Parkland Trauma Index of Mortality: Real-Time Predictive Model for Trauma Patients.

OBJECTIVE: Vital signs and laboratory values are used to guide decisions to use damage control techniques in lieu of early definitive fracture fixation. Previous models attempted to predict mortality risk but have limited utility. There is a need for a dynamic model that captures evolving physiologic changes during a trauma patient's hospital course. METHODS: The Parkland Trauma Index of Mortality (PTIM) is a machine learning algorithm that uses electronic medical record data to predict mortality within 48 hours during the first 3 days of hospitalization. It updates every hour, recalculating as physiology changes. The model was developed using 1935 trauma patient encounters from 2009 to 2014 and validated on 516 patient encounters from 2015 to 2016. Model performance was evaluated statistically. Data were collected retrospectively on its performance after 1 year of clinical use. RESULTS: In the validation data set, PTIM accurately predicted 52 of the sixty-three 12-hour time intervals within 48 hours of mortality, for sensitivity of 82.5% [95% confidence interval (CI), 73.1%-91.9%]. The specificity was 93.6% (95% CI, 92.5%-94.8%), and the positive predictive value (PPV) was 32.5% (95% CI, 25.2%-39.7%). PTIM predicted survival for 1608 time intervals and was incorrect only 11 times, yielding a negative predictive value of 99.3% (95% CI, 98.9%-99.7%). The area under the curve of the receiver operating characteristic curve was 0.94.During the first year of clinical use, when used in 776 patients, the last PTIM score accurately predicted 20 of the twenty-three 12-hour time intervals within 48 hours of mortality, for sensitivity of 86.9% (95% CI, 73%-100%). The specificity was 94.7% (95% CI, 93%-96%), and the positive predictive value was 33.3% (95% CI, 21.4%-45%). The model predicted survival for 716 time intervals and was incorrect 3 times, yielding a negative predictive value of 99.6% (95% CI, 99.1%-100%). The area under the curve of the receiver operating characteristic curve was 0.97. CONCLUSIONS: By adapting with the patient's physiologic response to trauma and relying on electronic medical record data alone, the PTIM overcomes many of the limitations of previous models. It may help inform decision-making for trauma patients early in their hospitalization. LEVEL OF EVIDENCE: Prognostic Level I. See Instructions for Authors for a complete description of levels of evidence.

Computed tomographic measurements predict component separation in ventral hernia repair.

BACKGROUND: Preoperative imaging with computed tomography (CT) scans can be useful in preoperative planning. We hypothesized that CT measurements of ventral hernia defect size and abdominal wall thickness (AWT) would correlate with postoperative complications and need for complex abdominal wall reconstruction (AWR). MATERIALS AND METHODS: Patients who underwent open ventral hernia repair and had preoperative abdominal CT imagining were identified from an institutional hernia-specific surgery outcomes database at our tertiary referral hernia center. Grade III and IV hernias and biologic mesh cases were excluded. CT measures of defect size and AWT were analyzed and correlated to complications and the need for AWR techniques using univariate, multivariate, and principal component (PC) analyses. PC1 and PC2 used five AWT measures, hernia defect width, and body mass index to create a new component variable. RESULTS: There were 151 open ventral hernia repairs included in the study. Preoperative findings included 37.7% male; age 55.3 ± 12.5 years; body mass index (BMI) 33.3 ± 7.8 kg/m(2); 60.3% were recurrent hernias with average defect width 8.5 ± 5.0 cm and area 178.3 ± 214 cm(2); AWT at umbilicus 3.5 ± 1.8 cm; and AWT at pubis 7.0 ± 3.2. Component separation was performed in 24.0% of patients and panniculectomy in 34.4%. Wound complications occurred in 13.3% patients, and 2.7% had hernia recurrence. Increasing defect width, length, and area as well as select AWT measurements were associated with increased need for component separation, concomitant panniculectomy, and higher rates of wound and total complications (all P < 0.05). Using multivariate regression, PC1 was associated with wound complications (odds ratio [OR], 1.08; 95% confidence interval [CI], 1.01-1.16); PC2 (hernia defect width) was associated with the need for component separation (OR, 1.16; 95% CI, 1.03-1.30). Hernia recurrence was not predicted by AWT or defect size (OR, 1.00; 95%CI, 0.87-1.15). CONCLUSIONS: Preoperative CT measurements of hernia defects and AWT predict wound complications and the need for complex AWR techniques. Obtaining preoperative CT imaging should be a consideration in preoperative planning and may help with patient counseling.

