Attempting to validate the over/under triage matrix at a level I trauma center.

The Optimal Resources Document (ORD) mandates trauma activation based on injury mechanism, physiologic and anatomic criteria and recommends using the over/undertriage matrix (Matrix) to evaluate the appropriateness of trauma team activation. The purpose of this study was to assess the effectiveness of the Matrix method by comparing patients appropriately triaged with those undertriaged. We hypothesized that these two groups are different and Matrix does not discriminate the needs or outcomes of these different groups of patients.Trauma registry data, from 1/2013-12/2015, at a Level I trauma center were reviewed. Over and undertriage rates were calculated by Matrix. Patients with ISS ≥16 were classified by activation level (full, limited, consultation), and triage category by Matrix. Patients in the limited activation and consultation groups were compared to patients with full activation by demographics, injuries, initial vital signs, procedures, delays to procedure, ICU admission, length of stay, and mortality.7031 patients met activation criteria. Compliance with ACS tiered activation criteria was 99%. The Matrix overtriage rate was 45% and undertriage was 24%. Of 2282 patients with an ISS ≥16, 1026 were appropriately triaged (full activation), and 1256 were under triaged. Undertriaged patients had better GCS, blood pressure, and BD than patients with full activation. ICU admission, hospital stays, and mortality were lower in the undertriaged group. The under triaged group required fewer operative interventions with fewer delays to procedure.Despite having an ISS ≥ 16, patients with limited activations were dissimilar to patients with full activation. Level of activation and triage are not equivalent. The ACS-COT full and tiered activation criteria are a robust means to have the appropriate personnel present based on available pre-hospital information. Evaluation of the process of care, regardless of level of activation should be used to evaluate trauma center performance.Level III Therapeutic and Care managementThis is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal

New light curves and ephemeris for the close eclipsing binary V963 PER

We have obtained CCD photometry in 2010-11 of V963 Per (=GSC3355 0394), which is a recently identified close binary star with unequal eclipse depths. The seven new eclipse timings yield an improved ephemeris, but we caution that secondary eclipse can be affected by variation of the light curve. This variation seems to be on a monthly timescale at the few percent level.Comment: 6 pages, 3 figure

Rearrests during mental health court supervision: Predicting rearrest and its association with final court disposition and post-court rearrests

Mental health courts are one means to address the involvement of persons with mental illness in the criminal justice system. Using a sample of 811 participants of a municipal mental health court, this study found that 23.2% of participants were rearrested during court supervision. This study also identified factors associated with these rearrests, as well as the effect of rearrests during supervision on program completion and rearrests in the 1-year period following program completion. This study concludes with implications for mental health court supervision

An Analysis of Readmissions to a Mental Health Court

Mental health courts (MHCs) have emerged as one option to address the needs of people with severe mental illness who enter the criminal justice system. Little is known about defendants having multiple referrals to MHCs or the outcomes of subsequent admissions. This study included a sample of 1,084 defendants referred to municipal MHC. During the 13-year study period, 14.3% of defendants had a second admission, with an estimated probability of readmission of 17.4%. Key factors associated with readmission included being eligible to participate in the court but choosing not to do so, being rearrested during court supervision, and having a negative termination from supervision. Defendants who had a second admission during the study period had poorer outcomes than those with one admission. When defendants are referred for readmission to MHCs, careful assessment is required to ensure that these courts are the best alternative for them

Evaluation of a community-based hypertension improvement program (ComHIP) in Ghana: data from a baseline survey

