Trauma systems are associated with increased level 3 trauma centers.

BACKGROUND: State-supported trauma systems have a proven association with improved mortality, but to date, there are no data reported on what mechanism leads to this benefit. Our hypothesis is that trauma systems with funding support are associated with increased number of trauma centers (TCs). MATERIALS AND METHODS: A retrospective population study: data for the number of American College of Surgeons-verified adult TCs in 2010 were obtained from the American College of Surgeons and for state-designated TCs from state departments of health. Population and gross domestic product (GDP) were obtained from the US Census. The main outcome measure was the number of TCs per population and per GDP. Statistical analysis was carried out using the Mann-Whitney U-test and Poisson regression. RESULTS: There was no association between a trauma system and the numbers of level 1 or 2 centers. In states with funded trauma systems, the numbers of level 3 centers per GDP and per million state population were 4.76 ± 2.37/$100 billion and 1.77 ± 0.51/million people compared with 0.72 ± 1.72/$100 billion and 0.28 ± 0.60/million people for unfunded states (P < 0.05). Poisson multivariate regression identified system funding as an independent predictor of number of level 3 centers. CONCLUSIONS: Our study shows that the number of level 3 TCs significantly and independently correlated with the presence of a funded trauma system. The number of level 1 and 2 centers showed no such correlation. Further study will determine if increased number of level 3 centers leads to improved clinical outcome.

Total Synthesis of K777: Successful Application of Transition-Metal-Catalyzed Alkyne Hydrothiolation toward the Modular Synthesis of a Potent Cysteine Protease Inhibitor.

We report the total synthesis of K777 and a series of analogues via alkyne hydrothiolation catalyzed by Wilkinson's complex (ClRh(PPh3)3). The alkyne hydrothiolation reactions proceeded with excellent regio- and diastereoselectivity to generate the desired E-linear vinyl sulfides in high yield. The use of Ellman's auxiliary generates the requisite propargyl amines in excellent enantiomeric excess (ee) and obviates the use of L-homophenylalanine, an expensive unnatural amino acid. The vinyl sulfone derivatives exhibit a large difference in rate toward Michael addition. Kinetic data are consistent with rate-limiting nucleophilic attack to generate the carbanion intermediate.