The Malawi trauma score: A model for predicting trauma-associated mortality in a resource-poor setting.

BACKGROUND: Globally, traumatic injury is a leading cause of morbidity and mortality in low-income countries. Current tools for predicting trauma-associated mortality are often not applicable in low-resource environments due to a lack of diagnostic adjuncts. This study sought to derive and validate a model for predicting mortality that requires only a history and physical exam. METHODS: We conducted a retrospective analysis of all patients recorded in the Kamuzu Central Hospital trauma surveillance registry in Lilongwe, Malawi from 2011 through 2014. Using statistical randomization, 80% of patients were used for derivation and 20% were used for validation. Logistic regression modeling was used to derive factors associated with mortality and the Malawi Trauma Score (MTS) was constructed. The model fitness was tested. RESULTS: 62,354 patients are included. Patients are young (mean age 23.0, SD 15.9 years) with a male preponderance (72%). Overall mortality is 1.8%. The MTS is tabulated based on initial mental status (alert, responds to voice, responds only to pain or worse), anatomical location of the most severe injury, the presence or absence of a radial pulse on examination, age, and sex. The score range is 2-32. A mental status exam of only responding to pain or worse, head injury, the absence of a radial pulse, extremes of age, and male sex all conferred a higher probability of mortality. The ROC area under the curve for the derivation cohort and validation cohort were 0.83 (95% CI 0.78, 0.87) and 0.83 (95% CI 0.75, 0.92), respectively. A MTS of 25 confers a 50% probability of death. CONCLUSIONS: The MTS provides a reliable tool for trauma triage in sub-Saharan Africa and helps risk stratify patient populations. Unlike other models previously developed, its strength is its utility in virtually any environment, while reliably predicting injury- associated mortality.

Preferences for arthritis interventions: identifying similarities and differences among African Americans and whites with osteoarthritis.

OBJECTIVE: To determine if there are differences or similarities in arthritis intervention preferences and barriers to participation between African Americans and whites with osteoarthritis (OA). METHODS: Using a needs assessment survey, intervention preferences and barriers to participation in arthritis interventions among African American (n = 60) and white (n = 55) adults with self-reported doctor-diagnosed OA were examined. T-tests, chi-square tests, and multiple regression analyses adjusting for covariates were examined to determine race effects. RESULTS: While there were many similarities, African Americans were more likely to report cost (P < 0.01), lack of trust (P = 0.04), fear of being the only person of their race (P < 0.001), lack of recommendation from their doctor (P = 0.04), and lack of recommendation of a family member or friend (P = 0.02) as barriers to participating in a community-based self-management arthritis intervention. After adjusting for covariates, African Americans preferred interventions that provide information on arthritis-related internet sources (P = 0.04), solving arthritis-related problems (P = 0.04), and talking to family and friends about their condition (P = 0.02) in comparison to whites. African Americans also preferred an intervention with child care services provided (P < 0.01), with instructors and participants of the same race (P < 0.01 and P < 0.001, respectively) or sex (P < 0.001 and P = 0.03, respectively), that allows a friend (P = 0.001) or family member (P = 0.02) to attend, that is offered at a local church (P = 0.01) or clinic (P < 0.01), or that is mailed (P < 0.01). CONCLUSION: Findings suggest that similar interventions are preferred across racial groups, but some practical adaptations could be made to existing arthritis interventions to minimize barriers, increase cultural sensitivity, and offer programs that would be appealing to African Americans and whites with arthritis.

A computational study of expanded heterocyclic nucleosides in DNA.

The first molecular dynamics study of a series of heterospacer-expanded tricyclic bases in DNA using modified force field parameters in AMBER is detailed. The expanded purine nucleoside monomers have been designed to probe the effects of a heteroaromatic spacer ring on the structure, function, and dynamics of the DNA helix. The heterobase scaffold has been expanded with a furan, pyrrole, or thiophene spacer ring. This structural modification increases the polarizability of the bases and provides an additional hydrogen bond donor with the amine hydrogen of the pyrrole ring or hydrogen bond acceptor with the furan or thiophene ring free electron pairs. The polarizability of the expanded bases were determined by AM1 calculations and the results of the MD simulations of 20-mers predict that the modified curvature of the expanded base leads to a much larger major groove, while the effect on the minor groove is negligible. Overall, the structure resembles A-DNA. MD simulations of 10-mers suggest that the balance between base pairing vs. base stacking and intercalation can be shifted towards the latter due to the increased surface area and polarizability of the expanded bases.