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  • 1
    Language: English
    In: Trauma, October 2019, Vol.21(4), pp.272-279
    Description: Introduction Traumatic aortic injury is an uncommon condition. Timely diagnosis may enable early haemostatic resuscitation, essential to prevent worsening of the injury prior to definitive management. The aim of this study was to assess the utility of initial vital signs and presenting clinical characteristics to confirm or rule out aortic injury. Methods A retrospective review of patients from The Alfred Trauma Registry was conducted. Patients presenting between January 2006 and July 2014 and diagnosed with aortic injury were identified. Demographics and presenting clinical characteristics were extracted. Sensitivity of individual clinical variables for the detection of aortic injury was calculated. Results There were 77 patients identified with aortic injury, with an in-hospital mortality rate of 19.5% (95% CI: 10.6–28.3%). Of these, 68 (88.3%) patients presented after high-energy blunt mechanisms. Clinical signs and early chest X-ray findings were poorly sensitive to detect aortic injury. Patients who presented with hypotension had a greater severity of aortic injury, more commonly had associated abnormal investigation findings and were more likely to require blood products and inotropic agents (p 〈 0.05). However, sensitivity of initial hypotension to rule out aortic injury was 39.0% (95% CI: 28.1–49.9%). Conclusions The diagnosis of aortic injury was uncommon in hospital. Most injuries were secondary to high-velocity road traffic crashes or high falls. Clinical signs were not adequately sensitive to be used for the exclusion of aortic injury. We recommend a high degree of clinical suspicion and liberal imaging among cases where aortic injury is possible.
    Keywords: Aorta ; Wounds and Injuries ; Aortic Rupture ; Aortic Aneurysm ; Hypotension
    ISSN: 1460-4086
    E-ISSN: 1477-0350
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  • 2
    Language: English
    In: The Lancet, 22 September 2012, Vol.380(9847), pp.1033-1034
    Description: By 2030, road traffic injuries are predicted to be the world's fifth leading cause of death and the third leading cause of disability.1 The Lancet's accompanying Series on trauma surgery updates present knowledge of three broad aspects of acute trauma care: haemorrhagic shock (responsible for most preventable...
    Keywords: Medicine
    ISSN: 0140-6736
    E-ISSN: 1474-547X
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  • 3
    In: Spine, 2013, Vol.38(12), pp.999-1007
    Description: STUDY DESIGN.: Retrospective review on prospective cohort and explicit chart review. OBJECTIVE.: To identify early spine trauma predictors of functional disability and to assess management compliance to established spine trauma treatment algorithms. SUMMARY OF BACKGROUND DATA.: Identification of early (within 48 hours) spine trauma predictors of functional disability is novel and may assist in the management of patients with trauma. Also, with significant global variation, spine trauma treatment algorithms are essential. METHODS.: Analysis was performed on patients with spine trauma from May 1, 2009, to January 1, 2011. Functional outcomes were determined using the Glasgow Outcome Scale (GOS) at 1 year. Univariate and multivariate regressions were applied to investigate the effects of the injury severity score, age, blood sugar level, vital signs, traumatic brain injury, comorbidities, coagulation profile, neurology, and spine injury characteristics. A compliance study was performed using the SLIC and TLICS spine trauma algorithms. RESULTS.: The completion rate for the GOS was 58.8%. The completed GOS cohort was 4.2 years younger in terms of mean age, had more number of patients with severe polytrauma, but less number of patients with severe spinal cord injuries (ASIA [American Spinal Injury Association] A, B, and C) in comparison with the uncompleted GOS cohort. Multivariate logistic regression revealed 3 independent early spine trauma predictors of functional disability with statistical significance (P 〈 0.05). They