Accuracy of prehospital triage of trauma patients by emergency physicians: a retrospective study in western Switzerland.

OBJECTIVE: Accurate identification of major trauma patients in the prehospital setting positively affects survival and resource utilization. Triage algorithms using predictive criteria of injury severity have been identified in paramedic-based prehospital systems. Our rescue system is based on prehospital paramedics and emergency physicians. The aim of this study was to evaluate the accuracy of the prehospital triage performed by physicians and to identify the predictive factors leading to errors of triage.METHODS: Retrospective study of trauma patients triaged by physicians. Prehospital triage was analyzed using criteria defining major trauma victims (MTVs, Injury Severity Score >15, admission to ICU, need for immediate surgery and death within 48 h). Adequate triage was defined as MTVs oriented to the trauma centre or non-MTV (NMTV) oriented to regional hospitals.RESULTS: One thousand six hundred and eighti-five patients (blunt trauma 96%) were included (558 MTV and 1127 NMTV). Triage was adequate in 1455 patients (86.4%). Overtriage occurred in 171 cases (10.1%) and undertriage in 59 cases (3.5%). Sensitivity and specificity was 90 and 85%, respectively, whereas positive predictive value and negative predictive value were 75 and 94%, respectively. Using logistic regression analysis, significant (P<0.05) predictors of undertriage were head or thorax injuries (odds ratio >2.5). Predictors of overtriage were paediatric age group, pedestrian or 2 wheel-vehicle road traffic accidents (odds ratio >2.0).CONCLUSION: Physicians using clinical judgement provide effective prehospital triage of trauma patients. Only a few factors predicting errors in triage process were identified in this study.

European integration, FDI and the internal geography of trade : evidence from Western European border regions

In this paper we use a gravity model to study the trade performance of French and Spanishborder regions relatively to non-border regions, over the past two decades. We find that,controlling for their size, proximity and location characteristics, border regions trade onaverage between 62% and 193% more with their neighbouring country than other regions,and twice as much if they are endowed with good cross border transport infrastructures.Despite European integration, however, this trade outperformance has fallen for the mostperipheral regions within the EU. We show that this trend was linked in part to a shift in the propensity of foreign investors to move their affiliates from the regions near their home market to the regions bordering the EU core.

The 500 Ma-old Thyon metagranite: A new A-type granite occurrence in the western Penninic Alps (Wallis, Switzerland)

The Thyon metagranite is located in the frontal part of the Siviez-Mischabel Nappe, in the western Penninic Alps. It is intrusive in a polymetamorphic banded volcanic complex as leucocratic concordant sills with pseudoaplitic rims. A distinct metamorphic schistosity is defined by dark-green Fe-rich biotite. Abundant mesoperthites, chess-board albite and low microcline are presumably related to magmatic stages and/or greenschist-facies metamorphic retrogression. Major, trace element and REE geochemistry, zircon typology, Y and Nb-bearing accessory minerals such as fergusonite and euxenite, all point to a metaluminous to peraluminous alkaline A-type granite. High-precision U-Pb zircon dating yielded a sub-concordant age of 500 +3/-4 Ma. The Thyon metagranite is the third record of a Cambro-Ordovician alkaline magmatic activity in the Alps. As A-type granitic magmatism is common in post-orogenic to anorogenic extensional tectonic regime, the Thyon intrusion could mark the transition between the Cadomian and the Caledonian orogenies.

Alpine deformation and 40Ar/39Ar geochronology of synkinematic white mica in the Siviez-Mischabel Nappe, western Pennine Alps, Switzerland

