Minor head injury in anticoagulated patients: Outcomes and analysis of clinical predictors. A prospective study

BACKGROUND

The optimal management of patients taking oral anticoagulants who experience minor head injury (MHI) is unclear. The availability of validated protocols and reliable predictors of prognosis would be of great benefit. We investigated clinical factors as predictors of clinical outcomes and intracranial injury (ICI).

METHODS

We conducted a single-cohort, prospective, observational study in an ED. Our structured clinical pathway included a first head CT scan, 24 h observation and a second CT scan. The primary outcome was the occurrence of MHI-related death or re-admission to ED at day +30. The secondary outcome was the rate of delayed ICI (dICI), defined as second positive CT scan after a first negative CT scan. We assessed some clinical predictors derived from guidelines and clinical prediction rules as potential risk factors for the outcomes.

RESULTS

450 patients with a negative first CT scan who underwent a second CT scan composed our 'study population'. The rate of the primary outcome was 4%. The rate of the secondary outcome was 4.7%. Upon univariate and multivariate analysis no statistically significant predictors for the outcomes were found.

CONCLUSIONS

Previous retrospective studies showed a lot of negative predictive factors for anticoagulated patients suffering a minor head injury. In our prospective study no clinical factors emerged as predictors of poor clinical outcomes and dICI. So, even if we confirmed a low rate of adverse outcomes, the best management of these patients in ED remains not so clear and future trials are needed.

The Role of Operating Conditions in the Precipitation of Magnesium Hydroxide Hexagonal Platelets Using NaOH Solutions

Magnesium hydroxide, Mg(OH)2, is an inorganic compound extensively employed in several industrial sectors. Nowadays, it is mostly produced from magnesium-rich minerals. Nevertheless, magnesium-rich solutions, such as natural and industrial brines, could prove to be a great treasure. In this work, synthetic magnesium chloride and sodium hydroxide (NaOH) solutions were used to recover Mg(OH)2 by reactive crystallization. A detailed experimental campaign was conducted aiming at producing grown Mg(OH)2 hexagonal platelets. Experiments were carried out in a stirred tank crystallizer operated in single- and double-feed configurations. In the single-feed configuration, globular and nanoflakes primary particles were obtained, as always reported in the literature when NaOH is used as a precipitant. However, these products are not complying with flame-retardant applications that require large hexagonal Mg(OH)2 platelets. This work suggests an effective precipitation strategy to favor crystal growth while, at the same time, limiting the nucleation mechanism. The double-feed configuration allowed the synthesis of grown Mg(OH)2 hexagonal platelets. The influence of reactant flow rates, reactant concentrations, and reaction temperature was analyzed. Scanning electron microscopy (SEM) pictures were also taken to investigate the morphology of Mg(OH)2 crystals. The proposed precipitation strategy paves the road to satisfy flame-retardant market requirements.

Computational Modeling of Magnesium Hydroxide Precipitation and Kinetics Parameters Identification

Magnesium is a critical raw material and its recovery as Mg(OH)₂ from saltwork brines can be realized via precipitation. The effective design, optimization, and scale-up of such a process require the development of a computational model accounting for the effect of fluid dynamics, homogeneous and heterogeneous nucleation, molecular growth, and aggregation. The unknown kinetics parameters are inferred and validated in this work by using experimental data produced with a T_2mm-mixer and a T_3mm-mixer, guaranteeing fast and efficient mixing. The flow field in the T-mixers is fully characterized by using the k-ε turbulence model implemented in the computational fluid dynamics (CFD) code OpenFOAM. The model is based on a simplified plug flow reactor model, instructed by detailed CFD simulations. It incorporates Bromley's activity coefficient correction and a micro-mixing model for the calculation of the supersaturation ratio. The population balance equation is solved by exploiting the quadrature method of moments, and mass balances are used for updating the reactive ions concentrations, accounting for the precipitated solid. To avoid unphysical results, global constrained optimization is used for kinetics parameters identification, exploiting experimentally measured particle size distribution (PSD). The inferred kinetics set is validated by comparing PSDs at different operative conditions both in the T_2mm-mixer and the T_3mm-mixer. The developed computational model, including the kinetics parameters estimated for the first time in this work, will be used for the design of a prototype for the industrial precipitation of Mg(OH)₂ from saltwork brines in an industrial environment.

