Firearm Acoustic Detection in Hartford, Connecticut: Outcomes of a Trauma Center - Law Enforcement Collaboration.

Introduction Firearm homicide is a leading cause of violence-related death in the United States.Unfortunately, more than 80% of illegal firearm discharges are never reported to police by traditional means.ShotSpotterTM (Newark, California) is an acoustic firearm event detection system that can localize gunfire, prompting police, and subsequent emergency medical services (EMS) presence. Previously reported healthcare effects of acoustic detection are speculative in nature. We sought to investigate Hartford, Connecticut's experience with ShotSpotter​​​​​​​TM given its smaller size and broad coverage.  Methods The three trauma centers in Hartford (two for adults and one for pediatric) collaborated with the Hartford Police to review outcomes of victims with acoustically detected gunshots and compare them to those who went undetected. We performed a retrospective review of patients who presented with gunshot wounds (GSW) over a 30-month period, from January 1, 2016 to June 30, 2018. Victim location and acoustic detection were reconciled by the police department and hospital staff independently. Patients were individually matched for location, prehospital response, treatment durations, and hospital outcomes. Results Of 387 GSW, 157 (40.6%) presented via EMS and were included in the sample. Of these, 89 correlated to a detection event (56.7%) and 68 had no correlating event (43.3%). These two groups had no difference in prehospital treatment times, scene and transport duration, and injury severity. Further, the need for surgery or transfusion, lengths of stay, and disposition, including mortality, did not differ. Conclusions Despite limited previous reports demonstrating conferred benefits to acoustic detection of gunshots, Hartford's experience showed no benefit. The potential for such systems to act as early warning systems is evident but may depend on a city's resources, geography, and technology.

The Use of Immersive and Virtual Reality Technologies to Enable Nursing Students to Experience Scenario-Based, Basic Life Support Training-Exploring the Impact on Confidence and Skills.

The link between effective basic life support and survival following cardiac arrest is well known. Nurses are often first responders at in-hospital cardiac arrests and receive annual basic life support training to ensure they have the adequate skills, and student nurses are taught this in preparation for their clinical practice. However, it is clear that some nurses still lack confidence and skills to perform basic life support in an emergency situation. This innovative study included 209 participants, used a mixed-methods approach, and examined three environments to compare confidence and skills in basic life support training. The environments were nonimmersive (basic skills room), immersive (immersive room with video technology), and the Octave (mixed reality facility). The skills were measured using a Laerdal training manikin (QCPR manikin), with data recorded on a wireless Laerdal Simpad, and confidence levels before and after training were measured using a questionnaire. The nonimmersive and the immersive rooms were familiar environments, and the students felt more comfortable, relaxed, and, thus, more confident. The Octave offered the higher level of simulation utilizing virtual reality technology. Students felt less comfortable and less confident in the Octave; we assert that this was because the environment was unfamiliar. The study identified that placing students in an unfamiliar environment influences the confidence and skills associated with basic life support; this could be used as a way of preparing student nurses with the necessary emotional resilience to cope in stressful situations.

Cochrane review on 'Statins for the treatment of dementia'.

OBJECTIVES: This review aimed to assess the clinical efficacy and tolerability of statins in the treatment of dementia. METHODS: We searched the Specialized Register of the Cochrane Dementia and Cognitive Improvement Group, The Cochrane Library, MEDLINE, EMBASE, PsycINFO, CINAHL and LILACS, as well as many trials registries and grey literature sources (27 October 2008). Double-blind, randomized controlled trials of statins given for at least 6 months in people with a diagnosis of dementia were included. Two independent authors extracted and assessed data independently against the inclusion criteria. Data were pooled where appropriate and entered into a meta-analysis. RESULTS: Three studies were identified (748 participants, age range 50-90 years). All patients had a diagnosis of probable or possible Alzheimer's disease according to standard criteria, and most patients were established on a cholinesterase inhibitor. Change in Alzheimer's Disease Assessment Scale cognitive subscale from baseline was a primary outcome in three studies; when data were pooled, statins did not provide any beneficial effect in this cognitive measure (mean difference -1.12; 95% confidence interval -3.99, 1.75; p = 0.44). All studies provided a change in Mini-Mental State Examination from baseline; there was no significant benefit from statins in this cognitive measure when the data were pooled (mean difference -1.53; 95% confidence interval -3.28; 0.21, p = 0.08). There were no studies identified assessing the role of statins in treatment of vascular dementia. There was no evidence that statins were detrimental to cognition. CONCLUSIONS: There is insufficient evidence to recommend statins for the treatment of dementia.