Memory banking: a life story intervention for aging preparation and mental health promotion.

OBJECTIVE: The aim of this study is to examine the feasibility of Memory Banking (MB), a life story development intervention within the context of aging preparation. Individuals participate in MB to strategically document and share their life story, including mapping out future dreams, aspirations, plans, and decisions. METHOD: Data (2010-2012) from eight MB workshops were examined to determine the impact of the intervention on mental health, social support, and quality of life. RESULTS: Recruitment efforts resulted in n = 72 participants, primarily female (72%), White/Caucasian (93%), average age of 70 years. Data indicated intervention effects showing improvements in depression (p = .041), mood disturbance (p = .0067), and cognitive performance (p = .0045). DISCUSSION: MB outcomes indicate that the intervention is promising and supports continued investigation and development in the area of life story development for aging preparation and improving late life mental health distress in a community setting. Future research is needed to examine the versatility and long-term effects of the MB intervention.

Direct reduction of carbon dioxide to formate in high-gas-capacity ionic liquids at post-transition-metal electrodes.

As an approach to combat the increasing emissions of carbon dioxide in the last 50 years, the sequestration of carbon dioxide gas in ionic liquids has become an attractive research area. Ionic liquids can be made that possess incredibly high molar absorption and specificity characteristics for carbon dioxide. Their high carbon dioxide solubility and specificity combined with their high inherent electrical conductivity also creates an ideal medium for the electrochemical reduction of carbon dioxide. Herein, a lesser studied ionic liquid, 1-ethyl-3-methylimidazolium trifluoroacetate, was used as both an effective carbon dioxide capture material and subsequently as an electrochemical matrix with water for the direct reduction of carbon dioxide into formate at indium, tin, and lead electrodes in good yield (ca. 3 mg h(-1) cm(-2)).

Liquid|liquid electrochemical bicarbonate and carbonate capture facilitated by boronic acids.

Reversible bicarbonate and carbonate liquid|liquid ion transfer processes from aqueous solution into an organic 4-(3-phenylpropyl)pyridine phase are driven electrochemically with TPPMn(III/II) and shown to be facilitated over a wide pH range by 2-naphthylboronic acid (bicarbonate transfer potential -0.08 V vs. SCE; binding constant K(AB) = 10(2) mol(-1) dm(3) and carbonate dianion transfer potential 0.07 V vs. SCE; binding constant K(AB2) = 2 × 10(10) mol(-2) dm(6)).

Ion-transfer- and photo-electrochemistry at liquid|liquid|solid electrode triple phase boundary junctions: perspectives.

Ion transfer at liquid|liquid junctions is one of the most fundamental processes in nature. It occurs coupled to simultaneous electron transfer at the line junction (or triple phase boundary) formed by the two liquids in contact to an electrode surface. The triple phase boundary can be assembled from a redox active microdroplet deposit of a water-immiscible liquid on a suitable electrode surface immersed into aqueous electrolyte. Ion transfer voltammetry measurements at this type of electrode allow both thermodynamic and kinetic parameters for coupled ion and electron transfer processes to be obtained. This overview summarises some recent advances in understanding and application of triple phase boundary redox processes at organic liquid|aqueous electrolyte|working electrode junctions. The design of novel types of electrodes is considered based on (i) extended triple phase boundaries, (ii) porous membrane processes, (iii) hydrodynamic effects, and (iv) generator-collector triple phase boundary systems. Novel facilitated ion transfer processes and photo-electrochemical processes at triple phase boundary electrodes are proposed. Potential future applications of triple phase boundary redox systems in electrosynthesis, sensing, and light energy harvesting are indicated.

Carbon nanoparticle surface functionalisation: converting negatively charged sulfonate to positively charged sulfonamide.

The surface functionalities of commercial sulfonate-modified carbon nanoparticles (ca. 9-18 nm diameter, Emperor 2000) have been converted from negatively charged to positively charged via sulfonylchloride formation followed by reaction with amines to give suphonamides. With ethylenediamine, the resulting positively charged carbon nanoparticles exhibit water solubility (in the absence of added electrolyte), a positive zeta-potential, and the ability to assemble into insoluble porous carbon films via layer-by-layer deposition employing alternating positive and negative carbon nanoparticles. Sulfonamide-functionalised carbon nanoparticles are characterised by Raman, AFM, XPS, and voltammetric methods. Stable thin film deposits are formed on 3 mm diameter glassy carbon electrodes and cyclic voltammetry is used to characterise capacitive background currents and the adsorption of the negatively charged redox probe indigo carmine. The Langmuirian binding constant K = 4000 mol(-1)dm(3) is estimated and the number of positively charged binding sites per particle determined as a function of pH.