We explore the timing of deformation and exhumation of the Siviez-Mischabel Nappe (western Swiss Alps), which has been considered a classic example of a midcrustal crystalline nappe since the studies of Argand [1916]. This study presents Ar-40/Ar-39 ages obtained on both synkinematic white mica from Permo-Triassic cover sediments and more complex white mica populations from basement gneisses of the Siviez-Mischabel and middle Pennine Nappes. Primary foliation developed in cover units by nucleation, growth, and rigid rotation of mica grains during noncoaxial Alpine deformation. Although some samples show a crenulation of this primary foliation, mica growth appears to have occurred only during the development of primary foliation, the main phase of greenschist facies deformation related to imbrication of the Siviez-Mischabel Nappe and other middle Pennine Nappes. Good agreement exists between independent estimates of the timing of deformation and reported Ar-40/Ar-39, white mica ages from cover units of the central and southern Siviez-Mischabel Nappe. In cover units from the central and southern Siviez-Mischabel regions of the study area, Ar-40/Ar-39 ages appear to date synkinematic white mica growth. Results suggest that the Siviez-Mischabel :Nappe was emplaced and developed foliation during a 5 m.y. period from 41 to 36 Ma. In cover units from the eastern Siviez-Mischabel, however, Ar-40/Ar-39 white mica ages appear to date postkinematic thermal events. These thermal events may be related to Oligocene magmatic activity in the lower Pennine Nappes or to Miocene development of the Simplon fault zone. Variations in the relation between Alpine age and grain size for cover samples from the central, eastern, and southern Siviez-Mischabel correlate well with the regional variations in temperature inferred from quartz microfabrics and the pattern of regional metamorphism. When considered in concert with other recent isotopic studies on the timing of major tectonic and thermal events in the western Swiss Alps, these data support arguments that the relative timing of events such as thrusting and back thrusting of crystalline nappes in hinterland units and exhumation of high-pressure units in the suture zone of the western Alps are intimately related and synchronous on the scale of a few million years. Copyright 1998 by the American Geophysical Union.

Secular changes of spinal canal dimensions in Western Switzerland: a narrowing epidemic?

STUDY DESIGN: Computed tomography-based anatomical study. OBJECTIVE: To study the secular changes in lumbar spinal canal dimensions. SUMMARY OF BACKGROUND DATA: Development of symptomatic lumbar spinal stenosis, among other factors, is related to the dimensions of the bony canal. The canal reaches its adult size early on in life. Several factors, including protein intake, may influence its final dimensions. As with increases in human stature from improvements of socioeconomic conditions, we hypothesized that adult bony canal size has also grown larger in recent generations. METHODS: This study analyzes computed tomographic reconstructions from 184 subjects performed for either trauma (n = 81) or abdominal pathologies (n = 103) and born either between 1940 and 1949 (n = 88) or 1970 and 1979 (n = 96). The cross-sectional area of the bony canal was digitally measured at the level of the pedicle (i.e., at a level not influenced by degenerative changes) for each lumbar vertebra. Intra- and interobserver reliability was assessed. RESULTS: Intra- and interobserver measurement reliability were excellent (interclass correlation coefficient = 0.87) and good (interclass correlation coefficient = 0.61), respectively. Contrary to our hypothesis, the 1940-1949 generation patient group exhibited larger lumbar canals at all levels as compared with the 1970-1979 group. Statistically this difference was highly significant (P < 0.001) and particularly pronounced in the trauma subgroup. CONCLUSION: Given that human stature evolution has stabilized and adult height is established during the first 2 years of long bone growth, it is possible that antenatal factors are responsible for this surprising finding. Maternal smoking and age may be possible explanations. This finding may have significant implications. An increasing number of patients may emerge with lumbar spinal stenosis as degenerative changes develop, putting a strain on health resources. Further studies in different population groups and countries will be important to further confirm this trend. LEVEL OF EVIDENCE: 3.

Western Iowa Missouri River Flooding -- Geo-Infrastructure Damage Assessment, Repair and Mitigation Strategies, TR-638, 2013

The 2011 Missouri River flooding caused significant damage to many geo-infrastructure systems including levees, bridge abutments/foundations, paved and unpaved roadways, culverts, and embankment slopes in western Iowa. The flooding resulted in closures of several interchanges along Interstate 29 and of more than 100 miles of secondary roads in western Iowa, causing severe inconvenience to residents and losses to local businesses. The main goals of this research project were to assist county and city engineers by deploying and using advanced technologies to rapidly assess the damage to geo-infrastructure and develop effective repair and mitigation strategies and solutions for use during future flood events in Iowa. The research team visited selected sites in western Iowa to conduct field reconnaissance, in situ testing on bridge abutment backfills that were affected by floods, flooded and non-flooded secondary roadways, and culverts. In situ testing was conducted shortly after the flood waters receded, and several months after flooding to evaluate recovery and performance. Tests included falling weight deflectometer, dynamic cone penetrometer, three-dimensional (3D) laser scanning, ground penetrating radar, and hand auger soil sampling. Field results indicated significant differences in roadway support characteristics between flooded and non-flooded areas. Support characteristics in some flooded areas recovered over time, while others did not. Voids were detected in culvert and bridge abutment backfill materials shortly after flooding and several months after flooding. A catalog of field assessment techniques and 20 potential repair/mitigation solutions are provided in this report. A flow chart relating the damages observed, assessment techniques, and potential repair/mitigation solutions is provided. These options are discussed for paved/unpaved roads, culverts, and bridge abutments, and are applicable for both primary and secondary roadways.