Statins for the treatment of dementia.

BACKGROUND: The use of statin therapy in established Alzheimer's disease (AD) or vascular dementia (VaD) is a relatively unexplored area. In AD ss-amyloid protein (Ass) is deposited in the form of extracellular plaques and previous studies have determined Ass generation is cholesterol dependent. Hypercholesterolaemia has also been implicated in the pathogenesis of VaD. Due to the role of statins in cholesterol reduction it is biologically plausible they may be efficacious in the treatment of AD and dementia. OBJECTIVES: To assess the clinical efficacy and tolerability of statins in the treatment of dementia. SEARCH STRATEGY: We searched the Specialized Register of the Cochrane Dementia and Cognitive Improvement Group, The Cochrane Library, MEDLINE, EMBASE, PsycINFO, CINAHL and LILACS, as well as many trials registries and grey literature sources (27 October 2008). SELECTION CRITERIA: Double-blind, randomized controlled trials of statins given for at least six months in people with a diagnosis of dementia. DATA COLLECTION AND ANALYSIS: Two independent authors extracted and assessed data independently against the inclusion criteria. Data were pooled where appropriate and entered into a meta-analysis. MAIN RESULTS: Three studies were identified (748 participants, age range 50-90 years). All patients had a diagnosis of probable or possible AD according to standard criteria and most patients were established on a cholinesterase inhibitor. Treatment in ADCLT 2005 consisted of 80mg atorvastatin compared to placebo for 52 weeks, serum low density lipoprotein (LDL) cholesterol was reduced by 54% in the atorvastatin group. Treatment in Simons 2002 consisted of 40mg simvastatin compared to placebo for 26 weeks, serum LDL cholesterol was reduced by 52% in the simvastatin group. Treatment in LEADe 2010 consisted of 80mg atorvastatin compared to placebo for 72 weeks, LDL cholesterol was reduced by 50.2% by month 3 and remained constant through month 18. Change in Alzheimer's Disease Assessment Scale- cognitive subscale (ADAS-Cog) from baseline was a primary outcome in 3 studies; when data were pooled there was considerable heterogeneity so the random effects model was used, statins did not provide any beneficial effect in this cognitive measure [mean difference -1.12, 95% CI -3.99, 1.75, p = 0.44]. All studies provided change in Mini Mental State Examination (MMSE) from baseline; again random effects model was used due to considerable heterogeneity: there was no significant benefit from statins in this cognitive measure when the data were pooled [mean difference -1.53, 95% CI -3.28, 0.21, p = 0.08]. There was some evidence that patients on statins in ADCLT 2005 maintained better cognitive function if serum cholesterol was high at baseline, MMSE was higher at baseline or if they had an apolipoprotein E4 allele present. This would need to be confirmed in larger studies however. Treatment related adverse effects were available from two studies, LEADe 2010 and Simons 2002; when data were pooled there was no significant difference between statins and placebo [odds ratio 2.45, 95% CI 0.69, 8.62, p = 0.16]. There was no significant difference in global function, behaviour or activities of daily living in the statin and placebo groups. One large randomised controlled trial (RCT) ( CLASP 2008) has not yet published its results. There were no studies identified assessing role of statins in treatment of VaD. There was no evidence that statins were detrimental to cognition. AUTHORS' CONCLUSIONS: There is insufficient evidence to recommend statins for the treatment of dementia. Analysis from the studies available, including one large RCT, indicate statins have no benefit on the outcome measures ADAS-Cog or MMSE. We need to await full results from CLASP 2008 before we can be certain. This Cochrane review will be updated as these results become available.

Ex vivo and in vivo regulation of lipocalin-2, a novel adipokine, by insulin.