A nested-PCR with an Internal Amplification Control for the detection and differentiation of Bartonella henselae and B. clarridgeiae: an examination of cats in Trinidad.

BACKGROUND: Bartonella species are bacterial blood parasites of animals capable of causing disease in both animals and man. Cat-Scratch Disease (CSD) in humans is caused mainly by Bartonella henselae and is acquired from the cat, which serves as a reservoir for the bacteria. A second species, B. clarridgeiae is also implicated in the disease. Diagnosis of Bartonellosis by culture requires a week or more of incubation on enriched media containing blood, and recovery is often complicated by faster growing contaminating bacteria and fungi. PCR has been explored as an alternative to culture for both the detection and species identification of Bartonella, however sensitivity problems have been reported and false negative reactions due to blood inhibitors have not generally been addressed in test design. METHODS: A novel, nested-PCR was designed for the detection of Bartonella henselae and B. clarridgeiae based on the strategy of targeting species-specific size differences in the 16S-23S rDNA intergenic regions. An Internal Amplification Control was used for detecting PCR inhibition. The nested-PCR was utilized in a study on 103 blood samples from pet and stray cats in Trinidad. RESULTS: None of the samples were positive by primary PCR, but the Nested-PCR detected Bartonella in 32/103 (31%) cats where 16 were infected with only B. henselae, 13 with only B. clarridgeiae and 3 with both species. Of 22 stray cats housed at an animal shelter, 13 (59%) were positive for either or both species, supporting the reported increased incidence of Bartonella among feral cats. CONCLUSION: The usefulness of a single PCR for the detection of Bartonella henselae and B. clarridgeiae in the blood of cats is questionable. A nested-PCR offers increased sensitivity over a primary PCR and should be evaluated with currently used methods for the routine detection and speciation of Bartonella henselae and B. clarridgeiae. In Trinidad, B. henselae and B. clarridgeiae are the predominant species in cats and infection appears highest with stray cats, however B. clarridgeiae may be present at levels similar to that of B. henselae in the pet population.

A nested-PCR with an Internal Amplification Control for the detection and differentiation of Bartonella henselae and B. clarridgeiae: an examination of cats in Trinidad

BACKGROUND: Bartonella species are bacterial blood parasites of animals capable of causing disease in both animals and man. Cat-Scratch Disease (CSD) in humans is caused mainly by Bartonella henselae and is acquired from the cat, which serves as a reservoir for the bacteria. A second species, B. clarridgeiae is also implicated in the disease. Diagnosis of Bartonellosis by culture requires a week or more of incubation on enriched media containing blood, and recovery is often complicated by faster growing contaminating bacteria and fungi. PCR has been explored as an alternative to culture for both the detection and species identification of Bartonella, however sensitivity problems have been reported and false negative reactions due to blood inhibitors have not generally been addressed in test design. METHODS: A novel, nested-PCR was designed for the detection of Bartonella henselae and B. clarridgeiae based on the strategy of targeting species-specific size differences in the 16S-23S rDNA intergenic regions. An Internal Amplification Control was used for detecting PCR inhibition. The nested-PCR was utilized in a study on 103 blood samples from pet and stray cats in Trinidad. RESULTS: None of the samples were positive by primary PCR, but the Nested-PCR detected Bartonella in 32/103 (31%) cats where 16 were infected with only B. henselae, 13 with only B. clarridgeiae and 3 with both species. Of 22 stray cats housed at an animal shelter, 13 (59%) were positive for either or both species, supporting the reported increased incidence of Bartonella among feral cats. CONCLUSION: The usefulness of a single PCR for the detection of Bartonella henselae and B. clarridgeiae in the blood of cats is questionable. A nested-PCR offers increased sensitivity over a primary PCR and should be evaluated with currently used methods for the routine detection and speciation of Bartonella henselae and B. clarridgeiae. In Trinidad, B. henselae and B. clarridgeiae are the predominant species in cats and infection appears highest with stray cats, however B. clarridgeiae may be present at levels similar to that of B. henselae in the pet population.