Stable isotope geochemistry and phase-equilibria of coesite-bearing whiteschists, Dora Maira massif, Western Alps

Peak metamorphic temperatures for the coesite-pyrope-bearing whiteschists from the Dora Maira Massif, western Alps were determined with oxygen isotope thermometry. The deltaO-18(SMOW) values of the quartz (after coesite) (delta O-18 = 8.1 to 8.6 parts per thousand, n = 6), phengite (6.2 to 6.4 parts per thousand, n = 3), kyanite (6.1 parts per thousand, n = 2), garnet (5.5 to 5.8 parts per thousand, n = 9), ellenbergerite (6.3 parts per thousand, n = 1) and rutile (3.3. to 3.6 parts per thousand, n = 3) reflect isotopic equilibrium. Temperature estimates based on quartz-garnet-rutile fractionation are 700-750-degrees-C. Minimum pressures are 31-32 kb based on the pressure-sensitive reaction pyrope + coesite = kyanite + enstatite. In order to stabilize pyrope and coesite by the temperature-sensitive dehydration reaction talc + kyanite = pyrope + coesite + H2O, the a(H2O) must be reduced to 0.4-0.75 at 700 750-degrees-C. The reduced a(H2O) cannot be due to dilution by CO2, as pyrope is not stable at X (CO2) > 0.02 (T = 750-degrees-C; P = 30 kb). In the absence of a more exotic fluid diluent (e.g. CH4 or N2), a melt phase is required. Granite solidus temperatures are approximately 680-degrees-C/30 kb at a(H2O) = 1.0 and are calculated to be approximately 70-degrees-C higher at a(H2O) = 0.7, consistent with this hypothesis. Kyanite-jadeite-quartz bands may represent a relict melt phase. Peak P-T-f(H2O) estimates for the whiteschist are 34 +/- 2 kb, 700-750-degrees-C and 0.4-0.75. The oxygen isotope fractionation between quartz (deltaO-18 = 11.6%.) and garnet (deltaO-18 = 8.7 parts per thousand) in the surrounding orthognesiss is identical to that in the coesite-bearing unit, suggesting that the two units shared a common, final metamorphic history. Hydrogen isotope measurements were made on primary talc and phengite (deltaD(smow) = -27 to -32 parts per thousand), on secondary talc and chlorite after pyrope (deltaD = - 39 to - 44 parts per thousand) and on the surrounding biotite (deltaD = -64 parts per thousand) and phengite (deltaD = -44 parts per thousand) gneiss. All phases appear to be in near-equilibrium. The very high deltaD values for the primary hydrous phases is consistent with an initial oceanic-derived/connate fluid source. The fluid source for the retrograde talc + chlorite after pyrope may be fluids evolved locally during retrograde melt crystallization. The similar deltaD, but dissimilar deltaO-18 values of the coesite-bearing whiteschists and hosting orthogneiss suggest that the two were in hydrogen isotope equilibrium, but not oxygen isotope equilibrium. The unusual hydrogen and oxygen isotope compositions of the coesite-bearing unit can be explained as the result of metasomatism from slab-derived fluids at depth.

A general approach to the in situ energy butget of Eudendrium racemosum (Cnidaria, Hydrozoa) in the Western Mediterranean

An in situ energy budget of the hydropolyp Eudendrium racemosum (Cavolini, 1785) is presented. Ingestion and respiration rates and ammonium excretion were studied over two 24 h cycles, with two-hour sample intervals. The species ingested as much as 25.9% of its own biomass per day (minimum rate). Respiration was 1.62 ml O2 g-1 d w h-1 while excretion was 13.6 mM NH4 g-1dw h-1. We estimated that the species increased its biomass at a rate of 9.6% per day (Growth + Reproduction). This value is higher than those previously reported for other cnidarians. We can assume that the capacity of E. racemosum to survive - albeit for a limited period of the year - in the highly-competitive shallow-water communities is based on its high growth rate.

Very low prevalence of meticillin-resistant Staphylococcus aureus carrying the mecC gene in western Switzerland.

