CDC field triage criteria accurately predicts outcomes in high impact trauma.

BACKGROUND: The precision of emergency medical services (EMS) triage criteria dictates whether an injured patient receives appropriate care. The trauma triage protocol is a decision scheme that groups patients into triage categories of major, moderate and minor. We hypothesized that there is a difference between trauma triage category and injury severity score (ISS). METHODS: This retrospective, observational study was conducted to investigate a difference between trauma triage category and ISS. Bivariate analysis was used to test for differences between the subgroup means. The differences between the group means on each measure were analyzed for direction and statistical significance using ANOVA for continuous variables and chi square tests for categorical variables. Logistic and linear regressions were performed to evaluate factors predicting mortality, ICU length of stay. RESULTS: With respect to trauma triage category, our findings indicate that minor and moderate triage categories are similar with respect to ISS, GCS, ICU LOS, hospital LOS, and mortality. However, after excluding for low impact injuries (falls), differences between the minor and moderate categories were evident when comparing to ISS, GCS, ICU LOS, and hospital LOS. Additionally, after excluding for low impact injures, ISS, ICU LOS, and hospital stay were found to correlate well with trauma triage category. CONCLUSIONS: In this retrospective, observational study significant differences were not seen when comparing ISS with the trauma triage categories of moderate and minor during our initial analysis. However, a difference was found after excluding for low impact injuries. These findings suggest that CDC criteria accurately predicts outcomes in high impact trauma.

Assessment of trace elements and legacy contaminant concentrations in California mussels (Mytilus spp.): relationship to land use and outfalls.

NOAA's Mussel Watch Program funded a regional pilot project in California that characterized contaminants associated with various land uses in conjunction with state, federal and private partners. Herein we assess the magnitude and distribution of trace elements and persistent organic contaminants in indigenous mussels with respect to land use, presence of outfalls and a subset of California Areas of Special Biological Significance (ASBS). We detected significant differences among the land use categories for the majority of trace elements and legacy contaminants measured. There was no significant difference between sites with and without outfalls. PCBs and PAHs were significantly lower in sites within ASBS boundary compared to other sites. The findings of this study will help fine tune future regional and national assessments as well as guide development of resource management and remediation activities and programs.

Chemical contamination assessment of the Hudson-Raritan Estuary as a result of the attacks on the World Trade Center: analysis of trace elements.

The attack on the World Trade Center (WTC) resulted in the destruction of buildings, and the release of tons of dust and debris into the environment. As part of the effort to characterize the environmental impact of the WTC collapse, Mussel Watch Program trace element measurements from the Hudson-Raritan Estuary (HRE) were assessed for the years before (1986-2001) and after (2001-2005) the attack. Trace element measurements in the HRE were significantly higher than Mussel Watch measurements taken elsewhere in the Nation. Post-attack trace element measurements were not significantly different from pre-attack measurements. The impacts of WTC collapse may have been obscured by high ambient levels of trace elements in the HRE.

A historical assessment of coastal contamination in Birch Harbor, Maine based on the analysis of mussels collected in the 1940s and the Mussel Watch Program.

Coastal contamination in the 1940s was assessed based on analysis of canned blue mussels presumably collected from Birch Harbor, Maine, USA. Analytical results on legacy organic contaminants were compared to long-term National Oceanic and Atmospheric Administration (NOAA) Mussel Watch (MW) monitoring data to estimate the degree of coastal contamination before World War II (WWII) when many synthetic organic compounds were first introduced into the environment. While dieldrin and chlordane were not detected in the canned mussels, dichloro-diphenyl-trichloroethane (DDT) and hexachlorocyclohexanes (HCHs) were present at lower concentrations relative to the more recent MW data. Polychlorinated biphenyls (PCBs) and polycyclic aromatic hydrocarbons (PAHs) were detected, and the later were significantly higher in canned mussels relative to the MW data (p<0.05). Furthermore, moving average analysis applied to the MW data depicted three-phased temporal trend patterns (increase-decrease-steady state) for virtually all contaminants indicating an overall increased coastal contamination in post WWII era.

