Enhancing trauma registries by integrating traffic records and geospatial analysis to improve bicyclist safety

BACKGROUND

Trauma registries are used to identify modifiable injury risk factors for trauma prevention efforts. However, these may miss factors useful for prevention of bicycle-automobile collisions, such as vehicle speeds, driver intoxication, street conditions, and neighborhood characteristics. We hypothesize that (GIS) analysis of trauma registry data matched with a traffic accident database could identify risk factors for bicycle-automobile injuries and better inform injury prevention efforts.

METHODS

The trauma registry of a US Level I trauma center was used retrospectively to identify bicycle-motor vehicle collision admissions from January 1, 2010, to December 31, 2018. Data collected included demographics, vitals, injury severity scores, toxicology, helmet use, and mortality.Matching with the Statewide Integrated Traffic Records System was done to provide collision, victim and GIS information. The GIS mapping of collisions was done with census tract data including poverty level scoring. Incident hot spot analysis to identify statistically significant incident clusters was done using the Getis Ord Gi* statistic.

RESULTS

Of 25,535 registry admissions, 531 (2.1%) were bicyclists struck by automobiles, 425 (80.0%) were matched to Statewide Integrated Traffic Records System. Younger age (odds ratio [OR], 1.026; 95% confidence interval [CI], 1.013-1.040, p < 0.001), higher census tract poverty level percentage (OR, 0.976; 95% CI, 0.959-0.993, p = 0.007), and high school or less education (OR, 0.60; 95 CI, 0.381-0.968; p = 0.036) were predictive of not wearing a helmet. Higher census tract poverty level percentage (OR, 1.019; 95% CI, 1.004-1.034; p = 0.012) but not educational level was predictive of toxicology positive-bicyclists in automobile collisions. Geographic information systems analysis identified hot spots in the catchment area for toxicology-positive bicyclists and lack of helmet use.

CONCLUSION

Combining trauma registry data and matched traffic accident records data with GIS analysis identifies additional risk factors for bicyclist injury. Trauma centers should champion efforts to prospectively link public traffic accident data to their trauma registries.

LEVEL OF EVIDENCE

Prognostic and Epidemiological, level III.

Survey of National Surgical Site Infection Surveillance Programs in Low- and Middle-Income Countries

Background: Surgical site infection (SSI) surveillance programs are strongly recommended as a core component of effective national infection prevention and control (IPC) programs. Participation in national SSI surveillance (nSSIS) programs has been shown to decrease reported SSIs among high-income countries (HICs), and it is expected that the same is possible among low- and middle-income countries (LMICs). We sought to determine what, if any nSSIS programs exist among LMICs. Methods: A cross-sectional survey was performed to evaluate existence of nSSIS of World Bank-defined LMICs. A digital survey assessment for presence of national IPC and nSSIS programs was delivered to persons capable of identifying the presence of such a program. Statistical analysis was performed using STATA. Institutional Review Board approval was obtained for this study. Results: Of the 137 countries identified, 55 (40%) were upper middle income (UMI), 47 (34%) were lower middle income (LMI), and 34 (25%) were low income. Representatives from 39 (28%) LMICs completed the survey. Of these respondent countries, 13 (33%) reported the presence of a national IPC program. There was no difference between countries with IPC programs and those without with respect to country income designation, population size, World Health Organization region, or conflict status. Only five (13% of all respondents) reported presence of a nSSIS program. Conclusions: National surgical site infection surveillance programs are an integral component of a country's ability to provide safe surgical procedures. Presence of nSSIS was reported infrequently in LMICs. International governing bodies should be encouraged to guide LMIC leadership in establishing a nSSIS infrastructure that will help enable safe surgical procedures.

Is the additional greenhouse effect already evident in the current climate?

Several greenhouse gases, which are in part or entirely produced by human activities, have accumulated in the atmosphere since approximately the middle of the 19th century. They are assumed to have an additional greenhouse effect causing a further increase of atmospheric temperatures near the ground and a decrease in the layers above approximately 15 km altitude. The currently observed near-surface warming over nearly the entire globe is already considered by a large fraction of our society to be result of this additional greenhouse effect. Complete justification of this assumption is, however, not yet possible, because there are still too many unknowns in our knowledge of participating processes and in our modeling capabilities.

Effect of site-specific modification on restriction endonucleases and DNA modification methyltransferases

Restriction endonucleases have site-specific interactions with DNA that can often be inhibited by site-specific DNA methylation and other site-specific DNA modifications. However, such inhibition cannot generally be predicted. The empirically acquired data on these effects are tabulated for over 320 restriction endonucleases. In addition, a table of known site-specific DNA modification methyltransferases and their specificities is presented along with EMBL database accession numbers for cloned genes.

