Development of a predictive algorithm for patient survival after traumatic injury using a five analyte blood panel.

Severe trauma can induce systemic inflammation but also immunosuppression, which makes understanding the immune response of trauma patients critical for therapeutic development and treatment approaches. By evaluating the levels of 59 proteins in the plasma of 50 healthy volunteers and 1000 trauma patients across five trauma centers in the United States, we identified 6 novel changes in immune proteins after traumatic injury and further new variations by sex, age, trauma type, comorbidities, and developed a new equation for prediction of patient survival. Blood was collected at the time of arrival at Level 1 trauma centers and patients were stratified based on trauma level, tissues injured, and injury types. Trauma patients had significantly upregulated proteins associated with immune activation (IL-23, MIP-5), immunosuppression (IL-10) and pleiotropic cytokines (IL-29, IL-6). A high ratio of IL-29 to IL-10 was identified as a new predictor of survival in less severe patients with ROC area of 0.933. Combining machine learning with statistical modeling we developed an equation ("VIPER") that could predict survival with ROC 0.966 in less severe patients and 0.8873 for all patients from a five analyte panel (IL-6, VEGF-A, IL-21, IL-29, and IL-10). Furthermore, we also identified three increased proteins (MIF, TRAIL, IL-29) and three decreased proteins (IL-7, TPO, IL-8) that were the most important in distinguishing a trauma blood profile. Biologic sex altered phenotype with IL-8 and MIF being lower in healthy women, but higher in female trauma patients when compared to male counterparts. This work identifies new responses to injury that may influence systemic immune dysfunction, serving as targets for therapeutics and immediate clinical benefit in identifying at-risk patients.

SARS-CoV-2 Seroprevalence and Drug Use in Trauma Patients from Six Sites in the United States.

In comparison to the general patient population, trauma patients show higher level detections of bloodborne infectious diseases, such as Hepatitis and Human Immunodeficiency Virus. In comparison to bloodborne pathogens, the prevalence of respiratory infections such as SARS-CoV-2 and how that relates with other variables, such as drug usage and trauma type, is currently unknown in trauma populations. Here, we evaluated SARS-CoV-2 seropositivity and antibody isotype profile in 2,542 trauma patients from six Level-1 trauma centers between April and October of 2020 during the first wave of the COVID-19 pandemic. We found that the seroprevalence in trauma victims 18-44 years old (9.79%, 95% confidence interval/CI: 8.33 - 11.47) was much higher in comparison to older patients (45-69 years old: 6.03%, 4.59-5.88; 70+ years old: 4.33%, 2.54 - 7.20). Black/African American (9.54%, 7.77 - 11.65) and Hispanic/Latino patients (14.95%, 11.80 - 18.75) also had higher seroprevalence in comparison, respectively, to White (5.72%, 4.62 - 7.05) and Non-Latino patients (6.55%, 5.57 - 7.69). More than half (55.54%) of those tested for drug toxicology had at least one drug present in their system. Those that tested positive for narcotics or sedatives had a significant negative correlation with seropositivity, while those on anti-depressants trended positive. These findings represent an important consideration for both the patients and first responders that treat trauma patients facing potential risk of respiratory infectious diseases like SARS-CoV-2.

Severe Acute Respiratory Syndrome Coronavirus 2 Antibody Status in Decedents Undergoing Forensic Postmortem Examination in Maryland, May 24 to June 30, 2020.

Seroprevalence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) antibodies was 10% among the subset of decedents undergoing forensic postmortem examination in June in Maryland. Decedents of motor vehicle crashes had similar seroprevalence compared with those with a natural death (including decedents with SARS-CoV-2 infection). Decedents of motor vehicle crashes may be a sentinel surveillance population.

ATTENTION MAINTENANCE IN NOVICE DRIVERS: ASSESSMENT AND TRAINING.

