Gang warfare: the medical repercussions.

Gang related violence in Los Angeles County has increased, with homicides increasing from 205 in 1982 to 803 in 1992. This study examines the medical and financial consequences of such violence on a level I trauma center. Of 856 gunshot injuries over a 29-month period, 272 were gang related. There were 55 pediatric and 217 adult patients. Eighty-nine percent were male and 11% were female. Trauma Score averaged 14.7 +/- 3.1, Glasgow Coma Scale average score was 13.7 +/- 3.4, and the mean Injury Severity Score was 10.8 +/- 14. Twenty-two percent of the gunshots were to the head and neck, 20% to the chest, 20% to the abdomen, 6% had a peripheral vascular injury, and 33% sustained an extremity musculoskeletal injury. Emergency surgery was performed on 43%, including laparotomy 58 (49%), craniotomy 16 (13%), laparoscopy 14 (12%), vascular procedures 10 (8%), orthopedic procedures 6 (5%), head and neck endoscopies 4 (3%), thoracotomies 2 (2%), and 10 (8%) unspecified. There were 25 deaths (9%), primarily caused by head injuries and exsanguinating hemorrhage. Eighty-six percent entered the hospital during the hours of minimal staffing that preempted the use of facilities for other emergent patients. Charges totaled $4,828,828 (emergency room, surgical procedures, intensive care, and surgical ward stay) which equated to $5,550 per patient per day. Fifty-eight percent had no third party reimbursement, 22% had Medi-Cal, and 20% had medical insurance. Because of dismal reimbursement rates, the costs of gang violence are passed on to the tax payer. The cost of gang related violence cannot be derived from hospital charges only, because death, disability, and pain are not entered into the calculation. Education, increased social programs, and strict criminal justice laws and enforcement may decrease gang related violence and the drain it has on financial and medical resources.

Age and gender influence the stereoselective pharmacokinetics of propranolol.

The effect of age and gender on the stereoselective pharmacokinetics of propranolol was studied in 12 young (25 to 33 years old) and 12 elderly (62 to 79 years old) healthy nonsmoking volunteers, half of whom were female. Racemic propranolol was administered (80 mg p.o.) each 8 hr for seven doses. Serum was obtained just before (0 time) and at 0.5, 1, 2, 4, 6, 8, 10, 12 and 24 hr after the final dose and analyzed for propranolol enantiomers. The serum concentration of alpha-1 acid glycoprotein was determined before propranolol administration. The binding of each enantiomer to serum proteins was determined in samples obtained before propranolol administration and two hr after the final dose of propranolol. We found that the intrinsic hepatic clearance of S-propranolol was about 30% smaller in the elderly than in the young, whether it was calculated for total or unbound drug. Additionally, the elimination half-lives of both enantiomers were 2- to 3-fold prolonged in the elderly compared with the young. In all subjects regardless of age or sex the intrinsic hepatic clearance of the total (bound plus free) S-isomer was smaller than that of the R-isomer. There was no age-related difference in alpha-1 acid glycoprotein concentration or protein binding of either enantiomer of propranolol. However, there was a gender-related difference with the females having significantly greater binding of the S-enantiomer than the males.(ABSTRACT TRUNCATED AT 250 WORDS)

Fringe pattern suppression in intracavity laser spectroscopy.

Absorption spectra obtained by intracavity laser spectroscopy (ILS) often contain fringe patterns that significantly mask absorption features and hamper the quantitative analysis of ILS data. Both the parasitic étalon fringes and the fringes that originate from spatially localized losses can be suppressed by a low-amplitude audio-frequency vibration of a folding mirror in the laser cavity. Using this methodology, we show that ILS spectra recorded with multimode lasers that contain nonideal intracavity surfaces have essentially no fringe contamination. The elimination of fringe contamination improves the detection sensitivity of ILS under normal experimental conditions and thus expands the potential for ILS applications.

The socioeconomic impact of assault injuries on an urban trauma center.

In 1983, Los Angeles County designated 23 level I or II trauma centers. During the subsequent 7 years, ten centers closed because of adverse financial impact. To analyze the causes of this trend, hospital admissions for gunshot and stabbing injuries were reviewed for two separate 1-year periods at a level I urban trauma center. Of 1,160 patients arriving with injuries meeting county triage criteria from January 1, 1986 through December 31, 1986, 323 (27%) sustained penetrating assault, of which 96 were with firearms (30%). From January 1, 1988 through December 31, 1988, 1,213 met triage criteria; 301 (25%) were intentional, of which 179 (59%) were due to firearms. Epidemiologic and clinical data from the two periods is similar with 90 per cent of the patients being men ages 25 to 30 and of minority ethnic background. Seventy-five per cent of the patients required a truncal operative procedure and needed about 5.5 days of hospitalization. Overall, mortality averaged 4.7 per cent and morbidity 14.5 per cent. Complete financial data was available on 561 of the 624 intentionally injured patients for which costs totaled $2,481,346 (mean = $5,260 for gunshots; mean = $3,640 for stab wounds). The total collections were $545,896 (22% of total charges). Only 5 per cent of the charges were reimbursed from insurance; MediCal reimbursed 13 per cent and only 1 per cent was from Medicare. Eighty-one per cent of the patients had no financial resources, resulting in a hospital deficit of $1,861,009 (75% of the total charges).(ABSTRACT TRUNCATED AT 250 WORDS)

Wild carnivore acceptance of baits for delivery of liquid rabies vaccine.

A series of experiments are described on the acceptance, by red foxes (Vulpes vulpes) and other species, of two types of vaccine-baits intended to deliver liquid rabies vaccine. The baits consisted of a cube of sponge coated in a mixture of tallow and wax, or a plastic blister-pack embedded in tallow. All baits contained tetracycline as a biological marking agent: examination of thin sections of carnivore canines under an ultraviolet microscope revealed a fluorescent line of tetracycline if an individual had eaten baits. Baits were dropped from fixed-wing aircraft flying about 100 m above ground at approximately 130 km/h. Flight lines followed the edges of woodlots midway between parallel roads. Baits were dropped at one/sec, resulting in one bait/36 m on the ground, or 17 to 25 baits per km2. Crows (Corvus brachyrhynchos) removed many baits, but did not appear to lower the percent of the fox population which took bait. Dropping baits only into corn and woodland to conceal baits, to reduce depredation by crows, reduced acceptance by foxes. Acceptance by foxes ranged between 37 and 68%. Meat added as an attractant did not raise acceptance. Presence, absence, color and perforations of plastic bags did not alter bait acceptance. Dispersal by juvenile foxes probably lowered the estimates of bait acceptance. It took 7 to 17 days for 80% (n = 330) of foxes to eat their first bait. The rapidity with which foxes picked up their first bait appeared more affected by unknown characteristics of years or study areas than by experimental variables. Skunks (Mephitis mephitis) and raccoons (Procyon lotor) also ate these baits, but acceptance was lower. Small mammals contacted baits, but rarely contacted the vaccine, which had the potential for vaccine-induced rabies in some species. Aerial distribution of baits was more cost-effective than ground distribution as practiced in Europe. This system has potential for field control of rabies, although higher acceptance will be desirable.