Comprehensive restriction enzyme lists to update any DNA sequence computer program

Restriction enzyme lists are presented for the practical working geneticist to update any DNA computer program. These lists combine formerly scattered information and contain all presently known restriction enzymes with a unique recognition sequence, a cut site, or methylation (in)sensitivity. The lists are in the shortest possible form to also be functional with small DNA computer programs, and will produce clear restriction maps without any redundancy or loss of information. The lists discern between commercial and noncommercial enzymes, and prototype enzymes and different isoschizomers are cross-referenced. Differences in general methylation sensitivities and (in)sensitivities against Dam and Dcm methylases of Escherichia coli are indicated. Commercial methylases and intron-encoded endonucleases are included. An address list is presented to contact commercial suppliers. The lists are constantly updated and available in electronic form as pure US ASCII files, and in formats for the DNA computer programs DNA-Strider for Apple Macintosh, and DNAsis for IBM personal computers or compatibles via e-mail from the internet address: NETSERV@EMBL-HEIDELBERG.DE by sending only the message HELP RELIBRARY.

Nucleotide sequence analysis of soybean small heat shock protein genes belonging to two different multigene families

In soybean, the small heat shock proteins of 15 to 18 kDa are encoded in the nucleus by at least two different multigene families, designated class I and class VI. Genomic DNA sequences of two new heat shock genes and flanking regions were determined: Gmhsp18.5-C, a class I gene, and Gmhsp17.9-D, the first known class VI gene. Comparison of both genes revealed a moderate homology (approx. 38%) mainly within the 3' ends of their coding regions. Hydropathic characterizations and secondary-structure predictions of the deduced amino acid sequences revealed two conserved domains within the C-terminal halves of the polypeptides that are also present in related proteins of other organisms. The transcription of both genes is heat shock dependent and the mRNA start sites, as determined by S1 nuclease mapping, are located downstream from typical TATA box sequences and multiple heat shock promoter elements such as 5' CT-GAA--TTC-AG. The putative promoter regions of the genes are preceded by long tracts of repetitive sequences with a high A + T content of 79 to 89%, which are bordered by runs of "simple sequences" such as (A) 12/13, (T)10 and (TA)10. Similar characteristic features are present in the promoter and 5'-flanking regions of other soybean heat shock genes. The possible function of these distinct sequences is discussed.

Functional analysis of sequences required for transcriptional activation of a soybean heat shock gene in transgenic tobacco plants

The 5' DNA sequences involved in the thermal inducibility of the soybean heat shock gene hs6871 were analysed in transgenic tobacco plants. The transcriptional activity of various in vitro generated deletion mutants was examined by Northern blot analysis, S1 nuclease mapping and dot-blot hybridization. At least 181 bp upstream from the translational start site are sufficient for thermal induction at 40 degrees C and correct initiation of transcripts. Full promoter activity with the induction of wild-type levels of transcripts requires additional upstream sequences contained within 439 bp 5' to the coding sequence. Our results suggest that faithful regulation and the generation of high levels of hs6871-specific mRNA depend on the presence of sequences which show homology to the 14-bp heat shock consensus element of Drosophila and, in addition, on as yet unidentified enhancer-like upstream sequences.

The DNA sequence analysis of soybean heat-shock genes and identification of possible regulatory promoter elements

The soybean possesses a gene family encoding the major low mol. wt. heat-shock proteins of 15-18 kd. We have determined the primary DNA sequences of two of the genes, both located on the same subgenomic DNA fragment. The protein coding regions are characterized by long uninterrupted open reading frames and by sequence homology of 92% and 100% with a heat-shock specific cDNA. One protein sequence deduced from the completely cloned gene hs6871 is composed of 153 amino acids with a total mol. wt. of 17.3 kd; the other protein is a truncated polypeptide containing 73 amino acids at the carboxy-terminal end of an incompletely cloned heat-shock gene designated hs6834. Investigations of the hydrophilic/hydrophobic characteristics of the polypeptides revealed a conservation of structural features between heat-shock proteins from soybean, Caenorhabditis and Drosophila and mammalian lens alpha-crystallin. The 5' end of the soybean heat-shock gene hs6871 was mapped by S1 nuclease at a position which is 100 nucleotides upstream from the translation start codon and 25 nucleotides downstream from a TATA-box sequence. Six other potential promoter elements which are homologous to the Drosophila heat-shock consensus sequence CT-GAA-TTC-AG-, are present within 150 nucleotides upstream from the TATA-box. The possible functions of these promoter elements in transcriptional regulation of expression of soybean heat-shock gene are discussed.

[Diagnosis and therapy of liver echinococcus (author's transl)]

From 1970 to April 1975 42 patients were treated for Echinococcus of the liver at the Bonn University Dept. of Surgery. There were 33 cases of E. cysticus and 9 cases of E. alveolaris. These two types of Echinococcus, different in parasitology and epidemiology present different clinical manifestation of disease with different course and prognosis. Angiography with celiaco- and superselective hepaticography are decisive for diagnosis. Therapy can only be surgical with total removal of the parasites. In E. cysticus this is almost always possible by enucleation-resection or pericystectomie following evacuation of the cyst and instillation of 20% sodium-chloride or formaldehyde. Such radicality is the exception in E. alveolaris. Here partial resections, biliodigestive and hepatodigestive anastomoses as palliative measures are carried out predominantly to ensure bile passage.

Management of hemorrhage from esophageal varices using the esophagoscopic sclerosing method

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