were (1) hypotension (OR [odds ratio] = 1.98; CI [confidence interval] = 1.13–3.49), (2) hyperglycemia (OR = 1.67; CI = 1.09–2.56), and (3) moderate/severe traumatic brain injury (OR = 5.88; CI = 1.71–20.16). There were 305 patients with subaxial cervical spine injuries and 653 patients with thoracolumbar spine injuries. The subaxial cervical spine injury classification and thoracolumbar injury classification and severity score compliance studies returned agreements of 96.1% and 98.9%, respectively. CONCLUSION.: Early independent spine trauma predictors of functional disability identified in a level 1 trauma center with high compliance to the subaxial cervical spine injury classification and thoracolumbar injury classification and severity score algorithms were hypotension, hyperglycemia, and moderate or severe traumatic brain injury. Spine trauma injury variables alone were shown not to be predictive of functional disability.Level of Evidence: 3
    Keywords: Disability Evaluation ; Trauma Centers ; Spinal Injuries -- Diagnosis ; Spine -- Physiopathology;
    ISSN: 0362-2436
    E-ISSN: 15281159
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  • 4
    Language: English
    In: JAMA surgery, 01 July 2017, Vol.152(7), pp.706
    Keywords: Hospitals ; Humans ; Pulmonary Embolism ; Vena Cava Filters ; Vena Cava, Inferior ; Abridged;
    ISSN: 21686254
    E-ISSN: 2168-6262
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  • 5
    In: Spine, 2013, Vol.38(2), pp.169-177
    Description: STUDY DESIGN.: Retrospective cohort study. OBJECTIVE.: To identify early independent mortality predictors after spine trauma. SUMMARY OF BACKGROUND DATA.: Spine trauma consists of spinal cord and spine column injury. The ability to identify early (within 24 hours) risk factors predictive of mortality in spine trauma has the potential to reduce mortality and improve spine trauma management. METHODS.: Analysis was performed on 215 spine column and/or spinal cord injured patients from July 2008 to August 2011. Univariate and multivariate logistic regression models were applied to investigate the effects of the Injury Severity Score, age, mechanism of injury, blood glucose level, vital signs, brain trauma severity, morbidity before trauma, coagulation profile, neurological status, and spine injuries on the risk of in-hospital death. RESULTS.: Applying a multivariate logistic regression model, there were 7 independent early predictive factors for mortality after spine injury. They were (1) Injury Severity Score more than 15 (odds ratio [OR] = 3.67; P = 0.009), (2) abnormal coagulation profile (OR = 6; P 〈 0.0001), (3) patients 65 years or older (OR = 3.49; P = 0.007), (4) hypotension (OR = 2.9; P = 0.033), (5) tachycardia (OR = 4.04; P = 0.005), (6) hypoxia (OR = 2.9; P = 0.033), and (7) multiple comorbidities (OR = 3.49; P = 0.007). Severe traumatic brain injury was also associated with mortality but was excluded from multivariate analysis because there were no patients with this variable in the comparison group. CONCLUSION.: Mortality predictors for spine trauma patients are similar to those for general trauma patients. Spine injury variables were shown not to be independent predictors of spine trauma mortality.
    Keywords: Aged–Epidemiology ; Australia–Diagnosis ; Cause of Death–Mortality ; Comorbidity–Diagnosis ; Early Diagnosis–Mortality ; Female–Mortality ; Humans–Mortality ; Male–Mortality ; Prognosis–Mortality ; Retrospective Studies–Mortality ; Risk Factors–Mortality ; Spinal Cord Injuries–Mortality ; Spinal Injuries–Mortality ; Survival Rate–Mortality ; Time Factors–Mortality ; Trauma Severity Indices–Mortality ; Vital Signs–Mortality;
    ISSN: 0362-2436
    E-ISSN: 15281159
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  • 6
    Dissertation
    Dissertation
    Goldsmiths College (University of London)
    Language: English
    Description: China’s economy continues to fascinate. For some time now, it has been the focus of a discourse centred on the nature and implications of the phenomenon of Chinese state capitalism. Much of the research on this phenomenon has highlighted the country’s...
