An Elevated Metrorail as a Source of Orthopedic Injuries and Death at a Level-I Trauma Center.

Background: Elevated Metrorail systems differ from conventional trains by their slower speeds and collisions with pedestrians predominantly occurring at accessible stations or platforms. Here, the orthopedic implications of pedestrians struck by a Metrorail are evaluated, as were the correlations of substance abuse and psychiatric history on injury and death. Methods: Retrospective cohort study at a single Level-1 trauma center of patients requiring admission with orthopedic injuries following Metrorail impact from 1/2004-2/2017. Demographics, substance abuse, psychiatric history, intentionality, LOS, follow-up, fracture characteristics, and management were studied. Results: 33 patients sustained 104 total orthopedic injuries requiring admission; nine sustained 15 traumatic amputations. There were at least 37 open fractures, with some incomplete data in deceased (5) and amputation (9) patients. Suicide attempts were completed at 35.7% and were associated with a documented psychiatric illness and prior psychiatric evaluation. Spine injuries were associated with increased traumatic brain injuries, rib fractures, and open pelvic ring injuries, yet fewer humerus fractures. Open fractures were significantly predictive of death. 14 patients (42.4%) required ICU admission, and 26 (78.8%) patients required orthopaedic surgery (mean 1.3 ± 1.4 operations). Conclusions: Metrorail systems are unique sources of orthopaedic injuries requiring high rates of critical care and surgical intervention. Patients sustain multiple injuries, many with amputations. With this mechanism, there is a high rate of open fractures and suicide. Trauma centers should emphasize an extensive evaluation of orthopaedic injuries in this patient setting.Level of Evidence: II.

Volatile organic compound concentrations, emission rates, and source apportionment in newly-built apartments at pre-occupancy stage.

The present study investigated the indoor concentrations of selected volatile organic compounds (VOCs) and formaldehyde and their indoor emission characteristics in newly-built apartments at the pre-occupancy stage. In total, 107 apartments were surveyed for indoor and outdoor VOC concentrations in two metropolitan cities and one rural area in Korea. A mass balanced model was used to estimate surface area-specific emission rates of individual VOCs and formaldehyde. Seven (benzene, ethyl benzene, toluene, m,p-xylene, o-xylene, n-hexane, and n-heptane) of 40 target compounds were detectable in all indoor air samples, whereas the first five were detected in all outdoor air samples. Formaldehyde was also predominant in the indoor air samples, with a high detection frequency of 96%. The indoor concentrations were significantly higher than the outdoor concentrations for aromatics, alcohols, terpenes, and ketones. However, six halogenated VOCs exhibited similar concentrations for indoor and outdoor air samples, suggesting that they are not major components emitted from building materials. It was also suggested that a certain portion of the apartments surveyed were constructed by not following the Korean Ministry of Environment guidelines for formaldehyde emissions. Toluene exhibited the highest emission rate with a median value of 138 µg m(-2) h(-1). The target compounds with median emission rates greater than 20 µg m(-2) h(-1) were toluene, 1-propanol, formaldehyde, and 2-butanone. The wood panels/vinyl floor coverings were the largest indoor pollutant source, followed by floorings, wall coverings, adhesives, and paints. The wood panels/vinyl floor coverings contributed nearly three times more to indoor VOC concentrations than paints.

A novel drill set for the enhancement and assessment of robotic surgical performance.

BACKGROUND: There currently exist several training modules to improve performance during video-assisted surgery. The unique characteristics of robotic surgery make these platforms an inadequate environment for the development and assessment of robotic surgical performance. METHODS: Expert surgeons (n=4) (>50 clinical robotic procedures and >2 years of clinical robotic experience) were compared to novice surgeons (n=17) (<5 clinical cases and limited laboratory experience) using the da Vinci Surgical System. Seven drills were designed to simulate clinical robotic surgical tasks. Performance score was calculated by the equation Time to Completion + (minor error) x 5 + (major error) x 10. The Robotic Learning Curve (RLC) was expressed as a trend line of the performance scores corresponding to each repeated drill. RESULTS: Performance scores for experts were better than novices in all 7 drills (p<0.05). The RLC for novices reflected an improvement in scores (p<0.05). In contrast, experts demonstrated a flat RLC for 6 drills and an improvement in one drill (p=0.027). CONCLUSION: This new drill set provides a framework for performance assessment during robotic surgery. The inclusion of particular drills and their role in training robotic surgeons of the future awaits larger validation studies.