ABSTRACT
INTRODUCTION: The 'golden hour' is a universal paradigm that suggests trauma patients have lower morbidity and mortality when provided with medical care within 1 hour after injury. The objective of this study was to examine whether transport time from point of injury to a military treatment facility (MTF) in-theatre was associated with patient-reported outcomes, such as post-traumatic stress disorder (PTSD), depression and quality of life (QOL), among US service members with combat-related injury. METHODS: Participants were injured between March 2003 and March 2016 and completed standardised assessments of PTSD, depression and QOL for theWounded Warrior Recovery Project (WWRP) between January 2013 and November 2017. Multivariable regressions were used to assess the relationship between transport time (≤1 hour or >1 hour from injury to MTF) and positive screens for PTSD and depression, and QOL, respectively.Overall, 45.6% of participants (n=879) arrived at an MTF within 1 hour postinjury. About 8 years passed between when participants were injured on deployment and when they completed their first WWRP assessment. Approximately 48% of participants screened positive for PTSD and 51.3% for depression, with a mean QOL score of 0.513 (SD=0.150). After adjusting for covariates, transport time was not significantly associated with PTSD (OR 1.04, 95% CI 0.79 to 1.38; p=0.77), depression (OR 0.92, 95% CI 0.69 to 1.21; p=0.55) or QOL (ß=0.009; p=0.38). CONCLUSION: Transport time was not associated with patient-reported outcomes among US service members with combat-related injury. These findings are important as we seek to understand how combat casualties may be affected by extended medical evacuation or transport times anticipated in future expeditionary operations.
Subject(s)
Military Personnel , Stress Disorders, Post-Traumatic , Humans , Quality of Life , Afghan Campaign 2001- , Patient Reported Outcome MeasuresABSTRACT
Oestrus was synchronized in 46 Afrikaner and Mashona beef cows by two injections of cloprostenol 11 days apart. All cows had a history of sub-optimum reproductive performance. Cows were inseminated up to three times after the second cloprostenol injection on the basis of observed oestrus and changes in the conductivity of cervical mucus. Half the cows received daily injections of 1000 i.u. HcG from days four to 19 after their last insemination; the other half received daily injections of 2 ml saline over the same period. Concentrations of progesterone in plasma was determined from samples taken on days 6, 8 and 22 after the last insemination. Treatment did not significantly affect conception rate and overall conception rate was 39 per cent. On day 8 after insemination none of the 8 cows that had progesterone levels of less than 1 ng/ml were pregnant when examined at day 70. Mean progesterone concentrations were not significantly different between treated and control cows on days 6 and 8, but were significantly higher (P<0,05) in treated cows by day 22. The practical significance of using HcG to stimulate luteal function in the early post-inseminaion period is discussed.
ABSTRACT
Oestrus was synchronised in ten Africander and eight Mashona mature dry cows by two injections of prostaglandin F(2) proportional, variant (PG) 11 days apart. Half the cows of each breed received an injection of 3000 i.u. pregnant mare serum gonadotrophin (PMSG) two days prior to the second PG injection. All cows were observed for the incidence of cestrus, and blood samples were taken at intervals for progesterone assay. Cows were slaughtered 11 days after the second PG injection and their reproductive tracts examined. Treatment with PMSG increased numbers both of corpora lutea and of follicles more than 10 mm in diameter. When numbers of corpora lutea and follicles were considered together, the response to treatment was significant in the Africanders (P<0,01) and markedly greater than that of Kashona cows. The concentration of progesterone in plasma on the day before slaughter was significantly correlated with the mass of corpora lutea (P<0,001), total mass of ovaries (P<0,001), but not with numbers of corpora lutea. It is suggested that generally Africander cows may secrete lower levels of follicle stimulating hormone and oestrogen than kashona cows during normal cyclic sexual activity.