Chemical contamination assessment of Gulf of Mexico oysters in response to hurricanes Katrina and Rita.

Hurricane Katrina made landfall on August 29, 2005 and caused widespread devastation along the central Gulf Coast states. Less than a month later Hurricane Rita followed a similar track slightly west of Katrina's. A coordinated multi-agency response followed to collect water, sediment and tissue samples for a variety of chemical, biological and toxicological indicators. The National Oceanic and Atmospheric Administration's National Status and Trends Program (NS&T) participated in this effort by measuring chemical contamination in sediment and oyster tissue as part of the Mussel Watch Program, a long-term monitoring program to assess spatial and temporal trends in a wide range of coastal pollutants. This paper describes results for contaminants measured in oyster tissue collected between September 29 and October 10, 2005 and discusses the results in the context of Mussel Watch and its 20-year record of chemical contamination in the region and the nation. In general, levels of metals in oyster tissue were higher then pre- hurricane levels while organic contaminants were at or near record lows. No contaminant reported here exceeded the FDA action level for food safety.

Chemical contamination of the Hudson-Raritan Estuary as a result of the attack on the World Trade Center: analysis of polycyclic aromatic hydrocarbons and polychlorinated biphenyls in mussels and sediment.

The September 11, 2001 attack on the World Trade Center (WTC) resulted in a massive plume of dust and smoke that blanketed lower Manhattan and part of the Hudson-Raritan Estuary (HRE). The NOAA National Status and Trends Mussel Watch Program has long-term monitoring sites in the area and thus had an opportunity to assess the effect of the WTC attack on PAH and PCB contamination of the surrounding estuary. Seven additional sites were added in the Upper HRE to attain higher sampling resolution for comparison with regularly sampled Mussel Watch Project HRE sites. Elevated background levels of PCBs and PAHs in mussel tissue and sediments were high enough before the WTC attack that concentrations were not measurably changed by WTC derived contaminant input.

Assessment of polycyclic aromatic hydrocarbon input to urban wetlands in relation to adjacent land use.

The relationship between polycyclic aromatic hydrocarbons (PAHs) in wetland surface sediments and adjacent land use was assessed in the Elizabeth River, VA, an urbanized sub-estuary of the Chesapeake Bay. Significant differences (p<0.05) in surface sediment PAH concentration between sites indicated adjacent land use had a substantial influence on PAH concentration in wetland sediments. Wetlands adjacent to parking lots and petroleum industrial sites exhibited the highest PAH concentrations of all wetlands examined. Overall, commercial land uses had the highest PAH concentrations and automotive sources dominated (52-69%) PAH input to wetland surface sediments irrespective of adjacent land use.

Chemical evidence for covalent linkages of a semi-synthetic glycoconjugate vaccine for Haemophilus influenzae type B disease.

We have defined the nature of the covalent linkages in a Haemophilus influenzae type b oligosaccharide-CRM197 conjugate vaccine, designated HbOC. The conjugate was acid hydrolyzed to release a novel amino-acid derivative, N epsilon-(2-hydroxyethyl)lysine (OHEt-Lys), identifiable with an amino-acid analyzer. This amino-acid derivative was formed by reduction of Schiff bases formed between H. influenzae type b oligosaccharides (HbO) and the lysyl epsilon-amino groups of CRM197 (a non-toxic, cross-reactive variant of diphtheria toxin), followed by acid hydrolysis of HbOC. Quantification of OHEt-Lys per CRM197 molecule allowed the determination of a covalency ratio, a useful parameter for evaluating the stoichiometry and consistency of HbOC preparations. Covalent association between HbO and CRM197 was also demonstrated by the coincidence of immunoreactivity of gel-electrophoresed HbOC on a Western blot probed with anti-CRM197 and anti-saccharide antisera.