes provided more information than cumulative trauma in the prediction of negative mental health outcomes. Therefore, use of these subtypes may enhance the utility of the HTQ when assessing at-risk populations. PMID:24549491

Specific trauma subtypes improve the predictive validity of the Harvard Trauma Questionnaire in Iraqi refugees.

PubMed

Arnetz, Bengt B; Broadbridge, Carissa L; Jamil, Hikmet; Lumley, Mark A; Pole, Nnamdi; Barkho, Evone; Fakhouri, Monty; Talia, Yousif Rofa; Arnetz, Judith E

2014-12-01

Trauma exposure contributes to poor mental health among refugees, and exposure often is measured using a cumulative index of items from the Harvard Trauma Questionnaire (HTQ). Few studies, however, have asked whether trauma subtypes derived from the HTQ could be superior to this cumulative index in predicting mental health outcomes. A community sample of recently arrived Iraqi refugees (N = 298) completed the HTQ and measures of posttraumatic stress disorder (PTSD) and depression symptoms. Principal components analysis of HTQ items revealed a 5-component subtype model of trauma that accounted for more item variance than a 1-component solution. These trauma subtypes also accounted for more variance in PTSD and depression symptoms (12 and 10%, respectively) than did the cumulative trauma index (7 and 3%, respectively). Trauma subtypes provided more information than cumulative trauma in the prediction of negative mental health outcomes. Therefore, use of these subtypes may enhance the utility of the HTQ when assessing at-risk populations.

Trismus in Face Transplantation Following Ballistic Trauma.

PubMed

Krezdorn, Nicco; Alhefzi, Muayyad; Perry, Bridget; Aycart, Mario A; Tasigiorgos, Sotirios; Bueno, Ericka M; Green, Jordan R; Pribaz, Julian J; Pomahac, Bohdan; Caterson, Edward J

2018-06-01

Trismus can be a challenging consequence of ballistic trauma to the face, and has rarely been described in the setting of face transplantation. Almost half of all current face transplant recipients in the world received transplantation to restore form and function after a ballistic injury. Here we report our experience and challenges with long standing trismus after face transplantation. We reviewed the medical records of our face transplant recipients whose indication was ballistic injury. We focused our review on trismus and assessed the pre-, peri- and postoperative planning, surgery and functional outcomes. Two patients received partial face transplantation, including the midface for ballistic trauma. Both patients suffered from impaired mouth opening, speech intelligibility, and oral competence. Severe scarring of the temporomandibular joint (TMJ) required intraoperative release in both patients, and additional total condylectomy on the left side 6 months posttransplant for 1 patient. Posttransplant, both patients achieved an improvement in mouth opening; however, there was persistent trismus. One year after transplantation, range of motion of the jaw had improved for both patients. Independent oral food intake was possible 1 year after surgery, although spillage of liquids and mixed consistency solids persisted. Speech intelligibility testing showed impairments in the immediate postoperative period, with improvement to over 85% for both patients at 1 year posttransplant. Ballistic trauma to the face and subsequent reconstructive measures can cause significant scarring and covert injuries to structures such as the TMJ, resulting in long standing trismus. Meticulous individual planning prior to interventions such as face transplantation must take these into account. We encourage intraoperative evaluation of these structures as well as peri- and postoperative treatment when necessary. Due to the nature of the primary injury, functional outcomes after face

The associations of earlier trauma exposures and history of mental disorders with PTSD after subsequent traumas

PubMed Central

Kessler, Ronald C.; Aguilar-Gaxiola, Sergio; Alonso, Jordi; Bromet, Evelyn J.; Gureje, Oye; Karam, Elie G.; Koenen, Karestan C.; Lee, Sing; Liu, Howard; Pennell, Beth-Ellen; Petukhova, Maria V.; Sampson, Nancy A.; Shahly, Victoria L.; Stein, Dan J.; Atwoli, Lukoye; Borges, Guilherme; Bunting, Brendan; de Girolamo, Giovanni; Gluzman, Semyon; Haro, Josep Maria; Hinkov, Hristo; Kawakami, Norito; Kovess-Masfety, Viviane; Navarro-Mateu, Fernando; Posada-Villa, Jose; Scott, Kate M.; Shalev, Arieh Y.; Have, Margreet ten; Torres, Yolanda; Viana, Maria Carmen; Zaslavsky, Alan M.

2017-01-01

Although earlier trauma exposure is known to predict post-traumatic stress disorder (PTSD) after subsequent traumas, it is unclear if this association is limited to cases where the earlier trauma led to PTSD. Resolution of this uncertainty has important implications for research on pre-trauma vulnerability to PTSD. We examined this issue in the WHO World Mental Health (WMH) Surveys with 34,676 respondents who reported lifetime trauma exposure. One lifetime trauma was selected randomly for each respondent. DSM-IV PTSD due to that trauma was assessed. We reported in a previous paper that four earlier traumas involving interpersonal violence significantly predicted PTSD after subsequent random traumas (OR=1.3–2.5). We also assessed 14 lifetime DSM-IV mood, anxiety, disruptive behavior, and substance disorders prior to random traumas. We show in the current report that only prior anxiety disorders significantly predicted PTSD in a multivariate model (OR=1.5–4.3) and that these disorders interacted significantly with three of the earlier traumas (witnessing atrocities, physical violence victimization, rape). History of witnessing atrocities significantly predicted PTSD after subsequent random traumas only among respondents with prior PTSD (OR=5.6). Histories of physical violence victimization (OR=1.5) and rape after age 17 (OR=17.6) significantly predicted only among respondents with no history of prior anxiety disorders. Although only preliminary due to reliance on retrospective reports, these results suggest that history of anxiety disorders and history of a limited number of earlier traumas might usefully be targeted in future prospective studies as distinct foci of research on individual differences in vulnerability to PTSD after subsequent traumas. PMID:28924183

The relationship of trauma severity and mortality with cardiac enzymes and cytokines at multiple trauma patients.

PubMed

Karakuş, Ali; Kekeç, Zeynep; Akçan, Ramazan; Seydaoğlu, Gülşah

2012-07-01

In this study, we aimed to determine the effects of trauma severity on cardiac involvement through evaluating the trauma severity score together with diagnostic tests in multiple trauma patients. A trauma score was determined using various trauma severity scales. After obtaining the approval of the ethics committee of the faculty, this prospective study was performed through evaluating 100 multiple trauma patients, aged over 15 years, who applied to our Emergency Department (ED). After determining the trauma severity score using instruments such as the Injury Severity Score (ISS), Glasgow Coma Scale (GCS), and Revised Trauma Score (RTS), the cardiac condition was evaluated using biochemical and radiological diagnostic tests. During the study period, 100 patients were evaluated (78 male, 22 female; mean age: 33.2±15.4; range 15 to 70 years). It was determined that 92 (92%) were blunt trauma cases, and 77 (77%) of them were due to traffic accidents. The majority of cases showed electrocardiogram (ECG) abnormalities (63%) and sinus tachycardia (36%). Abnormal echocardiogram (ECHO) findings, mostly accompanied by ventricular defects (n=24), were determined in 31 of the cases. Nineteen cases with high trauma severity score resulted in death, and 14 of all deaths were secondary to traffic accidents. Trauma scores were found to show a significant difference between the two groups. The ISS trauma scale was determined to be the most effective in terms of indicating heart involvement in patients with multiple traumas. Close follow-up and cardiac monitoring should be applied to patients with high trauma severity scores considering possible cardiac rhythm changes and hemodynamic disturbances due to cardiac involvement.

Trauma Type and Posttraumatic Stress Disorder as Predictors of Parenting Stress in Trauma-Exposed Mothers.

PubMed

Wilson, Christina K; Padrón, Elena; Samuelson, Kristin W

2017-02-01

Trauma exposure is associated with various parenting difficulties, but few studies have examined relationships between trauma, posttraumatic stress disorder (PTSD), and parenting stress. Parenting stress is an important facet of parenting and mediates the relationship between parental trauma exposure and negative child outcomes (Owen, Thompson, & Kaslow, 2006). We examined trauma type (child maltreatment, intimate partner violence, community violence, and non-interpersonal traumas) and PTSD symptoms as predictors of parenting stress in a sample of 52 trauma-exposed mothers. Community violence exposure and PTSD symptom severity accounted for significant variance in parenting stress. Further analyses revealed that emotional numbing was the only PTSD symptom cluster accounting for variance in parenting stress scores. Results highlight the importance of addressing community violence exposure and emotion regulation difficulties with trauma-exposed mothers.

Is it Trauma- or Fantasy-based? Comparing dissociative identity disorder, post-traumatic stress disorder, simulators, and controls.

PubMed

Vissia, E M; Giesen, M E; Chalavi, S; Nijenhuis, E R S; Draijer, N; Brand, B L; Reinders, A A T S

2016-08-01

The Trauma Model of dissociative identity disorder (DID) posits that DID is etiologically related to chronic neglect and physical and/or sexual abuse in childhood. In contrast, the Fantasy Model posits that DID can be simulated and is mediated by high suggestibility, fantasy proneness, and sociocultural influences. To date, these two models have not been jointly tested in individuals with DID in an empirical manner. This study included matched groups [patients (n = 33) and controls (n = 32)] that were compared on psychological Trauma and Fantasy measures: diagnosed genuine DID (DID-G, n = 17), DID-simulating healthy controls (DID-S, n = 16), individuals with post-traumatic stress disorder (PTSD, n = 16), and healthy controls (HC, n = 16). Additionally, personality-state-dependent measures were obtained for DID-G and DID-S; both neutral personality states (NPS) and trauma-related personality states (TPS) were tested. For Trauma measures, the DID-G group had the highest scores, with TPS higher than NPS, followed by the PTSD, DID-S, and HC groups. The DID-G group was not more fantasy-prone or suggestible and did not generate more false memories. Malingering measures were inconclusive. Evidence consistently supported the Trauma Model of DID and challenges the core hypothesis of the Fantasy Model. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Benchmarking of trauma care worldwide: the potential value of an International Trauma Data Bank (ITDB).

PubMed

Haider, Adil H; Hashmi, Zain G; Gupta, Sonia; Zafar, Syed Nabeel; David, Jean-Stephane; Efron, David T; Stevens, Kent A; Zafar, Hasnain; Schneider, Eric B; Voiglio, Eric; Coimbra, Raul; Haut, Elliott R

2014-08-01

National trauma registries have helped improve patient outcomes across the world. Recently, the idea of an International Trauma Data Bank (ITDB) has been suggested to establish global comparative assessments of trauma outcomes. The objective of this study was to determine whether global trauma data could be combined to perform international outcomes benchmarking. We used observed/expected (O/E) mortality ratios to compare two trauma centers [European high-income country (HIC) and Asian lower-middle income country (LMIC)] with centers in the North American National Trauma Data Bank (NTDB). Patients (≥16 years) with blunt/penetrating injuries were included. Multivariable logistic regression, adjusting for known predictors of trauma mortality, was performed. Estimates were used to predict the expected deaths at each center and to calculate O/E mortality ratios for benchmarking. A total of 375,433 patients from 301 centers were included from the NTDB (2002-2010). The LMIC trauma center had 806 patients (2002-2010), whereas the HIC reported 1,003 patients (2002-2004). The most important known predictors of trauma mortality were adequately recorded in all datasets. Mortality benchmarking revealed that the HIC center performed similarly to the NTDB centers [O/E = 1.11 (95% confidence interval (CI) 0.92-1.35)], whereas the LMIC center showed significantly worse survival [O/E = 1.52 (1.23-1.88)]. Subset analyses of patients with blunt or penetrating injury showed similar results. Using only a few key covariates, aggregated global trauma data can be used to adequately perform international trauma center benchmarking. The creation of the ITDB is feasible and recommended as it may be a pivotal step towards improving global trauma outcomes.

The Canadian Forces trauma care system

PubMed Central

Tien, Homer

2011-01-01

According to the Trauma Association of Canada, a trauma system is a preplanned, organized and coordinated injury-control effort in a defined geographic area. An effective trauma system engages in comprehensive injury surveillance and prevention programs; delivers trauma care from the time of injury to recovery; engages in research, training and performance improvement; and establishes linkages with an all-hazards emergency preparedness program. To support Canada’s combat mission in Afghanistan, the Canadian Forces (CF) developed a comprehensive trauma system based around its trauma hospital — the Role 3 Multinational Medical Unit (R3MMU) at Kandahar Airfield. This article reviews the essential components of a modern trauma system, outlines the evidence that trauma systems improve care to injury victims and describes how the current CF trauma system was developed. PMID:22099323

Posttraumatic Stress Among Syrian Refugees: Trauma Exposure Characteristics, Trauma Centrality, and Emotional Suppression.

PubMed

Chung, Man Cheung; Shakra, Mudar; AlQarni, Nowf; AlMazrouei, Mariam; Al Mazrouei, Sara; Al Hashimi, Shurooq

2018-01-01

This study revisited the prevalence of posttraumatic stress disorder (PTSD) and examined a hypothesized model describing the interrelationship between trauma exposure characteristics, trauma centrality, emotional suppression, PTSD, and psychiatric comorbidity among Syrian refugees. A total of 564 Syrian refugees participated in the study and completed the Harvard Trauma Questionnaire, General Health Questionnaire (GHQ-28), Centrality of Event Scale, and Courtauld Emotional Control Scale. Of the participants, 30% met the cutoff for PTSD. Trauma exposure characteristics (experiencing or witnessing horror and murder, kidnapping or disappearance of family members or friends) were associated with trauma centrality, which was associated with emotional suppression. Emotional suppression was associated with PTSD and psychiatric comorbid symptom severities. Suppression mediated the path between trauma centrality and distress outcomes. Almost one-third of refugees can develop PTSD and other psychiatric problems following exposure to traumatic events during war. A traumatized identity can develop, of which life-threatening experiences is a dominant feature, leading to suppression of depression with associated psychological distress.

Comparison of outcome between low and high thoracic trauma severity score in blunt trauma chest patients.

PubMed

Subhani, Shahzadi Samar; Muzaffar, Mohammad Sultan; Khan, Muhammad Imtiaz

2014-01-01

Blunt chest trauma is second leading cause of death among trauma patients. Early identification and aggressive management of blunt thoracic trauma is essential to reduce the significant rates of morbidity and mortality. Thoracic trauma severity score (TTS) is a better predictor of chest trauma related complications. The objective of the study was to compare outcomes between low-and high thoracic trauma severity score in blunt trauma chest patients. A cross sectional descriptive study was carried out in public and private sector hospitals of Rawalpindi, Pakistan from 2008 to 2012 and 264 patients with blunt trauma chest who reported to emergency department of the hospitals, within 48 hrs of trauma were recruited. All patients were subjected to detailed history and respiratory system examination to ascertain fracture ribs, flail segment and hemopneumothorax. Written and informed consent was taken from each patient. Permission was taken from ethical committee of the hospital. The patients with blunt chest trauma had an array of associated injuries; however there were 70.8% of patients in low TTS group and 29.2% in high TTS group. Outcome was assessed as post trauma course of the patient. Outcome in low and high TTS group was compared using Chi square test which shows a significant relationship (p=0.000) between outcome and TTS, i.e., outcome worsened with increase in TTS. It is concluded that there is a significant relationship between outcome and thoracic trauma severity. Outcome of the patient worsened with increase in thoracic trauma severity score.

Analysis of the Revised Trauma Score (RTS) in 200 victims of different trauma mechanisms.

