Post-mortem computed tomography improves completeness of the trauma registry: a single institution experience.

PURPOSE: To describe our institutional experience with post-mortem computed tomography (PMCT) and its impact on decedent injury severity score (ISS) and to assess the adequacy of emergently placed support medical devices. METHODS: Over a 5-year period, patients who died at or soon after arrival and have physical exam findings inconsistent with death were candidates for inclusion. Whole body CT was performed without contrast with support medical devices left in place. ISS was calculated with and without the PMCT findings. PMCT results were compared to autopsy findings, if performed. The location of support medical devices was documented. RESULTS: A total of 38 decedents underwent PMCT, including 53.1% males and a mean age of 42.0 years. Pre-PMCT ISS based on physical exam findings alone was 5.2 (range 0-25), including 16 with ISS = 0. Post-PMCT ISS using the additional imaging data was 50.3 (range 21-75), including 15 with ISS = 50 or greater. Nearly half (47.4%) had at least one support medical device that was either malpositioned or suboptimally positioned, including 26.3% with malpositioned airway devices, 10.3% with malpositioned intra-osseous catheters, and 100% with malpositioned decompressive needle thoracotomies. CONCLUSIONS: PMCT adds value in identifying injuries that otherwise may have gone undetected in lieu of a formal autopsy, thus creating a more complete trauma registry. The identification of malpositioned support lines and tubes allows for educational feedback to the first responders and trainees. Institutions with a low formal autopsy rate for trauma victims may benefit from developing a PMCT program.

Storage and release of road-salt contamination from a calcareous lake-basin fen, western Massachusetts, USA.

Road salt (NaCl) applications to highways have increased stream sodium and chloride concentrations due to retention within watersheds. The mechanisms for retention and export of Na(+) and Cl(-) from different environments are not fully understood. This field study examines the hydrologic and cation exchange processes that store and release Na(+) and Cl(-) from a calcareous fen adjacent to a highway. Despite high concentrations of Ca(2+) and Mg(2+), elevated salt concentrations enable Na(+) to occupy up to 15% of the cation exchange capacity of shallow peat. Calculations of selectivity coefficients show that Na(+) preferentially exchanges with Mg(2+), and Na(+) can be desorbed under more dilute conditions caused by precipitation and snowmelt. Detailed sampling of surface and ground waters during three snowmelt events illustrate early releases of Na(+) and Cl(-) at the onset of melting, with maximum fluxes coinciding with peak discharge. From 7 March through 4 April 2005, the flux of dissolved salt exiting the wetland amounts to 13% (Na) and 17% (Cl) of annual rock salt applied to the highway. For all of 2005, the total salt mass leaving the wetland via Kampoosa Brook is similar to the amount of road salt applied; 50% of the annual salt efflux occurred during the snowmelt season of March through May. In general, exported Na(+) and Cl(-) correlate with the number of lane miles of highway crossing the watershed. Large rain events outside of winter months are more effective than snowmelt with reducing dissolved salts because snowmelt also introduces contamination. For this and other wetlands having alkaline geochemistry and high flushing rates, management strategies that reduce rock salt amounts to roadways will assist with reducing salt contamination to levels less toxic to vegetation and aquatic organisms.

Iterative reconstruction improves image quality and preserves diagnostic accuracy in the setting of blunt solid organ injuries.

This study aims to investigate the effect of iterative reconstruction (IR) on MDCT image quality and radiologists' ability to diagnose and grade blunt solid organ injuries. One hundred (100) patients without and 52 patients with solid organ injuries were scanned on a 64-slice MDCT scanner using reference 300 mAs, 120 kVp, and fixed 75 s delay. Raw data was reconstructed using filtered back projection (FBP) and three levels of iterative reconstruction (Philips iDose levels 2, 4, and 6). Four emergency radiologists, blinded to the reconstruction parameters and original interpretation, independently reviewed each case, assessed image quality, and assigned injury grades. Each reader was then asked to determine if they thought that IR was used and, if so, what level. There was no significant difference in diagnostic accuracy between FBP and the various IR levels or effect on the detection and grading of solid organ injuries (p > 0.8). Images reconstructed using iDose level 2 were judged to have the best overall image quality (p < 0.01). The radiologists had high sensitivity in detecting if IR was used (80 %, 95 % CI 76-84 %). IR performed comparably to FBP with no effect on radiologist ability to accurately detect and grade blunt solid organ injuries.

E-portfolios and personalized learning: research in practice with two dyslexic learners in UK higher education.

This paper analyses the use of an e-portfolio system in contributing to the personalized learning of two dyslexic learners at the University of Wolverhampton, UK. The rationale for this research rests at the intersection of generic findings from e-portfolio (and wider e-learning) research and the still challenging project in higher education (HE) of creating inclusive curricula. A qualitative, ethnographic approach was employed in a piece of collaborative research between academic staff and dyslexic learners. Two retrospective learner narratives were constructed and then reviewed by all co-authors in terms of the 'personalized fit' which they allowed with dyslexic thinking, learning and writing experience. The findings suggest a potential refinement of the general pedagogical claims about e-portfolio-based learning when considering dyslexic learners and thence the value of an enhanced prioritization of e-portfolio learning practices within inclusive HE curricula. The review and analysis also allow a 'critical' discussion of the practical and theoretical issues arising within this work.