Spontaneous Pneumomediastinum and Subcutaneous Emphysema Associated With Diabetic Ketoacidosis: A Case Report.

Hamman's syndrome or Macklin phenomenon - spontaneous pneumomediastinum - is an uncommon condition that often gets missed due to the lack of awareness. It may rarely be associated with diabetic ketoacidosis (DKA) due to repeated vomiting or Kussmaul breathing associated with it. This condition is self-resolving, and improvement in symptoms is usually observed with appropriate management of DKA. Secondary pneumomediastinum is relatively more common, but spontaneous pneumomediastinum, which is rare, is often diagnosed incidentally. Here, we describe a case of a 24-year-old gentleman where this condition was found incidentally during the examination and was confirmed through imaging (X-ray and CT scans) and resolved with successful management of DKA.

A Conceptual Framework for Industrial Digital Transformation in the COVID-19 Pandemic Era.

Manufacturing has been hugely affected by the COVID-19 pandemic, with many critical global value chains either halted or seriously interrupted. Most interactions with customers and employees have to take place in a contactless or virtual way. As such, digital operation is the way to remain in business through mandatory shutdowns and restricted activity. To that end, this paper presents a literature review on the acceleration of the digital transformation triggered by COVID-19 as a catalyst in the utilization of Industry 4.0 technologies. Furthermore, a conceptual framework for digital transformation and Small Medium Enterprises (SMEs) business models change is proposed.

A Hybrid Teaching Factory Model for Supporting the Educational Process in COVID-19 era.

The lockdown due to SARS-CoV-2 (COVID-19) pandemic forced both educators and students to swift and rely on digital technologies in order to ensure the successful completion of modules based on the official curriculum. Universities are still facing the challenging issue to offer high quality learning opportunities without risking participants' health. Towards that end, the current study presents a Hybrid Model under the Teaching Factory framework concept that has been successfully implemented and validated. In a hybrid laboratory case study, Engineering students guided remotely laboratory personnel towards a successful manufacture and assembly of a customized remote-control car. Benefits and boundaries of the current approach are discussed along with future perspectives.

Assessment of mortality in older trauma patients sustaining injuries from falls or motor vehicle collisions treated in regional level I trauma centers.

OBJECTIVE: To compare mortality in elderly trauma patients sustaining fall or motor vehicle collision (MVC) related injuries and who are subsequently treated at regional Level I (tertiary) trauma centers. SUMMARY BACKGROUND DATA: An increase in the mean age of the Canadian population is leading to a higher proportion of older patients injured in falls who are subsequently treated at Level 1 trauma centers in Quebec. The Level 1 centers were designed to treat younger patients injured in MVCs and violent acts. As a result, discordance may exist between the type of care supplied at these centers and the increased demand for care tailored to older trauma patients. METHODS: A retrospective cohort study comprised of 4,717 patients over the age of 65; 606 (12.8%) injured in MVCs and 4,111 (87.2%) in falls. The mean (SD) age was 79.6 (8.0) years and 67.9% were female. The mean (SD) Injury Severity Score (ISS) was 10.8 (7.4). Data were obtained from the Quebec Trauma Registry (QTR) for patients treated at 3 Level I trauma centers in the province of Quebec, Canada. The primary outcome measure in this study was mortality. RESULTS: Being injured in a fall was a strong predictor for mortality, with an odds ratio of 5.11 (95% C.I. = 1.84-14.17, P = 0.002). Additionally, the adjusted mortality rate was 25.3% among fall victims, versus 7.8% for MVC patients. Female gender, older age, higher ISS and an increasing number of injuries were all associated with heightened mortality. In contrast, the number of body regions injured, experiencing complications, sustaining a hip fracture, the Revised Trauma Score, the Prehospital Index and the Charlson (comorbidity) Index had no association with mortality in the Level I centers. CONCLUSIONS: Elderly patients sustaining fall-related injuries and treated at Level I trauma centers are at risk for excess mortality when compared with those injured in MVCs. Effective and efficient methods for treating this population must be determined.

Functional status and quality of life in survivors of injury treated at tertiary trauma centers: what are we neglecting?

BACKGROUND: The purpose of this study was to describe the functional status and quality of life (QOL) of patients at 12 months after injury. METHODS: Retrospective study consisting of patients treated at three tertiary trauma centers for injuries. Functional capacity (FC) was measured using the Sickness Impact Profile and QOL was measured using the Medical Outcomes Study Short Form (MOS SF-36) at approximately 12 months after the date of injury. RESULTS: There were 144 patients that fulfilled the study inclusion and exclusion criteria. The mean duration of follow-up was 1.3 years, with a range of 0.8 to 1.5 years. Age and gender were not associated with the FC or QOL. The mean(standard deviation) Injury Severity Score (ISS) was 18.9(9.4), whereas ISS category distribution was 1 to 11 (22.9%), 12 to 24 (50.0%), and 25 to 49 (27.1%). Patients with an ISS of 25 to 49 had significantly worse physical (p = 0.008) and total (p = 0.023) Sickness Impact Profile scores and had more physical functioning (p = 0.096), emotional role functioning (p = 0.080), and energy (p = 0.017) impairments when compared with those with an ISS less than 24. Patients injured in motor vehicle collisions had significantly impaired psychosocial function (p = 0.031), whereas those injured in falls had reduced quality of life scores for physical function (p = 0.089), physical role (p = 0.066), and mental health (p = 0.081). CONCLUSION: Patients who survive injuries experience residual impairments in FC and QOL for as long as 1 year after injury. Changes to the long-term management of these patients should be considered.