PubMed

Alvarez, Bruno Durante; Razente, Danilo Mardegam; Lacerda, Daniel Augusto Mauad; Lother, Nicole Silveira; VON-Bahten, Luiz Carlos; Stahlschmidt, Carla Martinez Menini

2016-01-01

to analyze the epidemiological profile and mortality associated with the Revised Trauma Score (RTS) in trauma victims treated at a university hospital. we conducted a descriptive, cross-sectional study of trauma protocols (prospectively collected) from December 2013 to February 2014, including trauma victims admitted in the emergency room of the Cajuru University Hospital. We set up three groups: (G1) penetrating trauma to the abdomen and chest, (G2) blunt trauma to the abdomen and chest, and (G3) traumatic brain injury. The variables we analyzed were: gender, age, day of week, mechanism of injury, type of transportation, RTS, hospitalization time and mortality. we analyzed 200 patients, with a mean age of 36.42 ± 17.63 years, and 73.5% were male. The mean age was significantly lower in G1 than in the other groups (p <0.001). Most (40%) of the visits occurred on weekends and the most common pre-hospital transport service (58%) was the SIATE (Emergency Trauma Care Integrated Service). The hospital stay was significantly higher in G1 compared with the other groups (p <0.01). Regarding mortality, there were 12%, 1.35% and 3.95% of deaths in G1, G2 and G3, respectively. The median RTS among the deaths was 5.49, 7.84 and 1.16, respectively, for the three groups. the majority of patients were young men. RTS was effective in predicting mortality in traumatic brain injury, however failing to predict it in patients suffering from blunt and penetrating trauma. analisar o perfil epidemiológico e a mortalidade associada ao escore de trauma revisado (RTS) em vítimas de trauma atendidas em um hospital universitário. estudo transversal descritivo de protocolos de trauma (coletados prospectivamente) de dezembro de 2013 a fevereiro de 2014, incluindo vítimas de trauma admitidas na sala de emergência do Hospital Universitário Cajuru. Três grupos foram criados: (G1) trauma penetrante em abdome e tórax, (G2) trauma contuso em abdome e tórax, e (G3) trauma cranioencef

Epidemiological patterns of ocular trauma.

PubMed

Thylefors, B

1992-05-01

Ocular trauma is the cause of blindness in approximately half a million people worldwide, and many more have suffered partial loss of sight. Trauma is often the most important cause of unilateral loss of vision, particularly in developing countries. There is a cumulative risk of ocular trauma and visual loss during life, but the true incidence of accidents involving the eyes is not known. Males tend to have more eye trauma than females, and this is already apparent from childhood; lower socioeconomic classes are also more associated with ocular trauma. The setting for the occurrence of trauma is most commonly the workplace and, increasingly, road accidents. On the other hand, domestic accidents are probably under-reported. Of particular importance in some developing countries is the occurrence of superficial corneal trauma in agricultural work, often leading to rapidly progressing corneal ulceration and visual loss. The impact of ocular trauma, in terms of need for medical care, loss of income and cost of rehabilitation services when indicated, clearly makes the strengthening of preventive measures very worthwhile.

Characterization of blunt chest trauma in a long-term porcine model of severe multiple trauma

PubMed Central

Horst, K.; Simon, T. P.; Pfeifer, R.; Teuben, M.; Almahmoud, K.; Zhi, Q.; Santos, S. Aguiar; Wembers, C. Castelar; Leonhardt, S.; Heussen, N.; Störmann, P.; Auner, B.; Relja, B.; Marzi, I.; Haug, A. T.; van Griensven, M.; Kalbitz, M.; Huber-Lang, M.; Tolba, R.; Reiss, L. K.; Uhlig, S.; Marx, G.; Pape, H. C.; Hildebrand, F.

2016-01-01

Chest trauma has a significant relevance on outcome after severe trauma. Clinically, impaired lung function typically occurs within 72 hours after trauma. However, the underlying pathophysiological mechanisms are still not fully elucidated. Therefore, we aimed to establish an experimental long-term model to investigate physiological, morphologic and inflammatory changes, after severe trauma. Male pigs (sus scrofa) sustained severe trauma (including unilateral chest trauma, femur fracture, liver laceration and hemorrhagic shock). Additionally, non-injured animals served as sham controls. Chest trauma resulted in severe lung damage on both CT and histological analyses. Furthermore, severe inflammation with a systemic increase of IL-6 (p = 0.0305) and a local increase of IL-8 in BAL (p = 0.0009) was observed. The pO2/FiO2 ratio in trauma animals decreased over the observation period (p < 0.0001) but not in the sham group (p = 0.2967). Electrical Impedance Tomography (EIT) revealed differences between the traumatized and healthy lung (p < 0.0001). In conclusion, a clinically relevant, long-term model of blunt chest trauma with concomitant injuries has been developed. This reproducible model allows to examine local and systemic consequences of trauma and is valid for investigation of potential diagnostic or therapeutic options. In this context, EIT might represent a radiation-free method for bedside diagnostics. PMID:28000769

Acting Out: Enabling Meaningful Participation Among People With Long-Term Mental Health Problems in a Music and Theater Workshop.

PubMed

Ørjasæter, Kristin Berre; Ness, Ottar

2017-09-01

In this article, we explore what enables meaningful participation in a music and theater workshop from a first person's perspective of people with mental health problems. The study uses a hermeneutical-phenomenological approach. Data were collected from qualitative in-depth interviews with 12 participants in a music and theater workshop located in a Norwegian mental health hospital. Data were analyzed through thematic analysis. Two overarching themes were identified: (a) room for dignity and (b) a creative arena. This study indicates that to enable participation for people with long-term mental health problems, it is important to facilitate activities that are flexible, person centered, and resource oriented, in which participants have the possibility to participate regardless of symptoms, functional ability, or whether they are hospitalized. In addition, having professionals who believe in creative growth and offer an illness-free zone that belongs to the participants in a hospital setting is of great importance.

Influence of socioeconomic status on trauma center performance evaluations in a Canadian trauma system.

PubMed

Moore, Lynne; Turgeon, Alexis F; Sirois, Marie-Josée; Murat, Valérie; Lavoie, André

2011-09-01

Trauma center performance evaluations generally include adjustment for injury severity, age, and comorbidity. However, disparities across trauma centers may be due to other differences in source populations that are not accounted for, such as socioeconomic status (SES). We aimed to evaluate whether SES influences trauma center performance evaluations in an inclusive trauma system with universal access to health care. The study was based on data collected between 1999 and 2006 in a Canadian trauma system. Patient SES was quantified using an ecologic index of social and material deprivation. Performance evaluations were based on mortality adjusted using the Trauma Risk Adjustment Model. Agreement between performance results with and without additional adjustment for SES was evaluated with correlation coefficients. The study sample comprised a total of 71,784 patients from 48 trauma centers, including 3,828 deaths within 30 days (4.5%) and 5,549 deaths within 6 months (7.7%). The proportion of patients in the highest quintile of social and material deprivation varied from 3% to 43% and from 11% to 90% across hospitals, respectively. The correlation between performance results with or without adjustment for SES was almost perfect (r = 0.997; 95% CI 0.995-0.998) and the same hospital outliers were identified. We observed an important variation in SES across trauma centers but no change in risk-adjusted mortality estimates when SES was added to adjustment models. Results suggest that after adjustment for injury severity, age, comorbidity, and transfer status, disparities in SES across trauma center source populations do not influence trauma center performance evaluations in a system offering universal health coverage. Copyright © 2011 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

Classifying and Standardizing Panfacial Trauma With a New Bony Facial Trauma Score.

PubMed

Casale, Garrett G A; Fishero, Brian A; Park, Stephen S; Sochor, Mark; Heltzel, Sara B; Christophel, J Jared

2017-01-01

The practice of facial trauma surgery would benefit from a useful quantitative scale that measures the extent of injury. To develop a facial trauma scale that incorporates only reducible fractures and is able to be reliably communicated to health care professionals. A cadaveric tissue study was conducted from October 1 to 3, 2014. Ten cadaveric heads were subjected to various degrees of facial trauma by dropping a fixed mass onto each head. The heads were then imaged with fine-cut computed tomography. A Bony Facial Trauma Scale (BFTS) for grading facial trauma was developed based only on clinically relevant (reducible) fractures. The traumatized cadaveric heads were then scored using this scale as well as 3 existing scoring systems. Regression analysis was used to determine correlation between degree of incursion of the fixed mass on the cadaveric heads and trauma severity as rated by the scoring systems. Statistical analysis was performed to determine correlation of the scores obtained using the BFTS with those of the 3 existing scoring systems. Scores obtained using the BFTS were not correlated with dentition (95% CI, -0.087 to 1.053; P = .08; measured as absolute number of teeth) or age of the cadaveric donor (95% CI, -0.068 to 0.944; P = .08). Facial trauma scores. Among all 10 cadaveric specimens (9 male donors and 1 female donor; age range, 41-87 years; mean age, 57.2 years), the facial trauma scores obtained using the BFTS correlated with depth of penetration of the mass into the face (odds ratio, 4.071; 95% CI, 1.676-6.448) P = .007) when controlling for presence of dentition and age. The BFTS scores also correlated with scores obtained using 3 existing facial trauma models (Facial Fracture Severity Scale, rs = 0.920; Craniofacial Disruption Score, rs = 0.945; and ZS Score, rs = 0.902; P < .001 for all 3 models). In addition, the BFTS was found to have excellent interrater reliability (0.908; P = .001), which was similar to

Undergraduate Biology Students' Attitudes towards the Use of Curriculum-Based Reader's Theater in a Laboratory Setting

ERIC Educational Resources Information Center

Cross, Chrissy J.

2017-01-01

In the undergraduate biology laboratory, many freshmen are apathetic towards the content of the course. Curriculum based reader's theater (CRBT) is an instructional method that can increase interest the students in the content of the course while improving student communication, collaboration and understanding. This research is an examination of…

Trauma teams and time to early management during in situ trauma team training.

PubMed

Härgestam, Maria; Lindkvist, Marie; Jacobsson, Maritha; Brulin, Christine; Hultin, Magnus

2016-01-29

To investigate the association between the time taken to make a decision to go to surgery and gender, ethnicity, years in profession, experience of trauma team training, experience of structured trauma courses and trauma in the trauma team, as well as use of closed-loop communication and leadership styles during trauma team training. In situ trauma team training. The patient simulator was preprogrammed to represent a severely injured patient (injury severity score: 25) suffering from hypovolemia due to external trauma. An emergency room in an urban Scandinavian level one trauma centre. A total of 96 participants were divided into 16 trauma teams. Each team consisted of six team members: one surgeon/emergency physician (designated team leader), one anaesthesiologist, one registered nurse anaesthetist, one registered nurse from the emergency department, one enrolled nurse from the emergency department and one enrolled nurse from the operating theatre. HRs with CIs (95% CI) for the time taken to make a decision to go to surgery was computed from a Cox proportional hazards model. Three variables remained significant in the final model. Closed-loop communication initiated by the team leader increased the chance of a decision to go to surgery (HR: 3.88; CI 1.02 to 14.69). Only 8 of the 16 teams made the decision to go to surgery within the timeframe of the trauma team training. Conversely, call-outs and closed-loop communication initiated by the team members significantly decreased the chance of a decision to go to surgery, (HR: 0.82; CI 0.71 to 0.96, and HR: 0.23; CI 0.08 to 0.71, respectively). Closed-loop communication initiated by the leader appears to be beneficial for teamwork. In contrast, a high number of call-outs and closed-loop communication initiated by team members might lead to a communication overload. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Trauma teams and time to early management during in situ trauma team training

PubMed Central

Härgestam, Maria; Lindkvist, Marie; Jacobsson, Maritha; Brulin, Christine

2016-01-01

Objectives To investigate the association between the time taken to make a decision to go to surgery and gender, ethnicity, years in profession, experience of trauma team training, experience of structured trauma courses and trauma in the trauma team, as well as use of closed-loop communication and leadership styles during trauma team training. Design In situ trauma team training. The patient simulator was preprogrammed to represent a severely injured patient (injury severity score: 25) suffering from hypovolemia due to external trauma. Setting An emergency room in an urban Scandinavian level one trauma centre. Participants A total of 96 participants were divided into 16 trauma teams. Each team consisted of six team members: one surgeon/emergency physician (designated team leader), one anaesthesiologist, one registered nurse anaesthetist, one registered nurse from the emergency department, one enrolled nurse from the emergency department and one enrolled nurse from the operating theatre. Primary outcome HRs with CIs (95% CI) for the time taken to make a decision to go to surgery was computed from a Cox proportional hazards model. Results Three variables remained significant in the final model. Closed-loop communication initiated by the team leader increased the chance of a decision to go to surgery (HR: 3.88; CI 1.02 to 14.69). Only 8 of the 16 teams made the decision to go to surgery within the timeframe of the trauma team training. Conversely, call-outs and closed-loop communication initiated by the team members significantly decreased the chance of a decision to go to surgery, (HR: 0.82; CI 0.71 to 0.96, and HR: 0.23; CI 0.08 to 0.71, respectively). Conclusions Closed-loop communication initiated by the leader appears to be beneficial for teamwork. In contrast, a high number of call-outs and closed-loop communication initiated by team members might lead to a communication overload. PMID:26826152

Is trauma in Switzerland any different? epidemiology and patterns of injury in major trauma - a 5-year review from a Swiss trauma centre.

PubMed

Heim, C; Bosisio, F; Roth, A; Bloch, J; Borens, O; Daniel, R T; Denys, A; Oddo, M; Pasquier, M; Schmidt, S; Schoettker, P; Zingg, T; Wasserfallen, J B

2014-01-01

Switzerland, the country with the highest health expenditure per capita, is lacking data on trauma care and system planning. Recently, 12 trauma centres were designated to be reassessed through a future national trauma registry by 2015. Lausanne University Hospital launched the first Swiss trauma registry in 2008, which contains the largest database on trauma activity nationwide. Prospective analysis of data from consecutively admitted shock room patients from 1 January 2008 to 31 December 2012. Shock room admission is based on physiology and mechanism of injury, assessed by prehospital physicians. Management follows a surgeon-led multidisciplinary approach. Injuries are coded by Association for the Advancement of Automotive Medicine (AAAM) certified coders. Over the 5 years, 1,599 trauma patients were admitted, predominantly males with a median age of 41.4 years and median injury severity score (ISS) of 13. Rate of ISS >15 was 42%. Principal mechanisms of injury were road traffic (40.4%) and falls (34.4%), with 91.5% blunt trauma. Principal patterns were brain (64.4%), chest (59.8%) and extremity/pelvic girdle (52.9%) injuries. Severe (abbreviated injury scale [AIS] score ≥ 3) orthopaedic injuries, defined as extremity and spine injuries together, accounted for 67.1%. Overall, 29.1% underwent immediate intervention, mainly by orthopaedics (27.3%), neurosurgeons (26.3 %) and visceral surgeons (13.9%); 43.8% underwent a surgical intervention within the first 24 hours and 59.1% during their hospitalisation. In-hospital mortality for patients with ISS >15 was 26.2%. This is the first 5-year report on trauma in Switzerland. Trauma workload was similar to other European countries. Despite high levels of healthcare, mortality exceeds published rates by >50%. Regardless of the importance of a multidisciplinary approach, trauma remains a surgical disease and needs dedicated surgical resources.

A Study of the Effects of Readers' Theater on Second and Third Grade Special Education Students' Fluency Growth

ERIC Educational Resources Information Center

Corcoran, Carol A.; Davis, A. Dia

2005-01-01

The purpose of this study was to assess the effectiveness of a readers' theater fluency program. The participants were 12 students with learning disabilities in a combined second/third grade exceptional education classroom. Through the use of pre and post reading attitude surveys, field notes recorded by the observer, and pre and post oral fluency…

Male genital trauma

DOE Office of Scientific and Technical Information (OSTI.GOV)

Jordan, G.H.; Gilbert, D.A.

