Rotational thromboelastometry thresholds for patients at risk for massive transfusion.

BACKGROUND: Goal-directed hemostatic resuscitation based on thrombelastography has a survival benefit compared to conventional coagulation assays. While thrombelastography transfusion thresholds for patients at risk for massive transfusion (MT) have been defined, similar cutoffs do not exist for the other commonly used viscoelastic assay, rotational thromboelastometry (ROTEM). The purpose of this study was to develop ROTEM blood product thresholds in patients at risk for MT. METHODS: ROTEM was assessed in trauma activation patients admitted from 2010 to 2016 (n = 222). Receiver operating characteristic curve analyses were performed to test the predictive performance of ROTEM measurements in patients requiring MT. The Youden Index defined optimal thresholds for ROTEM-based resuscitation. RESULTS: Patients who required MT (n = 37, 17%) were more severely injured. EXTEM clotting time (CT) was longer in patients with MT compared to non-MT (87 versus 64 s, P < 0.0001). EXTEM angle was shallower in MT patients compared to non-MT (54° versus 69°, P < 0.0001). Clot amplitude after 10 min (CA10) was less in MT compared to non-MT patients (30.5 versus 50 mm, P < 0.0001). Clot lysis index 60 min (CLI60) was lower in patients who had MT than non-MT (47 versus 94%, P = 0.0006). EXTEM CT yielded an area under the receiver operating characteristic curve (AUROC) = 0.7116 and a cut point of >78.5 s. EXTEM angle had an AUROC = 0.865 and a cut point of <64.5°. EXTEM CA10 had an AUROC = 0.858, with a cut point of <40.5 mm. CLI60 had an AUROC = 0.6788 with a cut point at <74%. CONCLUSIONS: We have identified ROTEM thresholds for transfusion of blood components in severely injured patients requiring an MT. Based on our analysis, we propose plasma transfusion for EXTEM CT > 78.5 s, fibrinogen for angle <64.5°, platelet transfusion for CA10 < 40.5 mm, and antifibrinolytics for CLI60 < 74%.

Camera Calibration for Water-Biota Research: The Projected Area of Vegetation.

Imaging systems have an indisputable role in revealing vegetation posture under diverse flow conditions, image sequences being generated with off the shelf digital cameras. Such sensors are cheap but introduce a range of distortion effects, a trait only marginally tackled in hydraulic studies focusing on water-vegetation dependencies. This paper aims to bridge this gap by presenting a simple calibration method to remove both camera lens distortion and refractive effects of water. The effectiveness of the method is illustrated using the variable projected area, computed for both simple and complex shaped objects. Results demonstrate the significance of correcting images using a combined lens distortion and refraction model, prior to determining projected areas and further data analysis. Use of this technique is expected to increase data reliability for future work on vegetated channels.

The role of government and community in the scaling up and sustainability of mutual health organisations: An exploratory study in Ghana.

Governments of many developing countries, including those in Sub-Saharan Africa have embraced the community-based health insurance schemes phenomenon under the health sector reforms with optimism. Ghana has introduced a National Health Insurance Scheme, which is amalgamated with social health insurance and community-based health insurance schemes. The aim of this study was to explore the role of the Ghana government and community in the scaling-up and sustainability of mutual health organisations. Four district mutual health insurance schemes were selected using geographical locations, among other criteria, as case studies. Data were gathered through interviews and documentary/literature review. The findings of the empirical study were analysed and interpreted using social policy and community field theories. The findings of the paper suggest that in order to ensure their effective scaling up and maintain overall sustainability, there is the need for some form of government regulation and subsidy. However, since government regulation cannot work without the acceptance of the community, there is the need to integrate these actors in policy formulation.

Management of the patient with coagulation disorders.

Understanding normal haemostasis and the pathophysiology of its disorders is essential for providing optimal care and ensuring judicious usage of blood products, as is keeping abreast of novel therapeutic modalities in a rapidly evolving field. The growing availability of synthetic coagulation factors has (at least in the western hemisphere) helped to reduce morbidity and therapeutic complications, while expanding the indications and usage of these agents. Promising advances in gene therapy may indeed introduce a sea change in the next decade or two.