Correction of the VIR-visible dataset from the Dawn mission at Vesta

This work describes the correction method applied to the dataset acquired at the asteroid (4) Vesta by the visible channel of the visible and infrared mapping spectrometer. The rising detector temperature during data acquisitions in the visible wavelengths leads to a spectral slope increase over the whole spectral range. This limits the accuracy of the studies of the Vesta surface in this wavelength range. Here, we detail an empirical method to correct for the visible detector temperature dependency while taking into account the specificity of the Vesta dataset.

Correction of the VIR-visible data set from the Dawn mission

Data acquired at Ceres by the visible channel of the Visible and InfraRed mapping spectrometer (VIR) on board the NASA Dawn spacecraft are affected by the temperatures of both the visible (VIS) and the infrared (IR) sensors, which are, respectively, a charged coupled device and a HgCdTe array. The variations of the visible channel temperatures measured during the sessions of acquisitions are correlated with the variations in the spectral slope and shape for all the mission phases. The IR channel temperature is more stable during the acquisitions; nonetheless, it is characterized by a bimodal distribution whether the cryocooler (and, therefore, the IR channel) is used or not during the visible channel operations. When the infrared channel temperature is high (175 K, i.e., not in use and with the cryocooler off), an additional negative slope and a distortion are observed in the spectra of the visible channel. We developed an empirical correction based on a reference spectrum for the whole dataset; it is designed to correct the two issues related to the sensor temperatures that we have identified. The reference spectrum is calculated to be representative of the global Ceres' surface. It is also made of the data acquired when the visible and infrared channel temperatures are equal to the ones measured during an observation of the Arcturus star by VIR, which is consistent with several ground-based observations. The developed correction allows reliable analysis and mapping to be performed by minimizing the artifacts induced by fluctuations of the VIS temperature. Thanks to this correction, a direct comparison between different mission phases during which the VIR experienced different visible and infrared channel temperatures is now possible.

Localized aliphatic organic material on the surface of Ceres

Organic compounds occur in some chondritic meteorites, and their signatures on solar system bodies have been sought for decades. Spectral signatures of organics have not been unambiguously identified on the surfaces of asteroids, whereas they have been detected on cometary nuclei. Data returned by the Visible and InfraRed Mapping Spectrometer on board the Dawn spacecraft show a clear detection of an organic absorption feature at 3.4 micrometers on dwarf planet Ceres. This signature is characteristic of aliphatic organic matter and is mainly localized on a broad region of ~1000 square kilometers close to the ~50-kilometer Ernutet crater. The combined presence on Ceres of ammonia-bearing hydrated minerals, water ice, carbonates, salts, and organic material indicates a very complex chemical environment, suggesting favorable environments to prebiotic chemistry.

Artifacts reduction in VIR/Dawn data

Remote sensing images are generally affected by different types of noise that degrade the quality of the spectral data (i.e., stripes and spikes). Hyperspectral images returned by a Visible and InfraRed (VIR) spectrometer onboard the NASA Dawn mission exhibit residual systematic artifacts. VIR is an imaging spectrometer coupling high spectral and spatial resolutions in the visible and infrared spectral domain (0.25-5.0 μm). VIR data present one type of noise that may mask or distort real features (i.e., spikes and stripes), which may lead to misinterpretation of the surface composition. This paper presents a technique for the minimization of artifacts in VIR data that include a new instrument response function combining ground and in-flight radiometric measurements, correction of spectral spikes, odd-even band effects, systematic vertical stripes, high-frequency noise, and comparison with ground telescopic spectra of Vesta and Ceres. We developed a correction of artifacts in a two steps process: creation of the artifacts matrix and application of the same matrix to the VIR dataset. In the approach presented here, a polynomial function is used to fit the high frequency variations. After applying these corrections, the resulting spectra show improvements of the quality of the data. The new calibrated data enhance the significance of results from the spectral analysis of Vesta and Ceres.

Distribution of phyllosilicates on the surface of Ceres

The dwarf planet Ceres is known to host phyllosilicate minerals at its surface, but their distribution and origin have not previously been determined. We used the spectrometer onboard the Dawn spacecraft to map their spatial distribution on the basis of diagnostic absorption features in the visible and near-infrared spectral range (0.25 to 5.0 micrometers). We found that magnesium- and ammonium-bearing minerals are ubiquitous across the surface. Variations in the strength of the absorption features are spatially correlated and indicate considerable variability in the relative abundance of the phyllosilicates, although their composition is fairly uniform. These data, along with the distinctive spectral properties of Ceres relative to other asteroids and carbonaceous meteorites, indicate that the phyllosilicates were formed endogenously by a globally widespread and extensive alteration process.