1988-07-01

We have attempted to discuss genital trauma in relatively broad terms. In most cases, patients present with relatively minimal trauma. However, because of the complexity of the structures involved, minimal trauma can lead to significant disability later on. The process of erection requires correct functioning of the arterial, neurologic, and venous systems coupled with intact erectile bodies. The penis is composed of structures that are compliant and distensible to the limits of their compliance. These structures therefore tumesce in equal proportion to each other, allowing for straight erection. Relatively minimal trauma can upset this balance of elasticity, leading to disablingmore » chordee. Likewise, relatively minimal injuries to the vascular erectile structures can lead to significantly disabling spongiofibrosis. The urethra is a conduit of paramount importance. Whereas the development of stricture is generally related to the nature of the trauma, the extent of stricture and of attendant complications is clearly a function of the immediate management. Overzealous debridement can greatly complicate subsequent reconstruction. A delicate balance between aggressive initial management and maximal preservation of viable structures must be achieved. 38 references.« less

The Land Component Role in Maritime Security

DTIC Science & Technology

2016-12-31

U.S. Army Pacific (USARPAC) is designated as the Theater Joint Force Land Component Command (TJFLCC) and endeavors to support the PACOM Theater ...security. 1 Mike Wall , “What 11 Billion People Mean for Space Travel,” November 27, 2013...human outcomes that are a prerequisite for achieving national objectives”18. These are land-based operations designed to create stability in human

Safety in the operating room during orthopedic trauma surgery-incidence of adverse events related to technical equipment and logistics.

PubMed

van Delft, E A K; Schepers, T; Bonjer, H J; Kerkhoffs, G M M J; Goslings, J C; Schep, N W L

2018-04-01

Safety in the operating room is widely debated. Adverse events during surgery are potentially dangerous for the patient and staff. The incidence of adverse events during orthopedic trauma surgery is unknown. Therefore, we performed a study to quantify the incidence of these adverse events. Primary objective was to determine the incidence of adverse events related to technical equipment and logistics. The secondary objective was to evaluate the consequences of these adverse events. We completed a cross-sectional observational study to assess the incidence, consequences and preventability of adverse events related to technical equipment and logistics during orthopedic trauma surgery. During a 10 week period, all orthopedic trauma operations were evaluated by an observer. Six types of procedures were differentiated: osteosynthesis; arthroscopy; removal of hardware; joint replacement; bone grafting and other. Adverse events were divided in six categories: staff dependent factors; patient dependent factors; anaesthesia; imaging equipment; operation room equipment and instruments and implants. Adverse events were defined as any factor affecting the surgical procedure in a negative way. Hundred-fifty operative procedures were included. In 54% of the procedures, at least one adverse event occurred. In total, 147 adverse events occurred, with a range of 1-5 per procedure. Most adverse events occurred during joint replacement procedures. Thirty-seven percent of the incidents concerned defect, incorrect connected or absent instruments. In 36% of the procedures adverse events resulted in a prolonged operation time with a median prolongation of 10.0 min. In more than half of orthopedic trauma surgical procedures adverse events related to technical equipment and logistics occurred, most of them could easily be prevented. These adverse events could endanger the safety of the patient and staff and should therefore be reduced. 4.

The associations of earlier trauma exposures and history of mental disorders with PTSD after subsequent traumas.

PubMed

Kessler, R C; Aguilar-Gaxiola, S; Alonso, J; Bromet, E J; Gureje, O; Karam, E G; Koenen, K C; Lee, S; Liu, H; Pennell, B-E; Petukhova, M V; Sampson, N A; Shahly, V; Stein, D J; Atwoli, L; Borges, G; Bunting, B; de Girolamo, G; Gluzman, S F; Haro, J M; Hinkov, H; Kawakami, N; Kovess-Masfety, V; Navarro-Mateu, F; Posada-Villa, J; Scott, K M; Shalev, A Y; Ten Have, M; Torres, Y; Viana, M C; Zaslavsky, A M

2017-09-19

Although earlier trauma exposure is known to predict posttraumatic stress disorder (PTSD) after subsequent traumas, it is unclear whether this association is limited to cases where the earlier trauma led to PTSD. Resolution of this uncertainty has important implications for research on pretrauma vulnerability to PTSD. We examined this issue in the World Health Organization (WHO) World Mental Health (WMH) Surveys with 34 676 respondents who reported lifetime trauma exposure. One lifetime trauma was selected randomly for each respondent. DSM-IV (Diagnostic and Statistical Manual of Mental Disorders, 4th Edition) PTSD due to that trauma was assessed. We reported in a previous paper that four earlier traumas involving interpersonal violence significantly predicted PTSD after subsequent random traumas (odds ratio (OR)=1.3-2.5). We also assessed 14 lifetime DSM-IV mood, anxiety, disruptive behavior and substance disorders before random traumas. We show in the current report that only prior anxiety disorders significantly predicted PTSD in a multivariate model (OR=1.5-4.3) and that these disorders interacted significantly with three of the earlier traumas (witnessing atrocities, physical violence victimization and rape). History of witnessing atrocities significantly predicted PTSD after subsequent random traumas only among respondents with prior PTSD (OR=5.6). Histories of physical violence victimization (OR=1.5) and rape after age 17 years (OR=17.6) significantly predicted only among respondents with no history of prior anxiety disorders. Although only preliminary due to reliance on retrospective reports, these results suggest that history of anxiety disorders and history of a limited number of earlier traumas might usefully be targeted in future prospective studies as distinct foci of research on individual differences in vulnerability to PTSD after subsequent traumas.Molecular Psychiatry advance online publication, 19 September 2017; doi:10.1038/mp.2017.194.

Multiple trauma in children: critical care overview.

PubMed

Wetzel, Randall C; Burns, R Cartland

2002-11-01

Multiple trauma is more than the sum of the injuries. Management not only of the physiologic injury but also of the pathophysiologic responses, along with integration of the child's emotional and developmental needs and the child's family, forms the basis of trauma care. Multiple trauma in children also elicits profound psychological responses from the healthcare providers involved with these children. This overview will address the pathophysiology of multiple trauma in children and the general principles of trauma management by an integrated trauma team. Trauma is a systemic disease. Multiple trauma stimulates the release of multiple inflammatory mediators. A lethal triad of hypothermia, acidosis, and coagulopathy is the direct result of trauma and secondary injury from the systemic response to trauma. Controlling and responding to the secondary pathophysiologic sequelae of trauma is the cornerstone of trauma management in the multiply injured, critically ill child. Damage control surgery is a new, rational approach to the child with multiple trauma. The selection of children for damage control surgery depends on the severity of injury. Major abdominal vascular injuries and multiple visceral injuries are best considered for this approach. The effective management of childhood multiple trauma requires a combined team approach, consideration of the child and family, an organized trauma system, and an effective quality assurance and improvement mechanism.

Implementing Major Trauma Audit in Ireland.

PubMed

Deasy, Conor; Cronin, Marina; Cahill, Fiona; Geary, Una; Houlihan, Patricia; Woodford, Maralyn; Lecky, Fiona; Mealy, Ken; Crowley, Philip

2016-01-01

There are 27 receiving trauma hospitals in the Republic of Ireland. There has not been an audit system in place to monitor and measure processes and outcomes of care. The National Office of Clinical Audit (NOCA) is now working to implement Major Trauma Audit (MTA) in Ireland using the well-established National Health Service (NHS) UK Trauma Audit and Research Network (TARN). The aim of this report is to highlight the implementation process of MTA in Ireland to raise awareness of MTA nationally and share lessons that may be of value to other health systems undertaking the development of MTA. The National Trauma Audit Committee of the Royal College of Surgeons in Ireland, consisting of champions and stakeholders in trauma care, in 2010 advised on the adaptation of TARN for Ireland. In 2012, the Emergency Medicine Program endorsed TARN and in setting up the National Emergency Medicine Audit chose MTA as the first audit project. A major trauma governance group was established representing stakeholders in trauma care, a national project co-ordinator was recruited and a clinical lead nominated. Using Survey Monkey, the chief executives of all trauma receiving hospitals were asked to identify their hospital's trauma governance committee, trauma clinical lead and their local trauma data co-ordinator. Hospital Inpatient Enquiry systems were used to identify to hospitals an estimate of their anticipated trauma audit workload. There are 25 of 27 hospitals now collecting data using the TARN trauma audit platform. These hospitals have provided MTA Clinical Leads, allocated data co-ordinators and incorporated MTA reports formally into their clinical governance, quality and safety committee meetings. There has been broad acceptance of the NOCA escalation policy by hospitals in appreciation of the necessity for unexpected audit findings to stimulate action. Major trauma audit measures trauma patient care processes and outcomes of care to drive quality improvement at hospital and

Improving US theater nuclear doctrine. a critical analysis

DOE Office of Scientific and Technical Information (OSTI.GOV)

Sollinger, J.M.

This monograph argues that the doctrine, equipment, and training of US forces do not meet the demands of fighting a theater nuclear war. Current doctrine rests upon questionable assumptions, lacks the flexibility required to fight a tactical nuclear battle, and limits itself by concentrating on defense. Recommended improvements include increased flexibility and decentralized execution, emphasizing maneuver and dispersion. Service doctrinal writings should focus on enemy forces rather than terrain. Because the nuclear battlefield promises chaos and confusion, US forces need redundant command and control. The equipment of US forces also needs improving, The services must field equipment capable of withstandingmore » the effects of nuclear weapons. In most cases this requirement means making existing procedures work and the hardening of equipment. Some new items of equipment, such as monitoring devices, are needed. Training requires improvement at both the individual and unit levels. Individual enlisted training tends to concentrate specialized knowledge at too high a level. With substantial casualties expected in a nuclear battle, US forces cannot afford to confine specialized knowledge to a few individuals.« less

The clinical effectiveness of permissive hypotension in blunt abdominal trauma with hemorrhagic shock but without head or spine injuries or burns: a systematic review

PubMed Central

Alsawadi, Abdulrahman

2012-01-01

Background Trauma is a major cause of death and disability. The current trend in trauma management is the rapid administration of fluid as per the Advanced Trauma Life Support guidelines, although there is no evidence to support this and even some to suggest it might be harmful. Some guidelines, protocols, and recommendations have been established for the use of permissive hypotension although there is reluctance concerning its application in blunt injuries. Objectives The aim of this review is to determine whether there is evidence of the use of permissive hypotension in the management of hemorrhagic shock in blunt trauma patients. This review also aims to search for any reason for the reluctance to apply permissive hypotension in blunt injuries. Methods This systematic review has followed the steps recommended in the Cochrane Handbook for Systematic Reviews of Interventions. It is also being reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Statement and checklist. Database searches of MEDLINE, EMBASE, the Centre for Reviews and Dissemination databases and the Cochrane Library were made for eligible studies as well as journal searches. Inclusion criteria included systematic reviews that have similar primary questions to this review and randomized controlled trials where patients with blunt torso injuries and hemorrhagic shock were not excluded. Rapid or early fluid administration was compared with controlled or delayed fluid resuscitation and a significant outcome was obtained. Results No systematic reviews attempting to answer similar questions were found. Two randomized controlled trials with mixed types of injuries in the included patients found no significant difference between the groups used in each study. Data concerning the question of this review was sought after these papers were appraised. Conclusion The limited available data are not conclusive. However, the supportive theoretical concept and laboratory

A Pilot Study of Deaf Trauma Survivors’ Experiences: Early Traumas Unique to Being Deaf in a Hearing World

PubMed Central

Wolf Craig, Kelly S.; Hall, Wyatte C.; Ziedonis, Douglas M.

2016-01-01

Conducting semi-structured American Sign Language interviews with 17 Deaf trauma survivors, this pilot study explored Deaf individuals’ trauma experiences and whether these experiences generally align with trauma in the hearing population. Most commonly reported traumas were physical assault, sudden unexpected deaths, and “other” very stressful events. Although some “other” events overlap with traumas in the general population, many are unique to Deaf people (e.g., corporal punishment at oral/aural school if caught using sign language, utter lack of communication with hearing parents). These findings suggest that Deaf individuals may experience developmental traumas distinct to being raised in a hearing world. Such traumas are not captured by available trauma assessments, nor are they considered in evidence-based trauma treatments. PMID:28138351

A Pilot Study of Deaf Trauma Survivors' Experiences: Early Traumas Unique to Being Deaf in a Hearing World.

PubMed

Anderson, Melissa L; Wolf Craig, Kelly S; Hall, Wyatte C; Ziedonis, Douglas M

2016-12-01

Conducting semi-structured American Sign Language interviews with 17 Deaf trauma survivors, this pilot study explored Deaf individuals' trauma experiences and whether these experiences generally align with trauma in the hearing population. Most commonly reported traumas were physical assault, sudden unexpected deaths, and "other" very stressful events. Although some "other" events overlap with traumas in the general population, many are unique to Deaf people (e.g., corporal punishment at oral/aural school if caught using sign language, utter lack of communication with hearing parents). These findings suggest that Deaf individuals may experience developmental traumas distinct to being raised in a hearing world. Such traumas are not captured by available trauma assessments, nor are they considered in evidence-based trauma treatments.

Spectrum and outcome of pancreatic trauma.

PubMed

Kantharia, Chetan V; Prabhu, R Y; Dalvi, A N; Raut, Abhijit; Bapat, R D; Supe, Avinash N

2007-01-01

Pancreatic trauma is associated with high morbidity and mortality. Diagnosis is often difficult and surgery poses a formidable challenge. Data from 17 patients of pancreatic trauma gathered from a prospectively maintained database were analysed and the following parameters were considered: mode of injury, diagnostic modalities, associated injury, grade of pancreatic trauma and management. Pancreatic trauma was graded from I through IV, as per Modified Lucas Classification. The median age was 39 years (range 19-61). The aetiology of pancreatic trauma was blunt abdominal trauma in 14 patients and penetrating injury in 3. Associated bowel injury was present in 4 cases (3 penetrating injury and 1 blunt trauma) and 1 case had associated vascular injury. 5 patients had grade I, 3 had grade II, 7 had grade III and 2 had grade IV pancreatic trauma. Contrast enhanced computed tomography scan was used to diagnose pancreatic trauma in all patients with blunt abdominal injury. Immediate diagnosis could be reached in only 4 (28.5%) patients. 7 patients responded to conservative treatment. Of the 10 patients who underwent surgery, 6 required it for the pancreas and the duodenum. (distal pancreatectomy with splenectomy-3, pylorus preserving pancreatoduodenectomy-1, debridement with external drainage-1, associated injuries-duodenum-1). Pancreatic fistula, recurrent pancreatitis and pseudocyst formation were seen in 3 (17.05%), 2 (11.7%) and 1 (5.4%) patient respectively. Death occurred in 4 cases (23.5%), 2 each in grades III and IV pancreatic trauma. Contrast enhanced computed tomography scan is a useful modality for diagnosing, grading and following up patients with pancreatic trauma. Although a majority of cases with pancreatic trauma respond to conservative treatment, patients with penetrating trauma, and associated bowel injury and higher grade pancreatic trauma require surgical intervention and are also associated with higher morbidity and mortality.

[Trauma-Informed Peer Counselling in the Care of Refugees with Trauma-Related Disorders].