BACKGROUND: Ghana faces an increasing burden of non-communicable disease with rates of hypertension estimated as high as 36% in adults. Despite these high rates, hypertension control remains very poor in Ghana (4%). The current project aims to implement and evaluate a community-based programme to raise awareness, and to improve treatment and control of hypertension in the Eastern Region of Ghana. In this paper, we present the findings of the baseline cross-sectional survey focusing on hypertension prevalence, awareness, treatment, and control. METHODS: To evaluate the ComHIP project, a quasi-experimental design consisted of a before and after evaluations are being implemented in the intervention and comparison districts. A cohort study component is being implemented in the intervention district to assess hypertension control. Background anthropometric and clinical data collected as part of the baseline survey were analyzed in STATA Version 11. We examined the characteristics of individuals, associated with the baseline study outcomes using logistic regression models. RESULTS: We interviewed 2400 respondents (1200 each from the comparison and intervention districts), although final sample sizes after data cleaning were 1170 participants in the comparison district and 1167 in the intervention district. With the exception of ethnicity, the control and intervention districts compare favorably. Overall 32.4% of the study respondents were hypertensive (31.4% in the control site; and 33.4% in the intervention site); 46.2% of hypertensive individuals were aware of a previous diagnosis of hypertension (44.7% in the control site, and 47.7% in the intervention site), and only around 9% of these were being treated in either arm. Hypertension control was 1.3% overall (0.5% in the comparison site, and 2.1% in the intervention site). Age was a predictor of having hypertension, and so was increasing body mass index (BMI), waist, and hip circumferences. After adjusting for age, the risk factors with the greatest association with hypertension were being overweight (aOR = 2.30; 95% CI 1.53-3.46) or obese (aOR = 3.61; 95% CI 2.37-5.51). Older individuals were more likely to be aware of their hypertension status than younger people. After adjusting for age people with a family history of hypertension or CVD, or having an unhealthy waist hip ratio, were more likely to be aware of their hypertension status. CONCLUSIONS: The high burden of hypertension among the studied population, coupled with high awareness, yet very low level of hypertension treatment and control requires in-depth investigation of the bottlenecks to treatment and control. The low hypertension treatment and control rates despite current and previous general educational programs particularly in the intervention district, may suggest that such programs are not necessarily impactful on the health of the population

Vortex dynamics in layered superconductors with correlated defects: influence of interlayer coupling

We report a detailed study of the vortex dynamics and vortex phase diagrams of two amorphous Ta_0.3Ge_0.7/Ge multilayered films with intrinsic coplanar defects, but different interlayer coupling. A pinned Bose-glass phase in the more weakly coupled sample exists only below a cross-over field H* in striking contrast to the strongly coupled film. Above H* the flux lines are thought to break up into pancake vortices and the cross-over field is significantly increased when the field is aligned along the extended defects. The two films show different vortex creep excitations in the Bose-glass phase.Comment: zip file: 1 RevTex, 5 figures (png

The structural history and mineralization controls of the world-class Geita Hill gold deposit, Geita Greenstone Belt, Tanzania

The Geita Hill gold deposit is located in the Archean Geita Greenstone Belt and is one of the largest gold deposits in East Africa. The Geita Greenstone Belt experienced a complex deformation and intrusive history that is well illustrated and preserved in and around the Geita Hill gold deposit. Deformation involved early stages of ductile shearing and folding (D1 to D5), during which episodic emplacement of large diorite intrusive complexes, sills, and dykes occurred. These ductile deformation phases were followed by the development of brittle-ductile shear zones and faults (D6 to D8). The last stages of deformation were accompanied by voluminous felsic magmatism involving the intrusion of felsic porphyry dykes, within the greenstone belt, and the emplacement of large granitic bodies now forming the margins of the greenstone belt. Early, folded lamprophyre dykes, and later lamprophyre dykes, crosscutting the folded sequence are common, although volumetrically insignificant. The gold deposit formed late during the tectonic history of the greenstone belt, post-dating ductile deformation and synchronous with the development of brittle-ductile shear zones that overprinted earlier structural elements. The main mineralizing process involved sulfide replacement of magnetite-rich layers in ironstone and locally the replacement of ferromagnesian phases and magnetite in the diorite intrusions. The intersection between the brittle-ductile (D6) Geita Hill Shear Zone and different structural elements of ductile origin (e.g., fold hinges), and the contact between banded ironstone and folded diorite dykes and sills provided the optimal sites for gold mineralization