The process of identifying major trauma in the older person in a single major trauma centre: A service evaluation.

BACKGROUND: Diagnosis of major trauma in the older person is increasingly recognised as clinically challenging with recent reports finding that older patients sustaining major trauma are commonly under-recognised and subsequently are not receiving gold standard major trauma care. This paper is a service evaluation of the processes of major trauma (ISS > 15) care for patients > 65 years presenting to a UK major trauma centre. AIM: To identify modifiable factors within the patient journey that might inform future service improvement initiatives. METHODS: TARN audit data and retrospective notes review of 190 patients > 65 presenting to UHS ED from 1st January 2018 - 31st December 2018 who did not receive a level 1 trauma call on arrival were used to achieve the dataset. Descriptive statistics were combined with multiple logistic regression to look for associations between specific process factors and a missed or delayed diagnosis. RESULTS: The evaluation found that, of the cohort not receiving a level 1 trauma call, 42 (22.1%) patients received a level 2 trauma call; 87 (45.7%) patients were seen initially by a senior clinician, with only 31 (16.3%) patients meeting best practice tariff for consultant within 5 min; 60 (31.5%) patients were seen directly in the resuscitation room; 48 (25.2%) patients received a trauma CT scan with only 27 (14.2%) meeting BPT for CT head within 1 h; 142 (74.7%) patients were admitted to a trauma specialty after discharge from ED. A total of 76 (40%) patients had a missed diagnosis of major trauma with 80 (42%) having a delayed diagnosis. Logistic regression showed a significant association between being seen in a standard initial assessment area (referred to as pitstop in this article) vs the resuscitation room as a first location (p = 0.007) with a delayed diagnosis; and a significant association between plain film imaging vs CT imaging (p = 0.000) and no trauma call vs trauma call (p = 0.009) with a missed diagnosis of major trauma. CONCLUSION: The findings of this service evaluation suggest that service improvement initiatives should be aimed at the early stages of the patient journey to improve missed or delayed diagnoses of major trauma in this patient group.

Facilitators to healthy canteen policy implementation: A qualitative approach.

ISSUE ADDRESSED: Governments across the world use guidelines and policy to support improving the quality and nutrition in school canteens, yet little is known about what makes for success in supporting school canteens. This study aimed to investigate the factors influencing the implementation of a healthy school canteen policy. METHODS: A qualitative descriptive approach using interviews with a purposive sample of Victorian schools that had successfully implemented a healthy school canteen was conducted. Twelve interviews were conducted with principals (n = 4), assistant principal (n = 1), canteen managers (n = 5), food services manager (n = 1) and canteen staff members (n = 3) across six Victorian schools. Data were analysed using a content analysis approach. RESULTS: Three key themes explained the adoption of policy: Values - emphasising service over profit; Knowledge - understanding of nutrition and the policy; and Support - from within and external to the school. CONCLUSIONS: Implementation of school canteen policy is more likely to be achieved when a school can focus on the service and educative component of the policy and where there is a shared priority for healthy eating across the entire school community. SO WHAT?: Creating a culture of service and community engagement with a healthy school canteen may increase policy implementation and should be the focus of future health promotion efforts.

Nanoscale surface patterns from 10(3) single molecule helices of biodegradable poly(L-lactic acid).

Atomic force microscopy, reflection absorption infrared spectroscopy, and X-ray reflectivity studies reveal that poly(L-lactic acid) molecules in Langmuir-Blodgett (LB) films exist as 10(3) helices over nearly the entire length of the polymer chain. This feature gives rise to LB films with highly ordered nanoscale smectic liquid crystalline-like surface patterns with low surface roughness and lamellar spacings that scale with molar mass. These studies provide a new approach for controlling surface morphology with a biodegradable polymer commonly used for drug delivery and tissue engineering.

Corner capping of silsesquioxane cages by chemical warfare agent simulants.

The room-temperature uptake and reactivity of gas-phase methyl dichlorophosphate (MDCP) and trichlorophosphate (TCP) within trisilanolphenyl-polyhedral oligomeric silsesquioxane (POSS) Langmuir-Blodgett films are investigated. The halogenated phosphate molecules are found to readily diffuse into and react with the hybrid inorganic-organic silicon-oxide films under ambient conditions. Reflection absorption infrared spectroscopy (RAIRS), X-ray photoelectron spectroscopy (XPS), and fast atom bombardment-mass spectrometry (FAB-MS) measurements suggest that the chlorophosphates undergo hydrolysis with the silanol groups of the POSS LB-film. Substitution and elimination reactions appear to cap the corner of the POSS molecules, leaving a surface-bound phosphoryl group and a resulting structure that is highly stable at elevated temperatures.

Homologous, long-chain alkyl dendrons form homologous thin films on silver oxide surfaces.

As suggested by X-ray crystal structures, homologous, long-chain alkyl dendrons with three carboxyl groups form thin films on silver oxide surfaces, which give reflection-absorption infrared spectra that show a linear increase in intensities of methylene C-H stretching absorptions.

Sorption of dimethyl methylphosphonate within Langmuir-Blodgett films of trisilanolphenyl polyhedral oligomeric silsesquioxane.

Trisilanolphenyl polyhedral oligomeric silsesquioxane (POSS) molecules are used to create well-ordered Langmuir-Blodgett films containing silanol groups that interact strongly with dimethyl methylphosphonate (DMMP), a commonly used simulant for the chemical warfare agent sarin. The interaction of DMMP within multilayer POSS films is studied by uptake coefficient and temperature-programmed desorption (TPD) measurements, as well as reflection-absorption infrared spectroscopy (RAIRS). Results indicate a low uptake probability; however, in a DMMP-saturated atmosphere, the organophosphonate molecules are capable of diffusing into and adsorbing within the films. TPD and RAIRS measurements reveal no evidence of DMMP decomposition within the film. Rather, DMMP is found to desorb molecularly with a desorption energy of 122 kJ/mol. RAIRS reveals that strong hydrogen-bonding interactions between the phosphoryl groups of the organophosphonate molecules and the silanol groups of the POSS molecules are responsible for the high sorption energy of the system.