PubMed

Wöller, Wolfgang

2016-09-01

Providing adequate culture-sensitive care for a large number of refugees with trauma-related disorders constitutes a major challenge. In this context, peer support and trauma-informed peer counselling can be regarded as a valuable means to complement the psychosocial care systems. In recent years, peer support and peer education have been successfully implemented e. g. in health care education, in psychiatric care, and in the treatment of traumatized individuals. Only little research data is available for traumatized refugees. However, results are encouraging. A program is presented which integrates trauma-informed peer educators (TIP) with migration background in the care of traumatized refugees. Peers' responsibility includes emotional support and understanding the refugees' needs, sensitizing for trauma-related disorders, providing psychoeducation, and teaching trauma-specific stabilization techniques under supervision of professional psychotherapists. © Georg Thieme Verlag KG Stuttgart · New York.

Kinetic therapy in multiple trauma patients with severe blunt chest trauma: an analysis at a level-1 trauma center.

PubMed

Zeckey, C; Wendt, K; Mommsen, P; Winkelmann, M; Frömke, C; Weidemann, J; Stübig, T; Krettek, C; Hildebrand, F

2015-01-01

Chest trauma is a relevant risk factor for mortality after multiple trauma. Kinetic therapy (KT) represents a potential treatment option in order to restore pulmonary function. Decision criteria for performing kinetic therapy are not fully elucidated. The purpose of this study was to investigate the decision making process to initiate kinetic therapy in a well defined multiple trauma cohort. A retrospective analysis (2000-2009) of polytrauma patients (age > 16 years, ISS ⩾ 16) with severe chest trauma (AIS(Chest) ⩾ 3) was performed. Patients with AIS(Head) ⩾ 3 were excluded. Patients receiving either kinetic (KT+) or lung protective ventilation strategy (KT-) were compared. Chest trauma was classified according to the AIS(Chest), Pulmonary Contusion Score (PCS), Wagner Jamieson Score and Thoracic Trauma Severity Score (TTS). There were multiple outcome parameters investigated included mortality, posttraumatic complications and clinical data. A multivariate regression analysis was performed. Two hundred and eighty-three patients were included (KT+: n=160; KT-: n=123). AIS(Chest), age and gender were comparable in both groups. There were significant higher values of the ISS, PCS, Wagner Jamieson Score and TTS in group KT+. The incidence of posttraumatic complications and mortality was increased compared to group KT- (p< 0.05). Despite that, kinetic therapy failed to be an independent risk factor for mortality in multivariate logistic regression analysis. Kinetic therapy is an option in severely injured patients with severe chest trauma. Decision making is not only based on anatomical aspects such as the AIS(Chest), but on overall injury severity, pulmonary contusions and physiological deterioration. It could be assumed that the increased mortality in patients receiving KT is primarily caused by these factors and does not reflect an independent adverse effect of KT. Furthermore, KT was not shown to be an independent risk factor for mortality.

Evaluating trauma team performance in a Level I trauma center: Validation of the trauma team communication assessment (TTCA-24).

PubMed

DeMoor, Stephanie; Abdel-Rehim, Shady; Olmsted, Richard; Myers, John G; Parker-Raley, Jessica

2017-07-01

Nontechnical skills (NTS), such as team communication, are well-recognized determinants of trauma team performance and good patient care. Measuring these competencies during trauma resuscitations is essential, yet few valid and reliable tools are available. We aimed to demonstrate that the Trauma Team Communication Assessment (TTCA-24) is a valid and reliable instrument that measures communication effectiveness during activations. Two tools with adequate psychometric strength (Trauma Nontechnical Skills Scale [T-NOTECHS], Team Emergency Assessment Measure [TEAM]) were identified during a systematic review of medical literature and compared with TTCA-24. Three coders used each tool to evaluate 35 stable and 35 unstable patient activations (defined according to Advanced Trauma Life Support criteria). Interrater reliability was calculated between coders using the intraclass correlation coefficient. Spearman rank correlation coefficient was used to establish concurrent validity between TTCA-24 and the other two validated tools. Coders achieved an intraclass correlation coefficient of 0.87 for stable patient activations and 0.78 for unstable activations scoring excellent on the interrater agreement guidelines. The median score for each assessment showed good team communication for all 70 videos (TEAM, 39.8 of 54; T-NOTECHS, 17.4 of 25; and TTCA-24, 87.4 of 96). A significant correlation between TTTC-24 and T-NOTECHS was revealed (p = 0.029), but no significant correlation between TTCA-24 and TEAM (p = 0.77). Team communication was rated slightly better across all assessments for stable versus unstable patient activations, but not statistically significant. TTCA-24 correlated with T-NOTECHS, an instrument measuring nontechnical skills for trauma teams, but not TEAM, a tool that assesses communication in generic emergency settings. TTCA-24 is a reliable and valid assessment that can be a useful adjunct when evaluating interpersonal and team communication during trauma

Characteristics of ACS-verified Level I and Level II trauma centers: A study linking trauma center verification review data and the National Trauma Data Bank of the American College of Surgeons Committee on Trauma.

PubMed

Shafi, Shahid; Barnes, Sunni; Ahn, Chul; Hemilla, Mark R; Cryer, H Gill; Nathens, Avery; Neal, Melanie; Fildes, John

2016-10-01

The Trauma Quality Improvement Project of the American College of Surgeons (ACS) has demonstrated variations in trauma center outcomes despite similar verification status. The purpose of this study was to identify structural characteristics of trauma centers that affect patient outcomes. Trauma registry data on 361,187 patients treated at 222 ACS-verified Level I and Level II trauma centers were obtained from the National Trauma Data Bank of ACS. These data were used to estimate each center's observed-to-expected (O-E) mortality ratio with 95% confidence intervals using multivariate logistic regression analysis. De-identified data on structural characteristics of these trauma centers were obtained from the ACS Verification Review Committee. Centers in the lowest quartile of mortality based on O-E ratio (n = 56) were compared to the rest (n = 166) using Classification and Regression Tree (CART) analysis to identify institutional characteristics independently associated with high-performing centers. Of the 72 structural characteristics explored, only 3 were independently associated with high-performing centers: annual patient visits to the emergency department of fewer than 61,000; proportion of patients on Medicare greater than 20%; and continuing medical education for emergency department physician liaison to the trauma program ranging from 55 and 113 hours annually. Each 5% increase in O-E mortality ratio was associated with an increase in total length of stay of one day (r = 0.25; p < 0.001). Very few structural characteristics of ACS-verified trauma centers are associated with risk-adjusted mortality. Thus, variations in patient outcomes across trauma centers are likely related to variations in clinical practices. Therapeutic study, level III.

Is Trauma Memory Special? Trauma Narrative Fragmentation in PTSD: Effects of Treatment and Response.

PubMed

Bedard-Gilligan, Michele; Zoellner, Lori A; Feeny, Norah C

2017-03-01

Seminal theories posit that fragmented trauma memories are critical to posttraumatic stress disorder (PTSD; van der Kolk & Fisler, 1995; Brewin, 2014) and that elaboration of the trauma narrative is necessary for recovery (e.g., Foa, Huppert, & Cahill, 2006). According to fragmentation theories, trauma narrative changes, particularly for those receiving trauma-focused treatment, should accompany symptom reduction. Trauma and control narratives in 77 men and women with chronic PTSD were examined pre- and post-treatment, comparing prolonged exposure (PE) and sertraline. Utilizing self-report, rater coding, and objective coding of narrative content, fragmentation was compared across narrative types (trauma, negative, positive) by treatment modality and response, controlling for potential confounds. Although sensory components increased with PE ( d = 0.23 - 0.44), there were no consistent differences in fragmentation from pre- to post-treatment between PE and sertraline or treatment responders and non-responders. Contrary to theories, changes in fragmentation may not be a crucial mechanism underlying PTSD therapeutic recovery.

A novel process for integrating patient stories into patient education interventions: incorporating lessons from theater arts.

PubMed

Fix, Gemmae M; Houston, Thomas K; Barker, Anna M; Wexler, Laura; Cook, Natasha; Volkman, Julie E; Bokhour, Barbara G

2012-09-01

Patient narratives, or stories, are an effective means of educating patients because they increase personal relevance and may reduce counter-arguing. However, such stories must seamlessly combine evidenced-based health information while being true to real patient experiences. The purpose of this paper is to describe the process of developing an educational intervention using African-American patients' success stories controlling hypertension. We identified a process to address stories development challenges. (1) To help identify story tellers, we conducted a literature review and subsequently streamlined the process of storyteller identification through screening and telephone interviews. (2) To better elicit stories, we consulted with experts in storytelling and incorporated principles from theater. (3) To select stories, we used intervention mapping to map the intervention to theory and key clinical concepts, and also engaged members of the target community to ensure scientific criteria and maintain authenticity. Using personal narratives as intervention requires weaving together science, theory and clinically sound content, while still being true to the art of storytelling. Through a careful process of identifying storytellers and story selection and drawing upon theater arts, creating stories for intervention can be streamlined while meeting the goals of authenticity and scientific soundness. Published by Elsevier Ireland Ltd.

Rural Trauma: Is Trauma Designation Associated with Better Hospital Outcomes?

ERIC Educational Resources Information Center

Bowman, Stephen M.; Zimmerman, Frederick J.; Sharar, Sam R.; Baker, Margaret W.; Martin, Diane P.

2008-01-01

Context: While trauma designation has been associated with lower risk of death in large urban settings, relatively little attention has been given to this issue in small rural hospitals. Purpose: To examine factors related to in-hospital mortality and delayed transfer in small rural hospitals with and without trauma designation. Methods: Analysis…

Expanding Trauma through Space and Time: Mapping the Rhetorical Strategies of Trauma Carrier Groups

ERIC Educational Resources Information Center

Degloma, Thomas

2009-01-01

In this article, I detail two rhetorical strategies that trauma carrier groups--including social movement organizations, professional mental health associations, and patient advocacy groups--use to expand the relevance of trauma and Post-Traumatic Stress Disorder (PTSD) through space and time: the social transmission of trauma and the social…

How Yoga Helps Heal Interpersonal Trauma: Perspectives and Themes from 11 Interpersonal Trauma Survivors.

PubMed

Gulden, Ashley W; Jennings, Len

2016-01-01

Trauma is ubiquitous in our society; therefore, it is important to explore how individuals cultivate healing after traumatic experiences. Yoga may be one avenue to cultivate healing. Qualitative methods were employed to study the role yoga practice played in the healing process of those who experienced interpersonal trauma. Eleven interpersonal trauma survivors who practiced yoga regularly were identified through a criterion sampling method. Data analysis revealed that the emphasis of yoga on mind and physical body fostered numerous positive outcomes, such as spiritual growth, self-acceptance, alleviation of trauma-related symptoms, and increased feelings of self-compassion, empowerment, and serenity. Our findings suggest that yoga may be helpful to regain mental and physical health, foster wellbeing, and cultivate personal growth after interpersonal trauma.

How Yoga Helps Heal Interpersonal Trauma: Perspectives and Themes from 11 Interpersonal Trauma Survivors.

PubMed

Gulden, Ashley W; Jennings, Len

2016-08-15

Trauma is ubiquitous in our society; therefore, it is important to explore how individuals cultivate healing after traumatic experiences. Yoga may be one avenue to cultivate healing. Qualitative methods were employed to study the role yoga practice played in the healing process of those who experienced interpersonal trauma. Eleven interpersonal trauma survivors who practiced yoga regularly were identified through a criterion sampling method. Data analysis revealed that the emphasis of yoga on mind and physical body fostered numerous positive outcomes, such as spiritual growth, self-acceptance, alleviation of trauma-related symptoms, and increased feelings of self-compassion, empowerment, and serenity. Our findings suggest that yoga may be helpful to regain mental and physical health, foster wellbeing, and cultivate personal growth after interpersonal trauma.

Secrets of the Soil: Promotion of the Nov. 7 Science at the Theater Event

DOE Office of Scientific and Technical Information (OSTI.GOV)

Brodie, Eoin

2011-01-01

There are billions of microbes in a handful of soil, some of which could hold the key to our climate and energy future. Find out how at Secrets of the Soil, our next Science at the Theater Nov. 7 at the Berkeley Repertory Theatre. At the event, four Berkeley Lab scientists will reveal how our scientists travel the globe -- to deserts, rainforests, and the Arctic tundra -- to explore the secret world of soil microbes -- and what they mean to you. More info: http://www.lbl.gov/LBL-PID/fobl/

Secrets of the Soil: Promotion of the Nov. 7 Science at the Theater Event

ScienceCinema

Brodie, Eoin

2017-12-11

There are billions of microbes in a handful of soil, some of which could hold the key to our climate and energy future. Find out how at Secrets of the Soil, our next Science at the Theater Nov. 7 at the Berkeley Repertory Theatre. At the event, four Berkeley Lab scientists will reveal how our scientists travel the globe -- to deserts, rainforests, and the Arctic tundra -- to explore the secret world of soil microbes -- and what they mean to you. More info: http://www.lbl.gov/LBL-PID/fobl/

Determining venous thromboembolic risk assessment for patients with trauma: the Trauma Embolic Scoring System.

PubMed

Rogers, Frederick B; Shackford, Steven R; Horst, Michael A; Miller, Jo Ann; Wu, Daniel; Bradburn, Eric; Rogers, Amelia; Krasne, Margaret

2012-08-01

This study aimed to determine the relative "weight" of risk factors known to be associated with venous thromboembolism (VTE) for patients with trauma based on injuries and comorbidities. A retrospective review of 16,608 consecutive admissions to a trauma center was performed. Patients were separated into those who developed VTE (n = 141) versus those who did not (16,467). Univariate analysis was performed for each risk factor reported in the trauma literature. Risk factors that were shown to be significant (p < 0.05) by univariate analysis underwent multivariate analysis to develop odds ratios for VTE. The Trauma Embolic Scoring System (TESS) was derived from the multivariate coefficients. The resulting TESS was compared with a data set from the National Trauma Data Bank (2002-2006) to determine its ability to predict VTE. The multivariate analysis demonstrated that age, Injury Severity Score, obesity, ventilator use for more than 3 days, and lower-extremity trauma were significant predictors of VTE in our patient population. The TESS was from 0 to 14, with the best prediction for those patients with a score of more than 6 (sensitivity, 81.6%; specificity, 84%). Overall, the model had excellent discrimination in predicting VTE with a receiver operating characteristic curve of 0.89. The VTE rates for TESS in the National Trauma Data Bank data set were similar for all integers except for 3 and 4, in which the VTE rates were significantly higher (3, 0.2% vs. 0.6%; 4, 0.4% vs. 1.0%). The TESS provides an objective measure of classifying VTE risk for patients with trauma. The TESS could allow informed decision making regarding prophylaxis strategies in patients with trauma.

Major genitourinary-related bicycle trauma: Results from 20 years at a level-1 trauma center.

PubMed

Osterberg, E Charles; Awad, Mohannad A; Gaither, Thomas W; Sanford, Thomas; Alwaal, Amjad; Hampson, Lindsay A; Yoo, Jennie; McAninch, Jack W; Breyer, Benjamin N

2017-01-01

Epidemiological studies have shown that bicycle trauma is associated with genitourinary (GU) injuries. Our objective is to characterize GU-related bicycle trauma admitted to a level I trauma center. We queried a prospective trauma registry for bicycle injuries over a 20-year period. Patient demographics, triage data, operative interventions and hospital details were collected. In total, 1659 patients were admitted with major bicycle trauma. Of these, 48 cases involved a GU organ, specifically the bladder (n=7), testis (n=6), urethra (n=3), adrenal (n=4) and/or kidneys (n=36). The median age of cyclists with GU injuries was 29 (range 5-70). More men were injured versus women (35 versus 13). GU-related bicycle trauma involved a motor vehicle in 52% (25/48) of injuries. The median injury severity score for GU-related bicycle trauma was 17 (range 1-50). The median number of concomitant organ injuries was 2 (range 0-6), the most common of which was the lungs (13/48, 27%) and ribs (13/48, 27%). The majority of GU injured cyclists were admitted to an ICU (15/48, 31%) or hospital floor (12/48, 25%). Operative intervention for a GU-related trauma was low (12/48, 25%). The most common GU organ injured was the kidney (36/48, 75%) however most were managed nonoperatively (33/36, 92%). Bladder injuries most often required operative intervention (6/7, 86%). Mortality following GU-related bicycle trauma was low (2/48, 4%). In a large series of bicycle trauma, GU organs were injured in 3% of cases. The majority of cases were managed non-operatively and mortality was low. Published by Elsevier Ltd.