OBJECTIVE: Lipocalin-2, a novel adipokine, has been shown to be elevated in obese, insulin-resistant, and diabetic subjects. We therefore sought to study the ex vivo and in vivo effects of insulin on lipocalin-2 levels in humans. RESEARCH DESIGN AND METHODS: We investigated the in vivo effects of insulin (hyperinsulinemia) on circulating lipocalin-2 levels by enzyme-linked immunosorbent assay via a prolonged insulin-glucose infusion. The ex vivo effect of insulin on adipose tissue lipocalin-2 protein production and secretion into conditioned media was assessed by Western blotting and enzyme-linked immunosorbent assay, respectively. RESULTS: Hyperinsulinemic induction in human subjects significantly increased circulating lipocalin-2 levels (P < 0.01). Also, in omental adipose tissue explants, insulin caused a significant dose-dependent increase in lipocalin-2 protein production and secretion into conditioned media (P < 0.05, P < 0.01, respectively); these effects were negated by both phosphatidylinositol 3-kinase and mitogen-activated protein kinase kinase inhibitors. CONCLUSIONS: Lipocalin-2 is upregulated by insulin via phosphatidylinositol 3-kinase and mitogen-activated protein kinase signaling pathways.

A prospective evaluation of the outcome after small saphenous varicose vein surgery with one-year follow-up.

OBJECTIVE: The aim was to examine the effect of various surgical maneuvers during standard surgery for small saphenous varicose veins (SSV). METHODS: This was a prospective cohort study of patients that underwent small saphenous varicose vein surgery. Two-hundred nineteen consecutive patients (234 legs) with isolated primary or recurrent small saphenous varicose veins undergoing surgery were enrolled in a multicenter study involving nine vascular centers in the United Kingdom. Operative technique was determined by individual surgeon preference; clinical and operative details, including the use of stripping, were recorded. Clinical examination (recurrence rates) and duplex imaging (superficial and deep incompetence) were evaluated at six weeks and one year after surgery. RESULTS: A total of 204 legs were reviewed at one year; 67 had small saphenous varicose vein stripping, 116 had saphenopopliteal junction (SPJ) disconnection only, and the remainder had miscellaneous procedures. The incidence of visible recurrent varicosities at one year was lower after SSV stripping (12 of 67, 18%) than after disconnection only (28 of 116, 24%), although this did not reach statistical significance. There was no significant difference in the rate of numbness at one year between those who had SSV stripping (20 of 71, 28%) and those who had disconnection only (38 of 134, 28%). The rate of SPJ incompetence detected by duplex at one year was significantly lower in patients who underwent SSV stripping (9 of 67, 13%) than in those who did not (37 of 115, 32%) (P < .01). CONCLUSION: Stripping of the SSV significantly reduced the rate of SPJ incompetence after one year without increasing the rate of complications.

Statistical match of the March 1996 Current Population Survey and the 1995 National Health Interview Survey.

OBJECTIVES: Statistical matching is a method used to combine two files when it is unlikely that individuals on one file are also on the other file. The objectives of this report are to document and evaluate statistical matches of the March 1996 Current Population Survey (CPS) and the 1995 National Health interview Survey (NHIS) and give recommendations for improving future matches. The CPS-NHIS match was motivated by the need for a data set with data on health measures and family resources for use in policy analyses. METHODS: Three statistical matches between the March 1996 CPS and the 1995 NHIS are described in this report. All three matches used person-level constrained matching with partitioning and a predictive mean matching algorithm to link records on the two files. For two of the matches, the CPS served as the Host file and the NHIS served as the Donor file; for the third match, the NHIS was the Host file and the CPS was the Donor file. RESULTS: The results suggest that the constrained predictive mean matches of the March 1996 CPS and the 1995 NHIS successfully combined some of the information on the two files, but that relationships among some Host and Donor variables on the matched file may be distorted. The evaluation of the matches suggested that the variables used to partition the Host and Donor files prior to matching and the variables involved in the predictive mean matching play an important role in determining whether relationships among variables on the matched file correctly represent relationships among those variables in the population. The evaluation also indicated that estimates for small subgroups may be especially subject to error. The results reinforce the need to proceed cautiously when exploring relationships among Host and Donor variables on a statistically matched file.