    Keywords: 306
    ISSN: 00024056
    Source: The British Library
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  • 7
    Dissertation
    Dissertation
    Goldsmiths College (University of London)
    Description: China’s economy continues to fascinate. For some time now, it has been the focus of a discourse centred on the nature and implications of the phenomenon of Chinese state capitalism. Much of the research on this phenomenon has highlighted the country’s industrial sector. However, another distinctive yet comparatively under-researched characteristic of contemporary Chinese state capitalism is its financial system. Although the basics of this system are widely understood, the specifics remain very much a black box. In what follows, I position Beijing’s financial centre as a scholarship void that that will provide grounded insights into this lacuna in our understanding of a particular aspect of state capitalism in China. In particular, this study focuses on the Beijing ‘Financial Street’ (jinrong jie; 金融界). Drawing on a strand of economic sociology that focuses on institutions, networks, social capital and culture, the financial centre is seen here as a setting supporting a central component of China’s model of economic model. This setting is characterised by a networked hierarchy of firms constitutive of the commanding heights of the country’s financial system. In turn, this networked hierarchy is shown to be embedded and configured according to larger, more elaborate networks inclusive of the party-state. It is argued that the organisational structure of Chinese state capitalism in the Financial Street takes the form of a political financial industrial complex, which differs from the popular image of financial centres as spaces of globalised capital flow. Financial centres are phenomena of our time. They are the organisations according to which the economic landscapes of capitalism are configured. Whilst what is written here may be read as an attempt to bring the financial centre back down to earth, to ground it in a sustained scientific inquiry, this thesis is also meant to fit into the broader field of multiple capitalisms research. As a focal point for state capitalism, studying the Beijing Financial Street can tell us how China’s particular brand of capitalism is being constructed. It provides a window into some of the mechanics of Chinese economic development. This is important for deepening our knowledge and understanding of the nature of capitalism in general.
    Keywords: 306
    Source: Networked Digital Library of Theses and Dissertations
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  • 8
    Language: English
    In: Postgraduate Medical Journal, 23 August 2017, Vol.93(1102), p.454
    Description: CT of the brain (CTB) is one of the most common radiological investigations performed in the emergency department (ED). Emergency clinicians rely upon this imaging modality to aid diagnosis and guide management. However, their capacity to accurately interpret CTB is unclear. This systematic review aims to determine this capacity and identify the potential need for interventions directed towards improving the ability of emergency clinicians in this important area.
    Keywords: Accident & Emergency Medicine ; Medical Education & Training
    ISSN: 0032-5473
    ISSN: 00325473
    E-ISSN: 1469-0756
    E-ISSN: 14690756
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  • 9
    In: Surgical Practice, February 2018, Vol.22(1), pp.10-14
    Description: Aim Traumatic aortic injury (TAI) is a serious complication of blunt chest trauma. The traumatic aortic injury score (TRAINS) is a clinical tool for risk determination, with patients scoring 〈4 considered low risk. The aim of the present study was to...
    Keywords: Aortic Injury ; Aortic Transection ; Clinical Prediction ; Wounds And Injuries
    ISSN: 1744-1625
    E-ISSN: 1744-1633
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  • 10
    Language: English
    In: Emergency Medicine Journal, 9 April 2018, Vol.35(4), p.231
    Description: Blunt thoracic aortic injury (BTAI) is an uncommon diagnosis, usually developing as a consequence of high-impact acceleration–deceleration mechanisms. Timely diagnosis may enable early resuscitation and reduction of shear forces, essential to prevent worsening of the injury prior to definitive management. Death is commonly due to haemorrhagic shock, but clinical features may be absent until sudden and massive haemorrhage.
    Keywords: Aorta ; Wounds and Injuries ; Blunt ; Aortic Rupture ; Aortic Aneurysm ; Hypotension
    ISSN: 1472-0205
    ISSN: 14720205
    E-ISSN: 1472-0213
    E-ISSN: 14720213
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