Trauma Collaborative Care Intervention: Effect on Surgeon Confidence in Managing Psychosocial Complications After Orthopaedic Trauma.

PubMed

Wegener, Stephen T; Carroll, Eben A; Gary, Joshua L; McKinley, Todd O; OʼToole, Robert V; Sietsema, Debra L; Castillo, Renan C; Frey, Katherine P; Scharfstein, Daniel O; Huang, Yanjie; Collins, Susan C J; MacKenzie, Ellen J

2017-08-01

The impact of the Trauma Collaborative Care (TCC) program on surgeon confidence in managing the psychosocial sequelae of orthopaedic trauma was evaluated as part of a larger prospective, multisite, cluster clinical trial. We compared confidence and perceived resource availability among surgeons practicing in trauma centers that implemented the TCC program with orthopaedic trauma surgeons in similar trauma centers that did not implement the TCC. Prospective cohort design. Level-I trauma centers. Attending surgeons and fellows (N = 95 Pre and N = 82 Post). Self-report 10-item measure of surgeon confidence in managing psychosocial issues associated with trauma and perceived availability of support resources. Analyses, performed on the entire sample and repeated on the subset of 52 surgeons who responded to the survey at both times points, found surgeons at intervention sites experienced a significantly greater positive improvement (P < 0.05) in their (1) belief that they have strategies to help orthopaedic trauma patients change their psychosocial situation; (2) confidence in making appropriate referrals for orthopaedic trauma patients with psychosocial problems; and (3) belief that they have access to information to guide the management of psychosocial issues related to recovery. Initial data suggest that the establishment of the TCC program can improve surgeons' perceived availability of resources and their confidence in managing the psychosocial sequelae after injury. Further studies will be required to determine if this translates into beneficial patient effects. Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.

Attachment Dimensions and Post-traumatic Symptoms Following Interpersonal Traumas versus Impersonal Traumas in Young Adults in Taiwan.

PubMed

Huang, Yu-Lien; Chen, Sue-Huei; Su, Yi-Jen; Kung, Yi-Wen

2017-08-01

Greater risk of post-traumatic stress disorder (PTSD) is seen in individuals exposed to interpersonal traumatic events. Based on an attachment perspective, interpersonal trauma exposure may activate one's attachment insecurity system and disrupt affect, behaviour and interpersonal function, which may in turn create more difficulties to cope with interpersonal traumas and exacerbate PTSD symptomatology. The present study examined whether attachment anxiety relative to attachment avoidance would be a stronger predictor of greater PTSD symptoms following interpersonal traumas versus impersonal traumas in a Taiwanese sample. One hundred and sixty-two trauma-exposed Taiwanese young adults completed the measures of symptoms of depression, anxiety and PTSD, and attachment anxiety and attachment avoidance. In this Taiwanese study, higher attachment anxiety was observed in individuals who were exposed to interpersonal traumas. The interpersonal trauma group reported greater PTSD symptoms than did the impersonal trauma group. Specifically, after controlling for age, occurrence of trauma and distress of trauma, attachment anxiety, but not attachment avoidance, predicted more PTSD total severity and avoidance symptoms in the interpersonal trauma group. The findings may be pertinent to attachment anxiety-related hyperactivating strategies, as well as specific cultural values and a forbearance strategy applied to regulate traumatic distress in a collectivist society. Copyright © 2016 John Wiley & Sons, Ltd. Copyright © 2016 John Wiley & Sons, Ltd.

The role of trauma scoring in developing trauma clinical governance in the Defence Medical Services

PubMed Central

Russell, R. J.; Hodgetts, T. J.; McLeod, J.; Starkey, K.; Mahoney, P.; Harrison, K.; Bell, E.

2011-01-01

This paper discusses mathematical models of expressing severity of injury and probability of survival following trauma and their use in establishing clinical governance of a trauma system. There are five sections: (i) Historical overview of scoring systems—anatomical, physiological and combined systems and the advantages and disadvantages of each. (ii) Definitions used in official statistics—definitions of ‘killed in action’ and other categories and the importance of casualty reporting rates and comparison across conflicts and nationalities. (iii) Current scoring systems and clinical governance—clinical governance of the trauma system in the Defence Medical Services (DMS) by using trauma scoring models to analyse injury and clinical patterns. (iv) Unexpected outcomes—unexpected outcomes focus clinical governance tools. Unexpected survivors signify good practice to be promulgated. Unexpected deaths pick up areas of weakness to be addressed. Seventy-five clinically validated unexpected survivors were identified over 2 years during contemporary combat operations. (v) Future developments—can the trauma scoring methods be improved? Trauma scoring systems use linear approaches and have significant weaknesses. Trauma and its treatment is a complex system. Nonlinear methods need to be investigated to determine whether these will produce a better approach to the analysis of the survival from major trauma. PMID:21149354

Trauma-Informed HIV Prevention and Treatment.

PubMed

Sales, Jessica M; Swartzendruber, Andrea; Phillips, Ashley L

2016-12-01

The high prevalence of trauma and its negative impact on health and health-promoting behaviors underscore the need for multi-level interventions to address trauma and its associated sequelae to improve physical and mental well-being in both HIV-infected and HIV-uninfected populations. Growing global awareness of the intersection of trauma and HIV has resulted in development and testing of interventions to address trauma in the context of HIV treatment and HIV prevention in the USA and globally. Despite increasing recognition of the widespread nature of trauma and the importance of trauma to HIV transmission around the globe, several gaps remain. Through a survey of the literature, we identified eight studies (published in the past 5 years) describing interventions to address the effects of trauma on HIV-related outcomes. In particular, this study focused on the levels of intervention, populations the interventions were designed to benefit, and types of trauma addressed in the interventions in the context of both HIV prevention and treatment. Remarkably absent from the HIV prevention, interventions reviewed were interventions designed to address violence experienced by men or transgender individuals, in the USA or globally. Given the pervasive nature of trauma experienced generally, but especially among individuals at heightened risk for HIV, future HIV prevention interventions universally should consider becoming trauma-informed. Widespread acknowledgement of the pervasive impact of gender-based violence on HIV outcomes among women has led to multiple calls for trauma-informed care (TIC) approaches to improve the effectiveness of HIV services for HIV-infected women. TIC approaches may be relevant for and should also be tested among men and all groups with high co-occurring epidemics of HIV and trauma (e.g., men who have sex with men (MSM), transgendered populations, injection drug users, sex workers), regardless of type of trauma experience.

Trauma-Informed HIV Prevention and Treatment

PubMed Central

Sales, Jessica M.; Swartzendruber, Andrea; Phillips, Ashley L.

2016-01-01

The high prevalence of trauma and its negative impact on health and health-promoting behaviors underscore the need for multi-level interventions to address trauma and its associated sequelae to improve physical and mental well-being in both HIV-infected and HIV-uninfected populations. Growing global awareness of the intersection of trauma and HIV has resulted in development and testing of interventions to address trauma in the context of HIV treatment and HIV prevention in the U.S. and globally. Despite increasing recognition of the widespread nature of trauma and the importance of trauma to HIV transmission around the globe, several gaps remain. Through a survey of the literature, we identified 8 studies (published in the past 5 years) describing interventions to address the effects of trauma on HIV-related outcomes. In particular, this study focused on the levels of intervention, populations the interventions were designed to benefit, and types of trauma addressed in the interventions in the context of both HIV prevention and treatment. Remarkably absent from the HIV prevention interventions reviewed were interventions designed to address violence experienced by men or transgender individuals, in the U.S. or globally. Given the pervasive nature of trauma experienced generally, but especially among individuals at heightened risk for HIV, future HIV prevention interventions universally should consider becoming trauma-informed. Widespread acknowledgement of the pervasive impact of gender-based violence on HIV outcomes among women has led to multiple calls for trauma-informed care (TIC) approaches to improve the effectiveness of HIV services for HIV infected women. TIC approaches may be relevant for and should also be tested among men and all groups with high co-occurring epidemics of HIV and trauma (e.g., men who have sex with men (MSM), transgendered populations, injection drug users, sex workers), regardless of type of trauma experience. PMID:27704251

The trauma film paradigm as an experimental psychopathology model of psychological trauma: intrusive memories and beyond.

PubMed

James, Ella L; Lau-Zhu, Alex; Clark, Ian A; Visser, Renée M; Hagenaars, Muriel A; Holmes, Emily A

2016-07-01

A better understanding of psychological trauma is fundamental to clinical psychology. Following traumatic event(s), a clinically significant number of people develop symptoms, including those of Acute Stress Disorder and/or Post Traumatic Stress Disorder. The trauma film paradigm offers an experimental psychopathology model to study both exposure and reactions to psychological trauma, including the hallmark symptom of intrusive memories. We reviewed 74 articles that have used this paradigm since the earliest review (Holmes & Bourne, 2008) until July 2014. Highlighting the different stages of trauma processing, i.e. pre-, peri- and post-trauma, the studies are divided according to manipulations before, during and after film viewing, for experimental as well as correlational designs. While the majority of studies focussed on the frequency of intrusive memories, other reactions to trauma were also modelled. We discuss the strengths and weaknesses of the trauma film paradigm as an experimental psychopathology model of trauma, consider ethical issues, and suggest future directions. By understanding the basic mechanisms underlying trauma symptom development, we can begin to translate findings from the laboratory to the clinic, test innovative science-driven interventions, and in the future reduce the debilitating effects of psychopathology following stressful and/or traumatic events. Copyright © 2016 The Authors. Published by Elsevier Ltd.. All rights reserved.

Clinical characteristics of dental emergencies and prevalence of dental trauma at a university hospital emergency center in Korea.

PubMed

Bae, Ji-Hyun; Kim, Young-Kyun; Choi, Yong-Hoon

2011-10-01

The aim of this study was to examine the clinical characteristics of dental emergency patients who visited a university hospital emergency center and to evaluate the incidence of dental trauma. A retrospective chart review of patients with dental complaints and who visited the Seoul National University Bundang Hospital (SNUBH) emergency center in Gyeonggi-do, Korea, from January 2009 to December 2009 was conducted. Information regarding age, gender, the time, day, and month of presentation, diagnosis, treatment, and follow up was collected and analyzed. One thousand four hundred twenty-five patients with dental problems visited the SNUBH emergency center. Dental patients accounted for 1.47% of the total 96,708 patients at the emergency center. The male-to-female ratio was 1.68:1, with a considerably larger number of male patients (62.7%). The age distribution peak was at 0-9 years (27.5%), followed by patients in their forties (14.1%). The number of patients visiting the dental emergency center peaked in May (14.2%), on Sundays (22.4%), and between 2100 and 2400 h (20.8%). The patients' chief complaints were as follows: dental trauma, dental infection, oral bleeding, and temporomandibular joint disorder (TMD). The prevalence of dental trauma was 66%. The reasons for dental emergency visits included the following: dental trauma, dental infection, oral bleeding, and TMD, with 66% of the patients requiring management of dental trauma. It is important that dentists make a prompt, accurate diagnosis and initiate effective treatment in case of dental emergencies, especially dental trauma. © 2011 John Wiley & Sons A/S.

[Pediatric multiple trauma].

PubMed

Auner, B; Marzi, I

2014-05-01

Multiple trauma in children is rare so that even large trauma centers will only treat a small number of cases. Nevertheless, accidents are the most common cause of death in childhood whereby the causes are mostly traffic accidents and falls. Head trauma is the most common form of injury and the degree of severity is mostly decisive for the prognosis. Knowledge on possible causes of injury and injury patterns as well as consideration of anatomical and physiological characteristics are of great importance for treatment. The differences compared to adults are greater the younger the child is. Decompression and stopping bleeding are the main priorities before surgical fracture stabilization. The treatment of a severely injured child should be carried out by an interdisciplinary team in an approved trauma center with expertise in pediatrics. An inadequate primary assessment involves a high risk of early mortality. On the other hand children have a better prognosis than adults with comparable injuries.

Trauma scoring systems and databases.

PubMed

Lecky, F; Woodford, M; Edwards, A; Bouamra, O; Coats, T

2014-08-01

This review considers current trauma scoring systems and databases and their relevance to improving patient care. Single physiological measures such as systolic arterial pressure have limited ability to diagnose severe trauma by reflecting raised intracranial pressure, or significant haemorrhage. The Glasgow coma score has the greatest prognostic value in head-injured and other trauma patients. Trauma triage tools and imaging decision rules-using combinations of physiological cut-off measures with mechanism of injury and other categorical variables-bring both increased sophistication and increased complexity. It is important for clinicians and managers to be aware of the diagnostic properties (over- and under-triage rates) of any triage tool or decision rule used in their trauma system. Trauma registries are able to collate definitive injury descriptors and use survival prediction models to guide trauma system governance, through individual patient review and case-mix-adjusted benchmarking of hospital and network performance with robust outlier identification. Interrupted time series allow observation in the changes in care processes and outcomes at national level, which can feed back into clinical quality-based commissioning of healthcare. Registry data are also a valuable resource for trauma epidemiological and comparative effectiveness research studies. © The Author 2014. Published by Oxford University Press on behalf of the British Journal of Anaesthesia. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

The Effect of Trauma Center Designation and Trauma Volume on Outcome in Specific Severe Injuries

PubMed Central

Demetriades, Demetrios; Martin, Mathew; Salim, Ali; Rhee, Peter; Brown, Carlos; Chan, Linda

2005-01-01

Objective: The objective of this study was to investigate the effect of American College of Surgeons (ACS) trauma center designation and trauma volume on outcome in patients with specific severe injuries. Background: Trauma centers are designated by the ACS into different levels on the basis of resources, trauma volume, and educational and research commitment. The criteria for trauma center designation are arbitrary and have never been validated. Methods: The National Trauma Data Bank study, which included patients >14 years of age and had injury severity score (ISS) >15, were alive on admission and had at least one of the following severe injuries: aortic, vena cava, iliac vessels, cardiac, grade IV/V liver injuries, quadriplegia, or complex pelvic fractures. Outcomes (mortality, intensive care unit stay, and severe disability at discharge) were compared among level I and II trauma centers and between centers within the same level designation but different volumes of severe trauma (<240 vs ≥240 trauma admissions with ISS >15 per year). The outcomes were adjusted for age (<65 ≥65), gender, mechanism of injury, hypotension on admission, and ISS (≤25 and >25). Results: A total of 12,254 patients met the inclusion criteria. Overall, level I centers had significantly lower mortality (25.3% vs 29.3%; adjusted odds ratio [OR], 0.81; 95% confidence interval [CI], 0.71–0.94; P = 0.004) and significantly lower severe disability at discharge (20.3% vs 33.8%, adjusted OR, 0.55; 95% CI, 0.44–0.69; P < 0.001) than level II centers. Subgroup analysis showed that cardiovascular injuries (N = 2004) and grades IV–V liver injuries (N = 1415) had a significantly better survival in level I than level II trauma centers (adjusted P = 0.017 and 0.023, respectively). Overall, there was a significantly better functional outcome in level I centers (adjusted P < 0.001). Subgroup analysis showed level I centers had significantly better functional outcomes in complex pelvic

Trading Carbon: Can Cookstoves Light the Way (LBNL Science at the Theater)

ScienceCinema

Gadgil, Ashok; Booker, Kayje; Rausch, Adam

2018-06-08

Science at the Theater: Get smart about carbon! Learn how families in Africa, using stoves designed by Berkeley Lab, are at the forefront of global carbon reduction. Ashok Gadgil is the driving force behind the Berkeley-Darfur Cookstove. He is a researcher, inventor, renowned humanitarian, and director of Berkeley Lab's Environmental Energy Technologies Division. Kayje Booker is a Berkeley Lab researcher and UC Berkeley graduate student in ecosystem sciences. She is exploring how carbon markets can serve as catalysts for innovation in technologies for the poor. Adam Rausch is a Berkeley Lab researcher and UC Berkeley graduate student in civil environmental engineering. He helps to design and test stove designs in Ethiopia and elsewhere.