All programs assessing attention maintenance inside the vehicle have required eye trackers and either a driving simulator or a specially equipped field vehicle. Ideally, one would like a way to assess attention maintenance that could be implemented on a desktop PC. Additionally, one would like to have a program that could be used to train novice drivers to maintain their attention more safely on the forward roadway. An experiment was run (a) to determine whether a program FOCAL (Focused Concentration and Attention Learning) using a desktop PC could differentiate between the attention maintenance skills of novice and experienced drivers and (b) to determine whether a program that improved the hazard anticipation skills of novice drivers might also improve their attention maintenance skills. FOCAL was able to differentiate between the attention maintenance skills of novice and experienced drivers. However, hazard anticipation training did not improve the attention maintenance skills of the novice drivers.

Evaluation of a high visibility enforcement project focused on passenger vehicles interacting with commercial vehicles.

INTRODUCTION: In 2004, Washington State applied NHTSA's High Visibility Enforcement model used in the Click It or Ticket seat belt campaign in an attempt to reduce unsafe driving behaviors around commercial motor vehicles (CMVs). The program was called Ticketing Aggressive Cars and Trucks (TACT). This paper details the methods used to evaluate the program's effectiveness and the results of the evaluation. METHOD: Four high-crash interstate highway corridors, each approximately 25 miles in length, were selected. Two of these corridors received TACT media messages and increased enforcement over an 18-month period while two comparison corridors did not receive any increased media or enforcement. RESULTS: A total of 4,737 contacts were made with drivers during the two enforcement waves, and 72% of these contacts led to a citation. Drivers at the intervention sites who said they saw or heard any of the TACT messages increased from 17.7% in the pre period to a high of 67.3% in the post periods. Drivers at the intervention sites also reported increased exposure to the core message of leaving more space when passing trucks (14% pre to 40% post period). The percentage of drivers who said they leave more room when passing trucks than when passing cars rose from 16% in the pre period to 24% in the post period at the intervention sites, while comparison sites showed no change. Over 150 hours of video recorded by law enforcement officers in unmarked vehicles were utilized to examine violation rates and severity of violations before and after the intervention campaigns. Statistical analyses showed that violation rates were reduced significantly at the intervention sites (between 23% and 46%), while remaining constant at the comparison sites. Analyses of the video data also showed that the seriousness of the residual violations at the intervention sites decreased. CONCLUSIONS: Overall, the evaluation results provide a consistent picture of the effectiveness of the TACT pilot project. Success was demonstrated at every step - messages were received and understood, knowledge was changed in the intended direction, self reported driving behavior around large trucks improved, and observed driving behaviors confirmed the self reports. IMPACT ON INDUSTRY: After this initial success in Washington State, the TACT model will continue to be implemented and evaluated by FMCSA in an attempt to validate the program. Based on the results of this study and the consistent positive results found for other sTEP projects, it is likely that TACT will show continued success in a variety of settings and will help reduce the number and severity of crashes involving CMVs. Future research should attempt to use many of the methods described here to further validate the methods for not only evaluations of TACT programs, but also for any other highway safety programs that require measurements of the program's effectiveness.

Dental hygienists' opinions about loupes in education.

PURPOSE: The present study was conducted in order to explore dental Hygienists' perceptions of the advantages and disadvantages of loupes, and the extent to which dental hygienists believe loupes should be utilized in the educational setting. METHODS: Dental hygienists were contacted through a popular dental hygiene website and were asked to participate in a survey regarding the use of loupes. Eight hundred sixty-eight valid surveys were completed. Participants were asked to indicate the extent to which they use loupes, the environments in which they have used loupes, when they think loupes should be introduced to students in dental hygiene school, and the advantages and disadvantages of using loupes. RESULTS: Results indicated approximately 60.5% of practicing dental hygienists surveyed for the study always or sometimes use loupes, however only 21% had actually used loupes as a student. A number of differences were found between those respondents who use loupes and those who do not use loupes in regards to how they believe loupes should be used in education. Alleged advantages of using loupes received much greater support than alleged disadvantages. Members of the American Dental Hygienists' Association (ADHA) were much more likely to always use loupes than non-ADHA respondents. CONCLUSION: Dental hygienists participating in the survey believe that loupes should be introduced to dental hygiene students, although many believe using loupes should be an option while in school. Wide agreement exists among dental hygienists in regards to the advantages of using loupes. The authors contend that loupes are a vital tool that students should learn how to use, but the use of loupes should be optional once a student has learned how to use them properly.