Level One Trauma Center Proliferation May Worsen Patient Outcomes.

BACKGROUND: From 2013 to 2020, Arizona state trauma system expanded from seven to thirteen level 1 trauma centers (L1TCs). This study utilized the state trauma registry to analyze the effect of L1TC proliferation on patient outcomes. METHODS: Adult patients age≥15 in the state trauma registry from 2007-2020 were queried for demographic, injury, and outcome variables. These variables were compared across the 2 time periods: 2007-2012 as pre-proliferation (PRE) and 2013-2020 as post-proliferation (POST). Multivariate logistic regression was performed to assess independent predictors of mortality. Subgroup analyses were done for Injury Severity Score (ISS)≥15, age≥65, and trauma mechanisms. RESULTS: A total of 482,896 trauma patients were included in this study. 40% were female, 29% were geriatric patients, and 8.6% sustained penetrating trauma. The median ISS was 4. Inpatient mortality overall was 2.7%. POST consisted of more female, geriatric, and blunt trauma patients (P < .001). Both periods had similar median ISS. POST had more interfacility transfers (14.5% vs 10.3%, P < .001). Inpatient, unadjusted mortality decreased by .5% in POST (P < .001). After adjusting for age, gender, ISS, and trauma mechanism, being in POST was predictive of death (OR: 1.4, CI:1.3-1.5, P < .001). This was consistent across all subgroups except for geriatric subgroup, which there was no significant correlation. DISCUSSION: Despite advances in trauma care and almost doubling of L1TCs, POST had minimal reduction of unadjusted mortality and was an independent predictor of death. Results suggest increasing number of L1TCs alone may not improve mortality. Alternative approaches should be sought with future regional trauma system design and implementation.

Impact of lower level trauma center proliferation on patient outcomes.

Background: In attempt to increase trauma system coverage, our state added 21 level 3 (L3TC) and level 4 trauma centers (L4TC) to the existing 7 level 1 trauma centers from 2008 to 2012. This study examined the impact of adding these lower-level trauma centers (LLTC) on patient outcomes. Methods: Patients in the state trauma registry age ≥ 15 from 2007 to 2012 were queried for demographic, injury, and outcome variables. These were compared between 2007 (PRE) and 2008-2012 (POST) cohorts. Multivariate logistic regression was performed to assess independent predictors of mortality. Subgroup analyses were performed for Injury Severity Score (ISS) ≥15, age ≥ 65, and trauma mechanisms. Results: 143,919 adults were evaluated. POST had significantly more female, geriatric, and blunt traumas (all p < 0.001). ISS was similar. Interfacility transfers increased by 10.2 %. Overall mortality decreased by 0.6 % (p < 0.001). Multivariate logistic regression analysis showed that being in POST was not associated with survival (OR: 1.07, CI: 0.96-1.18, p = 0.227). Subgroup analyses showed small reductions in mortality, except for geriatric patients. After adjusting for covariates, POST was not associated with survival in any subgroup, and trended toward being a predictor for death in penetrating traumas (OR: 1.23; 1.00-1.53, p = 0.059). Conclusions: Unregulated proliferation of LLTCs was associated with increased interfacility transfers without significant increase in trauma patients treated. LLTC proliferation was not an independent protector against mortality in the overall cohort and may worsen mortality for penetrating trauma patients. Rather than simply increasing the number of LLTCs within a region, perhaps more planned approaches are needed. Key message: This is, to our knowledge, the first work to study the effect of rapid lower level trauma center proliferation on patient outcomes. The findings of our analysis have implications for strategic planning of future trauma systems.

Points to consider in the development of national human genome editing policy.

Clustered regularly interspaced short palindromic repeats and other genome editing technologies have the potential to transform the lives of people affected by genetic disorders for the better. However, it is widely recognised that they also raise large ethical and policy questions. The focus of this article is on how national genome editing policy might be developed in ways that give proper recognition to these big questions. The article first considers some of the regulatory challenges involved in dealing these big ethical and social questions, and also economic issues. It then reviews the outcomes of a series of major reports on genome editing from international expert bodies, with a particular focus on the work of the World Health Organization's expert committee on genome editing. The article then summarises five policy themes that have emerged from this review of the international reports together with a review of other literature, and the authors' engagement with members of the Australian public and with a wide range of experts across multiple disciplines. Each theme is accompanied by one to three pointers for policymakers to consider in developing genome editing policy.

How Should We Regulate Heritable Human Genome Editing in Australia?

Heritable human genome editing is a form of modification of the human genome that will be inherited by progeny of the person whose DNA has been edited. Editing human genomes in ways that are heritable is currently prohibited in many countries throughout the world, including in Australia. This section starts with an examination of the historical backdrop to Australia's current laws relating to heritable human genome editing, with particular focus on how technological advances and community responses have shaped our legislative environment for innovative artificial reproductive technologies. The section then examines how community responses to current developments in heritable human genome editing might shape future law reform. The aim is to provide a foundation for examining how the future regulatory environment for heritable human genome editing in Australia might be shaped in ways that are responsive both to technological developments and to contemporary ethical norms and social values.

A 'smart' aptamer-functionalized continuous label-free cell catch-transport-release system.

Label-free cell sorting devices are of great significance for biomedical research and clinical therapeutics. However, current platforms for label-free cell sorting cannot achieve continuity and selectivity simultaneously, resulting in complex steps and limited reliability. Here, an immunoaffinity-based cell catch-transport-release thermo-chemo-mechanical coupling hydrogel (iCatch) device is reported. It contains a temperature-responsive hydrogel that can generate spatial movement synergically with the reversible binding of affinity handle modified. The functionalized hydrogel is embedded inside a biphasic microfluidic platform to enable cell transportation between the flows. The cell sorting capability and biocompatibility of the iCatch device were validated with CCRF-CEM cells as a proof-of-concept, and CCRF-CEM-specific aptamers with thermo-responsive affinity as well as a hydrogel with temperature-dependent volume were employed accordingly. A cell catching efficiency of ∼40% and a recovery rate of ∼70% were achieved. The iCatch device provides a high-throughput (∼900 cells mm-1 s-1) platform for cell sorting and is ultimately valuable for downstream biomedical applications.

Vitamin D deficiency in burn patients.

Vitamin D deficiency has been reported in pediatric burn patients; however, no formal studies have been conducted in adult burn populations. The available literature on vitamin D status in burn patients has been reviewed. A literature search was conducted using Medline™, the Cochrane central register of controlled trials, and EMBASE to identify any trials of vitamin D deficiency in burn patients. Six published studies regarding vitamin D status in burn patients were found; however, five of these were in pediatric populations and several did not assess vitamin D levels as a major endpoint. Vitamin D deficiency has been demonstrated to result in itching, muscle weakness, and neuropathy, all of which are common postburn sequelae. The major source of vitamin D is synthesis in the skin with a small amount being absorbed through dietary intake. Population groups are at higher risk of vitamin D deficiency if they have inadequate exposure to UV light or reduced biosynthetic capability due to skin damage. Burn patients fall into both risk groups and also suffer common complaints that overlap with those reported by patients with vitamin D deficiency. Further research in adult burn patients is needed to determine the prevalence of deficiency in this population and whether vitamin D deficiency might influence postburn injury symptoms reported by patients.