Health Detectives: Uncovering the Mysteries of Disease (LBNL Science at the Theater)

ScienceCinema

Bissell, Mina; Canaria, Christie; Celnicker, Susan; Karpen, Gary

2018-06-20

In this April 23, 2012 Science at the Theater event, Berkeley Lab scientists discuss how they uncover the mysteries of disease in unlikely places. Speakers and topics include: World-renowned cancer researcher Mina Bissell's pioneering research on the role of the cellular microenvironment in breast cancer has changed the conversation about the disease. How does DNA instability cause disease? To find out, Christie Canaria images neural networks to study disorders such as Huntington's disease. Fruit flies can tell us a lot about ourselves. Susan Celniker explores the fruit fly genome to learn how our genome works. DNA is not destiny. Gary Karpen explores how environmental factors shape genome function and disease through epigenetics.

Reactions to Diversity: Using Theater to Teach Medical Students about Cultural Diversity.

PubMed

Ivory, Kimberley D; Dwyer, Paul; Luscombe, Georgina

2016-01-01

Training medical students to understand the effects of culture and marginalization on health outcomes is important to the future health of increasingly diverse populations. We devised and evaluated a short training module on working with diversity to challenge students' thinking about the role of both patient and practitioner culture in health outcomes. The workshop combined didactic teaching about culture as a social determinant of health using the cultural humility model, interactive exercises, and applied theater techniques. We evaluated changes in the students' perceptions and attitudes over time using the Reaction to Diversity Inventory. There was initial significant improvement. Women and students with no past diversity training responded best. However, scores largely reverted to baseline over 12 months.

Conscious sedation for awake craniotomy in intraoperative magnetic resonance imaging operating theater

PubMed Central

Takrouri, Mohamad Said Maani; Shubbak, Firas A.; Al Hajjaj, Aisha; Maestro, Rolando F. Del; Soualmi, Lahbib; Alkhodair, Mashael H.; Alduraiby, Abrar M.; Ghanem, Najeeb

2010-01-01

This case report describes the first case in intraoperative magnetic resonance imaging operating theater (iMRI OT) (BrainSuite®) of awake craniotomy for frontal lobe glioma excision in a 24-year-old man undergoing eloquent cortex language mapping intraoperatively. As he was very motivated to take pictures of him while being operated upon, the authors adapted conscious sedation technique with variable depth according to Ramsey's scale, in order to revert to awake state to perform the intended neurosurgical procedure. The patient tolerated the situation satisfactorily and was cooperative till the finish, without any event. We elicit in this report the special environment of iMRI OT for lengthy operation in pinned fixed patient having craniotomy. PMID:25885085

Health Detectives: Uncovering the Mysteries of Disease (LBNL Science at the Theater)

DOE Office of Scientific and Technical Information (OSTI.GOV)

Bissell, Mina; Canaria, Christie; Celnicker, Susan

In this April 23, 2012 Science at the Theater event, Berkeley Lab scientists discuss how they uncover the mysteries of disease in unlikely places. Speakers and topics include: World-renowned cancer researcher Mina Bissell's pioneering research on the role of the cellular microenvironment in breast cancer has changed the conversation about the disease. How does DNA instability cause disease? To find out, Christie Canaria images neural networks to study disorders such as Huntington's disease. Fruit flies can tell us a lot about ourselves. Susan Celniker explores the fruit fly genome to learn how our genome works. DNA is not destiny. Garymore » Karpen explores how environmental factors shape genome function and disease through epigenetics.« less

Reactions to Diversity: Using Theater to Teach Medical Students about Cultural Diversity

PubMed Central

Ivory, Kimberley D; Dwyer, Paul; Luscombe, Georgina

2016-01-01

Training medical students to understand the effects of culture and marginalization on health outcomes is important to the future health of increasingly diverse populations. We devised and evaluated a short training module on working with diversity to challenge students’ thinking about the role of both patient and practitioner culture in health outcomes. The workshop combined didactic teaching about culture as a social determinant of health using the cultural humility model, interactive exercises, and applied theater techniques. We evaluated changes in the students’ perceptions and attitudes over time using the Reaction to Diversity Inventory. There was initial significant improvement. Women and students with no past diversity training responded best. However, scores largely reverted to baseline over 12 months. PMID:29349320

Trading Carbon: Can Cookstoves Light the Way (LBNL Science at the Theater)

DOE Office of Scientific and Technical Information (OSTI.GOV)

Gadgil, Ashok; Booker, Kayje; Rausch, Adam

2010-09-20

Science at the Theater: Get smart about carbon! Learn how families in Africa, using stoves designed by Berkeley Lab, are at the forefront of global carbon reduction. Ashok Gadgil is the driving force behind the Berkeley-Darfur Cookstove. He is a researcher, inventor, renowned humanitarian, and director of Berkeley Lab's Environmental Energy Technologies Division. Kayje Booker is a Berkeley Lab researcher and UC Berkeley graduate student in ecosystem sciences. She is exploring how carbon markets can serve as catalysts for innovation in technologies for the poor. Adam Rausch is a Berkeley Lab researcher and UC Berkeley graduate student in civil environmentalmore » engineering. He helps to design and test stove designs in Ethiopia and elsewhere.« less

[Surgical tactics in duodenal trauma].

PubMed

Ivanov, P A; Grishin, A V

2004-01-01

Results of surgical treatment of 61 patients with injuries of the duodenum are analyzed. The causes of injuries were stab-incised wounds in 24 patients, missile wound -- in 7, closed abdominal trauma -- in 26, trauma of the duodenum during endoscopic papillosphincterotomy -- in 4. All the patients underwent surgery. Complications were seen in 32 (52.5%) patients, 21 patients died, lethality was 34.4%. Within the first 24 hours since the trauma 7 patients died due to severe combined trauma, blood loss, 54 patients survived acute period of trauma, including 28 patients after open trauma, 26 -- after closed and 4 -- after trauma of the duodenum during endoscopic papillosphincterotomy. Diagnostic and surgical policies are discussed. Results of treatment depending on kind and time of surgery are regarded. It is demonstrated that purulent complications due to retroperitoneal phlegmona, traumatic pancreatitis, pneumonia are the causes of significant number of unfavorable outcomes. Therefore, it is important to adequately incise and drainage infected parts of retroperitoneal fat tissue with two-lumen drainages. Decompression through duodenal tube is the effective procedure for prophylaxis of suture insufficiency and traumatic pancreatitis. Suppression of pancreatic and duodenal secretion with octreotid improves significantly surgical treatment results.

Relationship of strategic and theater nuclear forces

DOE Office of Scientific and Technical Information (OSTI.GOV)

Nitze, P.

Policies governing the development of nuclear forces and the relationship of strategic and theater forces are examined from five different levels: (1) the hierarchy of 10 levels of potential violence, (2) the military implications at each interface between levels, (3) historical aspects of changes in the way nuclear weapons are viewed, (4) strategic rivalry, and (5) a global challenge. The challenge acknowledges that the Soviet perception differs from the American view as is indicated by the extent of the Soviet civil defense effort. These differences are detailed in terms of specific weaponry and their effect on negotiations to limit strategicmore » nuclear arms. There has been a tendency to avoid the facts of the Soviet nuclear capability and, once faced, to avoid deciding what action to take. The author contends that the appropriate step is to deny the Soviets intercontinental nuclear supremacy by maintaining equivalent levels of force. To do this the U.S. must add strategically based cruise missiles and should consider including gray-area systems to its negotiations. The author also advocates deterrence by the unilateral use of nuclear weapons for self-defense and the use of short-range weapons by both sides on the edge of a battlefield. (DCK)« less

Sun protection training based on a theater play for preschoolers: an effective method for imparting knowledge on sun protection?

PubMed

Seidel, Nadja; Stoelzel, Friederike; Garzarolli, Marlene; Herrmann, Sandra; Breitbart, Eckhard Wilhelm; Berth, Hendrik; Baumann, Michael; Ehninger, Gerhard

2013-09-01

Sun protection in childhood is important to reduce the risk of developing skin cancer later in life. The "Periods-of-Life-Program" for primary prevention of skin cancer introduces a combination of individual and environmental interventions for the preschool period. Within this pilot study, an intervention group received cognitive-behavioral and environmental interventions. A control group had solely received the environmental intervention, and a wait-control group received no intervention. Nursery school children (n = 80, 3 to 6 years of age) of four nursery schools were randomly assigned to these groups on school level. The ability of the cognitive-behavioral intervention (a theater play) to enhance sun protection knowledge was examined. The theater play improved knowledge over all age groups (p < .05 η(2) = .06). Age-specific analyses showed better results for children aged 5 to 6 (p < .05 η(2) = .20) compared to children aged 3 to 4 years (p = .17 η(2) = .04). In combining cognitive-behavioral and environmental interventions, the "Periods-of-Life-Program" is a promising strategy for primary prevention of skin cancer.

The NASA/NOAA Electronic Theater

NASA Technical Reports Server (NTRS)

Hasler, A. F.

2003-01-01

The NASA/NOAA Electronic Theater presents Earth science observations and visualizations from space in a historical perspective. Fly in from outer space to Cambridge and Harvard University. Zoom through the Cosmos to SLC and site of the 2002 Winter Olympics using 1 m IKONOS "Spy Satellite" data. Contrast the 1972 Apollo 17 "Blue Marble" image of the Earth with the latest US and International global satellite images that allow us to view our Planet from any vantage point. See the latest spectacular images from NASA/NOAA remote sensing missions like Terra, GOES, TRMM, SeaWiFS, & Landsat 7, of storms & fires like Hurricane Isabel and the LNSan Diego firestorms of 2003. See how High Definition Television (HDTV) is revolutionizing the way we do science communication. Take the pulse of the planet on a daily, annual and 30-year time scale. See daily thunderstorms, the annual blooming of the northern hemisphere landmasses and oceans, fires in Africa, dust storms in Iraq, and carbon monoxide exhaust from global burning. See visualizations featured on Newsweek, TIME, National Geographic, Popular Science covers & National & International Network TV. Spectacular new global visualizations of the observed and simulated atmosphere & oceans are shown. See the currents and vortexes in the oceans that bring up the nutrients to feed tiny plankton and draw the fish, whales and fishermen. See the how the ocean blooms in response to El Niiioh Niiia climate changes. The Etheater will be presented using the latest High Definition TV (HDTV) and video projection technology on a large screen. See the global city lights, and the great NE US blackout of August 2003 observed by the "night-vision" DMSP satellite.

Childhood trauma and compulsive buying.

PubMed

Sansone, Randy A; Chang, Joy; Jewell, Bryan; Rock, Rachel

2013-02-01

Childhood trauma has been empirically associated with various types of self-regulatory difficulties in adulthood. However, according to the extant literature, no study has examined relationships between various types of childhood trauma and compulsive buying behavior in adulthood. Using a self-report survey methodology in a cross-sectional consecutive sample of 370 obstetrics/gynecology patients, we examined five types of childhood trauma before the age of 12 years (i.e. witnessing violence, physical neglect, emotional abuse, physical abuse, sexual abuse) in relationship to compulsive buying as assessed by the Compulsive Buying Scale (CBS). All forms of trauma demonstrated statistically significant correlations with the CBS. Using a linear regression analysis, both witnessing violence and emotional abuse significantly contributed to CBS scores. Further analyses indicated that race did not moderate the relationship between childhood trauma and compulsive buying. Findings indicate that various forms of childhood trauma are correlated with compulsive buying behavior, particularly witnessing violence and emotional abuse.

A Civilian/Military Trauma Institute: National Trauma Coordinating Center

DTIC Science & Technology

2012-10-01

the variation in practices for DVT screening, and there was another paper which talks about variation in practices about pain management for rib ...pelvic fractures , and long bone extremity fractures (femur or tibia). TBI was chosen as it is the most common cause of death and disability in...trauma patients, while hemorrhage is the second leading cause of death. Fractures were chosen as they represent a common injury in trauma patients. These

Trauma system evaluation in developing countries: applicability of American College of Surgeons/Committee on Trauma (ACS/COT) basic criteria.

PubMed

Latifi, Rifat; Ziemba, Michelle; Leppäniemi, Ari; Dasho, Erion; Dogjani, Agron; Shatri, Zhaneta; Kociraj, Agim; Oldashi, Fatos; Shosha, Lida

2014-08-01

Trauma continues to be a major health problem worldwide, particularly in the developing world, with high mortality and morbidity. Yet most developing countries lack an organized trauma system. Furthermore, developing countries do not have in place any accreditation process for trauma centers; thus, no accepted standard assessment tools exist to evaluate their trauma services. The aims of this study were to evaluate the trauma system in Albania, using the basic trauma criteria of the American College of Surgeons/Committee on Trauma (ACS/COT) as assessment tools, and to provide the Government with a situational analysis relative to these criteria. We used the ACS/COT basic criteria as assessment tools to evaluate the trauma system in Albania. We conducted a series of semi-structured interviews, unstructured interviews, and focus groups with all stakeholders at the Ministry of Health, at the University Trauma Hospital (UTH) based in Tirana (the capital city), and at ten regional hospitals across the country. Albania has a dedicated national trauma center that serves as the only tertiary center, plus ten regional hospitals that provide some trauma care. However, overall, its trauma system is in need of major reforms involving all essential elements in order to meet the basic requirements of a structured trauma system. The ACS/COT basic criteria can be used as assessment tools to evaluate trauma care in developing countries. Further studies are needed in other developing countries to validate the applicability of these criteria.

Knowledge, Stigma, and Behavioral Outcomes among Antiretroviral Therapy Patients Exposed to Nalamdana's Radio and Theater Program in Tamil Nadu, India

ERIC Educational Resources Information Center

Nambiar, Devaki; Ramakrishnan, Vimala; Kumar, Paresh; Varma, Rajeev; Balaji, Nithya; Rajendran, Jeeva; Jhona, Loretta; Chandrasekar, Chokkalingam; Gere, David

2011-01-01

Arts-based programs have improved HIV-related knowledge, attitudes, and behavior in general and at-risk populations. With HIV transformed into a chronic condition, this study compares patients at consecutive stages of receiving antiretroviral treatment, coinciding with exposure to a radio-and-theater-based educational program (unexposed [N = 120],…

Using the trauma film paradigm to explore interpersonal processes after trauma exposure.