The diurnal cycle of water ice on comet 67P/Churyumov-Gerasimenko

Observations of cometary nuclei have revealed a very limited amount of surface water ice, which is insufficient to explain the observed water outgassing. This was clearly demonstrated on comet 9P/Tempel 1, where the dust jets (driven by volatiles) were only partially correlated with the exposed ice regions. The observations of 67P/Churyumov-Gerasimenko have revealed that activity has a diurnal variation in intensity arising from changing insolation conditions. It was previously concluded that water vapour was generated in ice-rich subsurface layers with a transport mechanism linked to solar illumination, but that has not hitherto been observed. Periodic condensations of water vapour very close to, or on, the surface were suggested to explain short-lived outbursts seen near sunrise on comet 9P/Tempel 1. Here we report observations of water ice on the surface of comet 67P/Churyumov-Gerasimenko, appearing and disappearing in a cyclic pattern that follows local illumination conditions, providing a source of localized activity. This water cycle appears to be an important process in the evolution of the comet, leading to cyclical modification of the relative abundance of water ice on its surface.

Cometary science. The organic-rich surface of comet 67P/Churyumov-Gerasimenko as seen by VIRTIS/Rosetta

The VIRTIS (Visible, Infrared and Thermal Imaging Spectrometer) instrument on board the Rosetta spacecraft has provided evidence of carbon-bearing compounds on the nucleus of the comet 67P/Churyumov-Gerasimenko. The very low reflectance of the nucleus (normal albedo of 0.060 ± 0.003 at 0.55 micrometers), the spectral slopes in visible and infrared ranges (5 to 25 and 1.5 to 5% kÅ(-1)), and the broad absorption feature in the 2.9-to-3.6-micrometer range present across the entire illuminated surface are compatible with opaque minerals associated with nonvolatile organic macromolecular materials: a complex mixture of various types of carbon-hydrogen and/or oxygen-hydrogen chemical groups, with little contribution of nitrogen-hydrogen groups. In active areas, the changes in spectral slope and absorption feature width may suggest small amounts of water-ice. However, no ice-rich patches are observed, indicating a generally dehydrated nature for the surface currently illuminated by the Sun.

Ethanol in biological fluids: headspace GC measurement

The present study evaluates the suitability of headspace gas chromatography (GC) with a capillary column as a method for determining the ethanol content in different biological fluids. This procedure allows the use of headspace GC not only as a reference method but also in routine diagnostics and monitoring work. The recent literature reviewed reports no standardized methodology that is at the same time suitable for ethanol determination in all routinely available biological fluids (blood, serum, plasma, urine, and saliva). The proposed procedure seems to be a good solution to the problem. The reproducibility study for the biological fluids tested resulted in coefficients of variation that ranged from 0.8 to 2.9% and recoveries that averaged 99%. Linearity was verified in the range of 0.01-20 g/L of ethanol in aqueous solutions. Sensitivity was determined to be 0.01 g/L. Ethanol measurement by this method is easy, simple, and highly reliable, and only a small sample volume (0.1 mL) is required. An internal standard and sample manipulation are not necessary. The obtained results suggest that the use of headspace GC could be extended from confirmatory analyses to routine application in many biomedical fields.

[Nutritional studies in a commune of Lazio. Anthropometric data and food consumption in childhood]

The present study concerns with anthropometric and nutritional data collected in the school population of a small rural town in Lazio. We studied 368 school-children of both sexes, belonging to the following age groups: from 7 to 8 years, 9 to 10 years, 11 to 12 years, 13 to 14 years. The technique of evaluation of obesity used in this paper is: weight 20% higher than the height-adjusted figure according to NCHS's curves and triceps skinfold higher than 90 degrees centile according to Tanner's curves. Dietary intake was assessed by a "24 hour-recall" on three consecutive days one of which of holiday. The prevalence of obesity is 17.7%. In all the age groups daily caloric intake is adjusted to that recommended by Italian 1987 Larn. On the other hand the single nutrient's assumption shows important differences from Larn. Particularly in all the age groups daily protein intake is high (14.6%-15.8% of the energy in a day), with an increased animal-vegetable protein ratio (1.5-2.1). Dietary lipids are higher than 35.9% of day's energy (35.9%-39.5%); the polyunsaturated/saturated fatty acids ratio is low (0.3-0.5). Cholesterol in the diet (231-347 mg/day) exceeds the level recommended. The daily intake of total carbohydrates (45.3%-48.5%) is low. Crude fiber intake increases with age from 2.8 g to 4.5 g/day. There is no statistical difference between obese and not obese subjects for what concerns energy intake or single nutrient's assumption.(ABSTRACT TRUNCATED AT 250 WORDS)