Injury Severity is a Key Contributor to Coagulation Dysregulation and Fibrinogen Consumption.

Background: Traumatic injury is a leading cause of death for those under the age of 45, with 40% occurring due to hemorrhage. Severe tissue injury and hypoperfusion lead to marked changes in coagulation, thereby preventing formation of a stable blood clot and increasing hemorrhage associated mortality. Objectives: We aimed to quantify changes in clot formation and mechanics occurring after traumatic injury and the relationship to coagulation kinetics, and fibrinolysis. Methods: Plasma was isolated from injured patients upon arrival to the emergency department. Coagulation kinetics and mechanics of healthy donors and patient plasma were compared with rheological, turbidimetric and thrombin generation assays. ELISA's were performed to determine tissue plasminogen activator (tPA) and D-dimer concentration, as fibrinolytic markers. Results: Sixty-three patients were included in the study. The median injury severity score (ISS) was 17, median age was 37.5 years old, and mortality rate was 30%. Rheological, turbidimetric and thrombin generation assays indicated that trauma patients on average, and especially deceased patients, exhibited reduced clot stiffness, increased fibrinolysis and reduced thrombin generation compared to healthy donors. Fibrinogen concentration, clot stiffness, D-dimer and tPA all demonstrated significant direct correlation to increasing ISS. Machine learning algorithms identified and highlighted the importance of clinical factors on determining patient outcomes. Conclusions: Viscoelastic and biochemical assays indicate significant contributors and predictors of mortality for improved patient treatment and therapeutic target detection. ESSENTIALS: Traumatic injury may lead to alterations in a patient's ability to form stable blood clotsA study was performed to assess how trauma severity affects coagulation kineticsKey alterations were observed in trauma patients, who exhibit weaker and slower forming clotsPaired with machine learning methods, the results indicate key aspects contributing to mortality.

Estimating drug consumption during a college sporting event from wastewater using liquid chromatography mass spectrometry.

Consumption of licit and/or illicit compounds during sporting events has traditionally been monitored using population surveys, medical records, and law enforcement seizure data. This pilot study evaluated the temporal and geospatial patterns in drug consumption during a university football game from wastewater using liquid chromatography tandem mass spectrometry (LC-MS/MS). Untreated wastewater samples were collected from three locations within or near the same football stadium every 30 min during a university football game. This analysis leveraged two LCMS/ MS instruments (Waters Acquity TQD and a Shimadzu 8040) to analyze samples for 58 licit or illicit compounds and some of their metabolites. Bayesian multilevel models were implemented to estimate mass load and population-level drug consumption, while accounting for multiple instrument runs and concentrations censored at the lower limit of quantitation. Overall, 29 compounds were detected in at least one wastewater sample collected during the game. The 10 most common compounds included opioids, anorectics, stimulants, and decongestants. For compounds detected in more than 50% of samples, temporal trends in median mass load were correlated with the timing of the game; peak loads for cocaine and tramadol occurred during the first quarter of the game and for phentermine during the third quarter. Stadium-wide estimates of the number of doses of drugs consumed were rank ordered as follows: oxycodone (n = 3246) > hydrocodone (n = 2260) > phentermine (n = 513) > cocaine (n = 415) > amphetamine (n = 372) > tramadol (n = 360) > pseudoephedrine (n = 324). This analysis represents the most comprehensive assessment of drug consumption during a university football game and indicates that wastewater-based epidemiology has potential to inform public health interventions focused on reducing recreational drug consumption during large-scale sporting events.

A metrics framework to get and keep management engaged.

Conferences and webinar presentations regularly extol the importance of executive support when building a successful, sustainable business continuity, IT disaster recovery, crisis or emergency management programme. When executives are engaged, it is a beautiful thing. One feels empowered and appreciated. Then one day, it is gone. Or worse, it was never there. Was it somebody's fault, or was it some other factor? Business continuity management (BCM) practitioners monitor the progression of their efforts and quality of results through metrics. However, which metrics or key performance indicators provide the greatest value, particularly in the context of gaining and keeping executive support? This paper reviews several traditional metrics models, assessing both the positive and negatives that each offer. This is followed by an in-depth overview of the Business Continuity Maturity Model (BCMM), a publicly-available organisation resilience programme assessment tool that, when applied effectively, provides a rigorous framework for programme assessment and ongoing metrics reporting. This is followed by an analysis of the models, and recommendations on the use of metrics to tell a resiliency story that demonstrates value.

Assessment of physician preparedness and response capacity to bioterrorism or other public health emergency events in a major metropolitan area.

BACKGROUND: The role of physicians in the detection, reporting, and response to infectious disease outbreaks, anomalous biologic events, or other public health emergencies is critical to the community's safety. OBJECTIVE/METHOD: In an effort to assess the level of preparedness of local physicians to respond to such events, the City of Fort Worth Public Health Department, the Fort Worth/Tarrant County Health Authority, and the Tarrant County Medical Society collaborated in designing and administering a cross-sectional study in spring 2006. RESULTS: The results serve as a baseline of the local clinical community's preparedness, with 91% of local physicians reporting their knowledge as "fair-poor," 80% desiring more information, and 83% favoring more training opportunities. CONCLUSION: Information obtained through this assessment is used to help cultivate educational interventions that will enhance the participation, integration, and mobilization of clinicians in the event of a community emergency.