PubMed

Woodward, Matthew J; Beck, J Gayle

2017-07-01

The present study sought to examine ways in which social support might influence trauma symptoms using a variation of the trauma film paradigm. Sixty-seven undergraduate female students in romantic relationships were randomized to watch a stressful film clip depicting a sexual assault, either in the presence (PP) or absence (PA) of their romantic partner. Analyses showed that the PP condition experienced more intrusive memories of the film than the PA condition. In addition, participants in the PP condition whose romantic partner reported low relationship trust had higher film-related distress than participants in the PP condition whose romantic partner reported high relationship trust. Observational coding of partner behaviors after viewing the film clip found that greater expression of negative emotion from partners predicted participants' negative affect and intrusive memories over time. Positive emotional support did not have any effect upon participants' distress. Findings identify possible ways in which interpersonal processes influence trauma adjustment and suggest that the trauma film paradigm can be adapted to examine the role of interpersonal processes in post-trauma adjustment. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

Role of Islamic appraisals, trauma-related appraisals, and religious coping in the posttraumatic adjustment of Muslim trauma survivors.

PubMed

Berzengi, Azi; Berzenji, Latef; Kadim, Aladdin; Mustafa, Falah; Jobson, Laura

2017-03-01

This research investigated the role of Islamic appraisals, trauma-related appraisals, and religious coping in Muslim trauma survivors. We report 2 studies of Muslim trauma survivors with and without posttraumatic stress disorder (PTSD) living in the United Kingdom (Study 1) and a sample of Muslim trauma survivors living in Northern Iraq (Study 2). In both studies participants completed the Posttraumatic Stress Diagnostic Scale, Brief Religious Coping Scale, Islamic Appraisal Questionnaire, and Posttraumatic Cognitions Inventory in Arabic. First, it was found that negative religious coping differentiated between trauma survivors with and without PTSD (Study 1) and was significantly correlated with PTSD symptoms (Study 2). Second, negative Islamic appraisals were significantly associated with greater PTSD symptoms whereas positive Islamic appraisals were significantly associated with fewer PTSD symptoms (Study 2). Third, negative trauma-related appraisals correlated significantly with, and uniquely predicted, PTSD symptoms (Study 2). Finally, trauma-related appraisals were found to mediate the relationship between negative Islamic appraisals and negative religious coping and PTSD symptoms. These findings suggest that the theoretical emphasis on trauma-related cognitions may also be applicable to our understanding of PTSD in Muslim trauma survivors. However, for this population, trauma-related appraisals and subsequent coping strategies may be influenced by Islamic beliefs and values. Clinically, our findings suggest that addressing PTSD symptoms in Muslim trauma survivors may require clinicians to consider the impact of trauma on the survivor's religious appraisals and relationship with God. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

Western Trauma Association Critical Decisions in Trauma: Management of rib fractures.

PubMed

Brasel, Karen J; Moore, Ernest E; Albrecht, Roxie A; deMoya, Marc; Schreiber, Martin; Karmy-Jones, Riyad; Rowell, Susan; Namias, Nicholas; Cohen, Mitchell; Shatz, David V; Biffl, Walter L

2017-01-01

This is a recommended management algorithm from the Western Trauma Association addressing the management of adult patients with rib fractures. Because there is a paucity of published prospective randomized clinical trials that have generated Class I data, these recommendations are based primarily on published observational studies and expert opinion of Western Trauma Association members. The algorithm and accompanying comments represent a safe and sensible approach that can be followed at most trauma centers. We recognize that there will be patient, personnel, institutional, and situational factors that may warrant or require deviation from the recommended algorithm. We encourage institutions to use this as a guideline to develop their own local protocols.

What Are the Costs of Trauma Center Readiness? Defining and Standardizing Readiness Costs for Trauma Centers Statewide.

PubMed

Ashley, Dennis W; Mullins, Robert F; Dente, Christopher J; Garlow, Laura; Medeiros, Regina S; Atkins, Elizabeth V; Solomon, Gina; Abston, Dena; Ferdinand, Colville H

2017-09-01

Trauma center readiness costs are incurred to maintain essential infrastructure and capacity to provide emergent services on a 24/7 basis. These costs are not captured by traditional hospital cost accounting, and no national consensus exists on appropriate definitions for each cost. Therefore, in 2010, stakeholders from all Level I and II trauma centers developed a survey tool standardizing and defining trauma center readiness costs. The survey tool underwent minor revisions to provide further clarity, and the survey was repeated in 2013. The purpose of this study was to provide a follow-up analysis of readiness costs for Georgia's Level I and Level II trauma centers. Using the American College of Surgeons Resources for Optimal Care of the Injured Patient guidelines, four readiness cost categories were identified: Administrative, Clinical Medical Staff, Operating Room, and Education/Outreach. Through conference calls, webinars and face-to-face meetings with financial officers, trauma medical directors, and program managers from all trauma centers, standardized definitions for reporting readiness costs within each category were developed. This resulted in a survey tool for centers to report their individual readiness costs for one year. The total readiness cost for all Level I trauma centers was $34,105,318 (avg $6,821,064) and all Level II trauma centers was $20,998,019 (avg $2,333,113). Methodology to standardize and define readiness costs for all trauma centers within the state was developed. Average costs for Level I and Level II trauma centers were identified. This model may be used to help other states define and standardize their trauma readiness costs.

The Science Behind the NASA/NOAA Electronic Theater 2002

NASA Technical Reports Server (NTRS)

Hasler, A. Fritz; Starr, David (Technical Monitor)

2002-01-01

Details of the science stories and scientific results behind the Etheater Earth Science Visualizations from the major remote sensing institutions around the country will be explained. The NASA Electronic Theater presents Earth science observations and visualizations in a historical perspective. Fly in from outer space to Temple Square and the University of Utah Campus. Go back to the early weather satellite images from the 1960s see them contrasted with the latest US/Europe/Japan global weather data. See the latest images and image sequences from NASA & NOAA missions like Terra, GOES, NOAA, TRMM, SeaWiFS, Landsat 7 visualized with state-of-the art tools. A similar retrospective of numerical weather models from the 1960s will be compared with the latest "year 2002" high-resolution models. See the inner workings of a powerful hurricane as it is sliced and dissected using the University of Wisconsin Vis-5D interactive visualization system. The largest super computers are now capable of realistic modeling of the global oceans. See ocean vortexes and currents that bring up the nutrients to feed phitoplankton and zooplankton as well as draw the crill fish, whales and fisherman. See the how the ocean blooms in response to these currents and El Nino/La Nina climate regimes. The Internet and networks have appeared while computers and visualizations have vastly improved over the last 40 years. These advances make it possible to present the broad scope and detailed structure of the huge new observed and simulated datasets in a compelling and instructive manner. New visualization tools allow us to interactively roam & zoom through massive global images larger than 40,000 x 20,000 pixels. Powerful movie players allow us to interactively roam, zoom & loop through 4000 x 4000 pixel bigger than HDTV movies of up to 5000 frames. New 3D tools allow highly interactive manipulation of detailed perspective views of many changing model quantities. See the 1m resolution before and after

International survey among orthopaedic trauma surgeons: Lack of a definition of fracture-related infection.

PubMed

Morgenstern, M; Moriarty, T F; Kuehl, R; Richards, R G; McNally, M A; Verhofstad, M H J; Borens, O; Zalavras, C; Raschke, M; Kates, S L; Metsemakers, W J

2018-03-01

Fracture-related infection (FRI) is one of the most challenging musculoskeletal complications in orthopaedic-trauma surgery. Although the orthopaedic community has developed and adopted a consensus definition of prosthetic joint infections (PJI), it still remains unclear how the trauma surgery community defines FRI in daily clinical practice or in performing clinical research studies. The central aim of this study was to survey the opinions of a global network of trauma surgeons on the definitions and criteria they routinely use, and their opinion on the need for a unified definition of FRI. The secondary aims were to survey their opinion on the utility of currently used definitions that may be at least partially applicable for FRI, and finally their opinion on the important clinical parameters that should be considered as diagnostic criteria for FRI. An 11-item questionnaire was developed to cover the above-mentioned aims. The questionnaire was administered by SurveyMonkey and was sent via blast email to all registered users of AO Trauma (Davos, Switzerland). Out of the 26'563 recipients who opened the email, 2'327 (8.8%) completed the questionnaire. Nearly 90% of respondents agreed that a consensus-derived definition for FRI is required and 66% of the surgeons also agreed that PJI and FRI are not equal with respect to diagnosis, treatment and outcome. Furthermore, "positive cultures from microbiology testing", "elevation of CRP", "purulent drainage" and "local clinical signs of infection" were voted the most important diagnostic parameters for FRI. This international survey infers the need for a consensus definition of FRI and provides insight into the clinical parameters seen by an international community of trauma surgeons as being critical for defining FRI. Copyright © 2018 Elsevier Ltd. All rights reserved.

The Aftermath of Road Trauma: Survivors' Perceptions of Trauma and Growth

ERIC Educational Resources Information Center

Harms, Louise; Talbot, Michelle

2007-01-01

For many survivors of serious road trauma, the physical and psychological consequences are complex and lifelong. The longer-term psychosocial recovery experience for survivors, however, is rarely documented in the social work literature. This article reports on findings from a study of road trauma recovery experiences. The findings are presented…

Evaluating trauma care capabilities in Mexico with the World Health Organization's Guidelines for Essential Trauma Care publication.

PubMed

Arreola-Risa, Carlos; Mock, Charles; Vega Rivera, Felipe; Romero Hicks, Eduardo; Guzmán Solana, Felipe; Porras Ramírez, Giovanni; Montiel Amoroso, Gilberto; de Boer, Melanie

2006-02-01

To identify affordable, sustainable methods to strengthen trauma care capabilities in Mexico, using the standards in the Guidelines for Essential Trauma Care, a publication that was developed by the World Health Organization and the International Society of Surgery to provide recommendations on elements of trauma care that should be in place in the various levels of health facilities in all countries. The Guidelines publication was used as a basis for needs assessments conducted in 2003 and 2004 in three Mexican states. The states were selected to represent the range of geographic and economic conditions in the country: Oaxaca (south, lower economic status), Puebla (center, middle economic status), and Nuevo León (north, higher economic status). The sixteen facilities that were assessed included rural clinics, small hospitals, and large hospitals. Site visits incorporated direct inspection of physical resources as well as interviews with key administrative and clinical staff. Human and physical resources for trauma care were adequate in the hospitals, especially the larger ones. The survey did identify some deficiencies, such as shortages of stiff suction tips, pulse oximetry equipment, and some trauma-related medications. All of the clinics had difficulties with basic supplies for resuscitation, even though some received substantial numbers of trauma patients. In all levels of facilities there was room for improvement in administrative functions to assure quality trauma care, including trauma registries, trauma-related quality improvement programs, and uniform in-service training. This study identified several low-cost ways to strengthen trauma care in Mexico. The study also highlighted the usefulness of the recommended norms in the Guidelines for Essential Trauma Care publication in providing a standardized template by which to assess trauma care capabilities in nations worldwide.

IMM tracking of a theater ballistic missile during boost phase

NASA Astrophysics Data System (ADS)

Hutchins, Robert G.; San Jose, Anthony

1998-09-01

Since the SCUD launches in the Gulf War, theater ballistic missile (TBM) systems have become a growing concern for the US military. Detection, tracking and engagement during boost phase or shortly after booster cutoff are goals that grow in importance with the proliferation of weapons of mass destruction. This paper addresses the performance of tracking algorithms for TBMs during boost phase and across the transition to ballistic flight. Three families of tracking algorithms are examined: alpha-beta-gamma trackers, Kalman-based trackers, and the interactive multiple model (IMM) tracker. In addition, a variation on the IMM to include prior knowledge of a booster cutoff parameter is examined. Simulated data is used to compare algorithms. Also, the IMM tracker is run on an actual ballistic missile trajectory. Results indicate that IMM trackers show significant advantage in tracking through the model transition represented by booster cutoff.

Epidemiology of severe trauma in Spain. Registry of trauma in the ICU (RETRAUCI). Pilot phase.

PubMed

Chico-Fernández, M; Llompart-Pou, J A; Guerrero-López, F; Sánchez-Casado, M; García-Sáez, I; Mayor-García, M D; Egea-Guerrero, J; Fernández-Ortega, J F; Bueno-González, A; González-Robledo, J; Servià-Goixart, L; Roldán-Ramírez, J; Ballesteros-Sanz, M Á; Tejerina-Alvarez, E; García-Fuentes, C; Alberdi-Odriozola, F

2016-01-01

To describe the characteristics and management of severe trauma disease in Spanish Intensive Care Units (ICUs). Registry of trauma in the ICU (RETRAUCI). Pilot phase. A prospective, multicenter registry. Thirteen Spanish ICUs. Patients with trauma disease admitted to the ICU. None. Epidemiology, out-of-hospital attention, registry of injuries, resources utilization, complications and outcome were evaluated. Patients, n=2242. Mean age 47.1±19.02 years. Males 79%. Blunt trauma 93.9%. Injury Severity Score 22.2±12.1, Revised Trauma Score 6.7±1.6. Non-intentional in 84.4% of the cases. The most common causes of trauma were traffic accidents followed by pedestrian and high-energy falls. Up to 12.4% were taking antiplatelet medication or anticoagulants. Almost 28% had a suspected or confirmed toxic influence in trauma. Up to 31.5% required an out-of-hospital artificial airway. The time from trauma to ICU admission was 4.7±5.3hours. At ICU admission, 68.5% were hemodynamically stable. Brain and chest injuries predominated. A large number of complications were documented. Mechanical ventilation was used in 69.5% of the patients (mean 8.2±9.9 days), of which 24.9% finally required a tracheostomy. The median duration of stay in the ICU and in hospital was 5 (range 3-13) and 9 (5-19) days, respectively. The ICU mortality rate was 12.3%, while the in-hospital mortality rate was 16.0%. The pilot phase of the RETRAUCI offers a first impression of the epidemiology and management of trauma disease in Spanish ICUs. Copyright © 2015 Elsevier España, S.L.U. y SEMICYUC. All rights reserved.

Whole-body multislice computed tomography (MSCT) improves trauma care in patients requiring surgery after multiple trauma.

PubMed

Wurmb, T E; Quaisser, C; Balling, H; Kredel, M; Muellenbach, R; Kenn, W; Roewer, N; Brederlau, J

2011-04-01

Whole-body multislice helical CT becomes increasingly important as a diagnostic tool in patients with multiple injuries. Time gain in multiple-trauma patients who require emergency surgery might improve outcome. The authors hypothesised that whole-body multislice computed tomography (MSCT) (MSCT trauma protocol) as the initial diagnostic tool reduces the interval to start emergency surgery (tOR) if compared to conventional radiography, combined with abdominal ultrasound and organ-focused CT (conventional trauma protocol). The second goal of the study was to investigate whether the diagnostic approach chosen has an impact on outcome. The authors' level 1 trauma centre uses whole-body MSCT for initial radiological diagnostic work-up for patients with suspected multiple trauma. Before the introduction of MSCT in 2004, a conventional approach was used. Group I: data of trauma patients treated with conventional trauma protocol from 2001 to 2003. Group II: data from trauma patients treated with whole-body MSCT trauma protocol from 2004 to 2006. tOR in group I (n=155) was 120 (90-150) min (median and IQR) and 105 (85-133) min (median and IQR) in group II (n=163), respectively (p<0.05). Patients of group II had significantly more serious injuries. No difference in outcome data was found. 14 patients died in both groups within the first 30 days; five of these died within the first 24 h. A whole-body MSCT-based diagnostic approach to multiple trauma shortens the time interval to start emergency surgery in patients with multiple injuries. Mortality remained unchanged in both groups. Patients of group II were more seriously injured; an improvement of outcome might be assumed.

Comparing premodern melancholy/mania and modern trauma: an argument in favor of historical experiences of trauma.

PubMed

Trembinski, Donna

2011-02-01

Historians and psychiatrists have repeatedly looked to both real and imagined individuals of the past, like Achilles and Samuel Pepys, and found evidence that they were suffering from symptoms of trauma and posttraumatic stress disorder. The assumptions that allow such historical "diagnoses" have, however, recently been called into question by philosophers such as lan Hacking, anthropologists like Allan Young and psychiatrists such as Patrick Bracken. These scholars have all suggested in various ways that experiences of trauma could not have occurred until the diagnosis of trauma and its symptoms had been formalized and the language of trauma had been developed in the late 19th century. This article attempts to resolve this bifurcation of opinion on the universality of the mind and historical experiences of trauma in two ways. First, it argues for the necessity of applying modern categories of analysis to further present understandings of the past. Second, it considers discussions of"melancholia" and "mania" in premodern medical literature and argues that there are enough similarities between the causes and symptoms of these premodern disorders and modern trauma to suggest that experiences of trauma may not be wholly culturally bound to the modern world, as the above scholars have suggested. While melancholy or mania cannot simply be understood as premodern names for trauma, and it is not always correct to "diagnose" a premodern person who exhibits symptoms of these illnesses with trauma, such an assumption is not always ahistorical or incorrect either.

Mortality factors in geriatric blunt trauma patients.

PubMed

Knudson, M M; Lieberman, J; Morris, J A; Cushing, B M; Stubbs, H A

1994-04-01

To examine various clinical factors for their ability to predict mortality in geriatric patients following blunt trauma. In this retrospective study, trauma registries and medical records from three trauma centers were reviewed for patients 65 years and older who had sustained blunt trauma. The following variables were extracted and examined independently and in combination for their ability to predict death: age, gender, mechanism of injury, admission blood pressure, and Glasgow Coma Scale score, respiratory status, Trauma Score, Revised Trauma Score, and Injury Severity Score. Three urban trauma centers. Geriatric trauma patients entering three trauma centers (Stanford [Calif] University Hospital, Vanderbilt University Medical Center, Nashville, Tenn, and Maryland Institute for Emergency Medical Services Systems, Baltimore) following blunt trauma during a 7-year period (1982 to 1989). The Injury Severity Score was the single variable that correlated most significantly with mortality. Mortality rates were higher for men than for women and were significantly higher in patients 75 years and older. Admission variables associated with the highest relative risks of death included a Trauma Score less than 7; hypotension (systolic blood pressure, < 90 mm Hg); hypoventilation (respiratory rate, < 10 breaths per minute); or a Glasgow Coma Scale score equal to 3. Admission variables in geriatric trauma patients can be used to predict outcome and may also be useful in making decisions about triage, quality assurance, and use of intensive care unit beds.

Deployment Surveillance Summary, U.S. Army Operation Iraqi Freedom/Operation New Dawn/Operation Enduring Freedom, 2010

DTIC Science & Technology

2012-12-10

and pain (overuse) (38 percent), joint derangement with neurological involvement (30 percent), sprain/strain/rupture of muscle or tendons (15...musculoskeletal conditions were joint derangement with neurological involvement of the lumbar spine (22 percent), inflammation and pain (overuse...musculoskeletal conditions leading to in-theater hospitalization were inflammation and pain (overuse) (63 percent), joint derangement with neurological

Evaluation of an educational, theater-based intervention on attitudes toward organ donation in Risaralda, Colombia

PubMed Central

Buitrago, Juliana; Gómez, Sandra; Guerra, Alvaro; Lucumí, Leidy; Romero, César

2013-01-01

Introduction: The shortage of organs for transplantation is a worldwide problem and the main cause is the refusal of family members to donate. Consent to donate is influenced by many factors and educational interventions are strongly recommended. Objective: To evaluate the impact of an educational, theaterbased strategy on the attitudes toward organ donation. Methods: This study employed an intervention using theater as the central tool. The impact of this intervention on the intention to donate was assessed through a controlled, prospective, nonrandomized designed study. The sample consisted of 1,038 people. All the participants answered a survey that asked about sex, age and intent to donate. Afterward, one portion of the sample was exposed to the play, The Gift of Life, and a subsequent discussion forum that was guided by experts. The same survey was administered again after the intervention. Results: Before the intervention, donation attitudes were positive in 68.3% of the responses, negative in 6.8% and uncertain in 24.9%. Females showed a greater intent to donate while age had no apparent influence on the donation decision. Those exposed to the intervention were found to be more likely to donate and show a favorable change in attitude toward donation than those who were not exposed to the intervention. Conclusion: An educational intervention using theater is an effective tool to generate a short-term change in the intent to donate. Educational strategies should be employed to increase the rates of organ donation. PMID:24892320

Seeing the Light (LBNL Science at the Theater)

DOE Office of Scientific and Technical Information (OSTI.GOV)

Brunger, Axel; Segalman, Rachel; Westphal, Andrew

2011-09-12

Berkeley Lab's Science at the Theater event "Seeing the Light" took place on Sept 12, 2011, at Berkeley Repertory's Roda Theatre. Learn how the Advanced Light Source is improving medicine, paving the way for clean energy, changing the future of computers, and much more. Featured speakers are Berkeley Lab's Roger Falcone, Rachel Segalman, Andrew Westphal, and Stanford University's Axel Brunger. Rachel Segalman: The future of clean energy technology relies on a better understanding of materials at the nanoscale. Berkeley Lab's Rachel Segalman uses the ALS to conduct this research, which could lead to improved photovoltaics and fuel cells. Axel Brunger:more » Improved treatment for human diseases hinges on understanding molecular-scale processes. Stanford University's Axel Brunger will discuss a new melanoma drug that was developed by a local company, Plexxikon, using the ALS for X-ray data collection. Andrew Westphal: What's comet dust made of? Andrew Westphal of UC Berkeley's Space Sciences Laboratory uses the ALS to study comet dust and interplanetary space dust collected by a NASA spacecraft. Moderated by Roger Falcone, Division Director of the Advanced Light Source« less

Trauma is a public health issue.

PubMed

Magruder, Kathryn M; McLaughlin, Katie A; Elmore Borbon, Diane L

2017-01-01

Exposure to trauma is pervasive in societies worldwide and is associated with substantial costs to the individual and society, making it a significant global public health concern. We present evidence for trauma as a public health issue by highlighting the role of characteristics operating at multiple levels of influence - individual, relationship, community, and society - as explanatory factors in both the occurrence of trauma and its sequelae. Within the context of this multi-level framework, we highlight targets for prevention of trauma and its downstream consequences and provide examples of where public health approaches to prevention have met with success. Finally, we describe the essential role of public health policies in addressing trauma as a global public health issue, including key challenges for global mental health and next steps for developing and implementing a trauma-informed public health policy agenda. A public health framework is critical for understanding risk and protective factors for trauma and its aftermath operating at multiple levels of influence and generating opportunities for prevention.

Inhibition of prostaglandin biosynthesis as the mechanism of analgesia of aspirin-like drugs in the dog knee joint.

PubMed

Moncada, S; Ferreira, S H; Vane, J R

1975-04-01

A method has been developed to measure the analgesic action of aspirin-like drugs in knee joints of anaesthetized dogs. Bradykinin, injected into the joint cavity, induced a reflex rise in blood pressure which was dose-dependent; this was used as a measure of nociceptive activity. The joint cavity became more sensitive to bradykinin as the experiment proceeded, or when a low concentration of prostaglandin E1 or E2 was infused locally. The increase in sensitivity with time was prevented by local injection of aspirin or indomethacin, but that induced by exogenous prostaglandin infusion was not. Injections of carrageenin into dog knee joints increased the prostaglandin E2 content of synovial fluid by up to 160 ng per joint; indomethacin prevented this increase. These experiments support our previous conclusion that local biosynthesis of a prostaglandin (induced by mild trauma) sensitizes pain receptors to mechanical or chemical stimuli. Aspirin-like drugs are analgesic because they prevent prostaglandin biosynthesis, thereby preventing this sensitization.

[Bone and joint decade--"mile step" in diagnostics and treatment of movement system diseases?].

PubMed

Brongel, Leszek; Lorkowski, Jacek; Hładki, Waldemar; Trybus, Marek

2006-01-01

Musculoskeletal disorders affect hundreds of millions of people across the world and are the most common causes of severe long-term pain and physical disability. The impact from such disorders on the individual and on society let to propose by WHO for the Decade of the Bone and Joint from 2000 to 2010. The goal of the Decade is to improve the health-related quality of life for people with musculoskeletal disorders throughout the world and this could be achieved by raising awareness of the growing burden of bone and joint diseases on society, promoting prevention and treatment and advancing understanding of musculoskeletal disorders through research. The main fields of interest during the Decade are joint diseases, spinal disorders and low back pain, osteoporosis and severe trauma of the extremities. In our Department we study problems concerning on traumatology of old patients, multitrauma injury, biomechanics in spinal disorders, in degenerative joint disease and foot diseases. Apart from contemporary imaging methods like US or CT we use pedobarographic diagnostics and fotogrammetric examination. In this study we present strategic goals and the summary of our ongoing projects in our Department related to the goals of the Bone and Joint Decade.

Gun trauma and ophthalmic outcomes.

PubMed

Chopra, N; Gervasio, K A; Kalosza, B; Wu, A Y

2018-04-01

PurposeThis retrospective cohort study assesses the visual outcomes of patients who survive gunshot wounds to the head.MethodsThe Elmhurst City Hospital Trauma Registry and Mount Sinai Data Warehouse were queried for gun trauma resulting in ocular injury over a 16-year period. Thirty-one patients over 16 years of age were found who suffered a gunshot wound to the head and resultant ocular trauma: orbital fracture, ruptured globe, foreign body, or optic nerve injury. Gun types included all firearms and air guns. Nine patients were excluded due to incorrect coding or unavailable charts. Statistical analysis was performed using a simple bivariate analysis (χ 2 ).ResultsOf the 915 victims of gun trauma to the head, 27 (3.0%) sustained ocular injuries. Of the 22 patients whose records were accessible, 18 survived. Eight of the 18 surviving patients (44%) suffered long-term visual damage, defined as permanent loss of vision in at least one eye to the level of counting fingers or worse. Neither location of injury (P=0.243), nor type of gun used (P=0.296), nor cause of gun trauma (P=0.348) predicted visual loss outcome. The Glasgow Coma Scale eye response score on arrival to the hospital also did not predict visual loss outcome (P=0.793).ConclusionThere has been a dearth of research into gun trauma and even less research on the visual outcomes following gun trauma. Our study finds that survivors of gun trauma to the head suffer long-term visual damage 44% of the time after injury.

Gender differences among recidivist trauma patients.

PubMed

Kwan, Rita O; Cureton, Elizabeth L; Dozier, Kristopher C; Victorino, Gregory P

2011-01-01

Gender differences among trauma recidivist patients are not well-understood. We hypothesized that males are more likely to be repeatedly involved in the trauma system and have a shorter time to recurrence between repeat episodes of injury compared with females. A retrospective analysis of trauma patients treated at an urban university-based trauma center was performed. Variables including gender, race, insurance status, age, mechanism of injury, outcomes, and injury secondary to domestic violence were compared. Differences were compared using χ(2) tests and log-rank (Mantel-Cox) Kaplan-Meier cumulative event curves. We identified 689 trauma recidivist patients (4.0% of all trauma visits) over a 10-y period. Compared to single-visit patients, recidivist patients were more likely to be male (87% versus 73%), uninsured (78% versus 66%), and have injuries secondary to assaults (54% versus 37%) (P < 0.05). Time from the first to second trauma visit was shorter for females compared with males (23 ± 2.5 versus 30 ± 1.2 mo, P < 0.02). Additionally, female recidivists were more likely to be involved in blunt trauma than were male recidivists (69% versus 43%, P < 0.001). Furthermore, domestic violence was identified in a higher proportion of female recidivist patients than female single-visit patients (3.5% versus 1.6%, P < 0.0003). Contrary to our hypothesis, female recidivist trauma patients have a much shorter time to recurrence for a second traumatic injury than do males. Female recidivists have a high likelihood of assault-associated injuries and domestic violence. Trauma centers should screen for domestic violence among trauma patients to aid in preventing further repeat episodes of injury. Copyright © 2011 Elsevier Inc. All rights reserved.

Trauma Focused CBT for Children with Co-Occurring Trauma and Behavior Problems

ERIC Educational Resources Information Center

Cohen, Judith A.; Berliner, Lucy; Mannarino, Anthony

2010-01-01

Objective: Childhood trauma impacts multiple domains of functioning including behavior. Traumatized children commonly have behavioral problems that therapists must effectively evaluate and manage in the context of providing trauma-focused treatment. This manuscript describes practical strategies for managing behavior problems in the context of…

Impact of Sexual Trauma on HIV Care Engagement: Perspectives of Female Patients with Trauma Histories in Cape Town, South Africa.

PubMed

Watt, Melissa H; Dennis, Alexis C; Choi, Karmel W; Ciya, Nonceba; Joska, John A; Robertson, Corne; Sikkema, Kathleen J

2017-11-01

South African women have disproportionately high rates of both sexual trauma and HIV. To understand how sexual trauma impacts HIV care engagement, we conducted in-depth qualitative interviews with 15 HIV-infected women with sexual trauma histories, recruited from a public clinic in Cape Town. Interviews explored trauma narratives, coping behaviors and care engagement, and transcripts were analyzed using a constant comparison method. Participants reported multiple and complex traumas across their lifetimes. Sexual trauma hindered HIV care engagement, especially immediately following HIV diagnosis, and there were indications that sexual trauma may interfere with future care engagement, via traumatic stress symptoms including avoidance. Disclosure of sexual trauma was limited; no women had disclosed to an HIV provider. Routine screening for sexual trauma in HIV care settings may help to identify individuals at risk of poor care engagement. Efficacious treatments are needed to address the psychological and behavioral sequelae of trauma.

Adrenal trauma: Elvis Presley Memorial Trauma Center experience.

PubMed

Mehrazin, Reza; Derweesh, Ithaar H; Kincade, Matthew C; Thomas, Adam C; Gold, Robert; Wake, Robert W

2007-11-01

Adrenal gland injury is a potentially devastating event if unrecognized in the treatment course of a trauma patient. We reviewed our single-center experience and outcomes in patients with adrenal gland trauma. We performed a retrospective review of all patients presenting with trauma to the Regional Medical Center at Memphis who had adrenal gland injuries from January 1991 through March 2006. Each chart was reviewed with attention to the demographics, associated injuries, complications, and outcomes. Patients were stratified into two subgroups according to age (35 years or younger and older than 35 years) to allow for an age-based comparison between the two groups. Of 58,000 patients presenting with trauma, 130 (0.22%) were identified with adrenal injuries, of which 8 (6.2%) were isolated and 122 (93.8%) were not. Of these 130 patients, 125 (96.2%) had their injury diagnosed by computed tomography and 5 (3.8%) had their injury diagnosed during exploratory laparotomy. Right-sided injuries predominated (78.5%), with six (4.6%) bilateral. Four patients (3.1%) underwent adrenalectomy. Seven patients (5.4%) with adrenal injuries died. One patient (0.77%) required chronic steroid therapy. Patients older than 35 years were more likely to have complications such as deep venous thrombosis, pneumonia, and urinary tract infections. Patient age of 35 years or younger was associated with a significantly increased incidence of liver lacerations. Adrenal gland injury is uncommon, although mostly associated with greater injury severity. Although adding to morbidity, most are self-limited and do not require intervention.

Developing Orthopaedic Trauma Capacity in Uganda: Considerations From the Uganda Sustainable Trauma Orthopaedic Program.