We report the first case of meticillin-resistant Staphylococcus aureus (MRSA) with the mecC gene in a patient in western Switzerland. After this first identification, a polymerase chain reaction protocol was established to investigate the occurrence of this new mecC gene in the population of this region. Enrichment broths were investigated from 1062 patients screened for MRSA, meticillin-susceptible Staphylococcus aureus isolates from clinical specimens from 475 patients, and 80 MRSA isolates (from 2005 to 2011) showing discrepancies between genotypic and phenotypic meticillin resistance. None was positive for mecC, suggesting that it is rare in the patient population of this region.

The Upper Oligocene of Montgat (Catalan Coastal Ranges, Spain): new age constraints to the western Mediterranean Basin opening

The Oligocene deposits of Montgat are integrated in a small outcrop made up of Cenozoic and Mesozoic rocks located in the Garraf-Montnegre horst, close to the major Barcelona fault. The Oligocene of Montgat consists of detrital sediments of continental origin mainly deposited in alluvial fan environments; these deposits are folded and affected by thrusts and strike-slip faults. They can be divided in two lithostratigraphic units separated by a minor southwest-directed thrust: (i) the Turó de Montgat Unit composed of litharenites and lithorudites with high contents of quartz, feldspar, plutonic and limestone rock fragments; and (ii) the Pla de la Concòrdia Unit composed of calcilitharenites and calcilithorudites with high contents of dolosparite and dolomicrite rock fragments. The petrological composition of both units indicates that sediments were derived from the erosion of Triassic (Buntsandstein, Muschelkalk and Keuper facies), Jurassic and Lower Cretaceous rocks (Barremian to Aptian in age). Stratigraphic and petrological data suggest that these units correspond to two coalescent alluvial fans with a source area located northwestwards in the adjoining Collserola and Montnegre inner areas. Micromammal fossils (Archaeomys sp.) found in a mudstone layer of the Pla de la Concòrdia Unit assign a Chattian age (Late Oligocene) to the studied materials. Thus, the Montgat deposits are the youngest dated deposits affected by the contractional deformation that led to the development of the Catalan Intraplate Chain. Taking into account that the oldest syn-rift deposits in the Catalan Coastal Ranges are Aquitanian in age, this allows to precise that the change from a compressive to an extensional regime in this area took place during latest Oligocene-earliest Aquitanian times. This age indicates that the onset of crustal extension related to the opening of the western Mediterranean Basin started in southern France during latest Eocene-early Oligocene and propagated southwestward, affecting the Catalan Coastal Ranges and the northeastern part of the Valencia trough during the latest Chattian-earliest Aquitanian times.

Deep crustal electromagnetic structure of Bhuj earthquake region (India) and its implications

The existence of fluids and partial melt in the lower crust of the seismically active Kutch rift basin (on the western continental margin of India) owing to underplating has been proposed in previous geological and geophysical studies. This hypothesis is examined using magnetotelluric (MT) data acquired at 23 stations along two profiles across Kutch Mainland Uplift and Wagad Uplift. A detailed upper crustal structure is also presented using twodimensional inversion of MT data in the Bhuj earthquake (2001) area. The prominent boundaries of reflection in the upper crust at 5, 10 and 20 km obtained in previous seismic reflection profiles correlate with conductive structures in our models. The MT study reveals 1-2 km thick Mesozoic sediments under the Deccan trap cover. The Deccan trap thickness in this region varies from a few meters to 1.5 km. The basement is shallow on the northern side compared to the south and is in good agreement with geological models as well as drilling information. The models for these profiles indicate that the thickness of sediments would further increase southwards into the Gulf of Kutch. Significant findings of the present study indicate 1) the hypocentre region of the earthquake is devoid of fluids, 2) absence of melt (that is emplaced during rifting as suggested from the passive seismological studies) in the lower crust and 3) a low resistive zone in the depth range of 5-20 km. The present MT study rules out fluidsand melt (magma) as the causative factors that triggered the Bhuj earthquake. The estimated porosity value of 0.02% will explain 100-500 ohm·m resistivity values observed in the lower crust. Based on the seismic velocities and geochemical studies, presence of garnet is inferred. The lower crust consists of basalts - probably generated by partial melting of metasomatised garnet peridotite at deeper depths in the lithosphere - and their composition might be modified by reaction with the spinel peridotites.

Influence of weather, rank, and home advantage on football outcomes in the gulf region.

PURPOSE: The objective of this study was to investigate the effects of weather, rank, and home advantage on international football match results and scores in the Gulf Cooperation Council (GCC) region. METHODS: Football matches (n = 2008) in six GCC countries were analyzed. To determine the weather influence on the likelihood of favorable outcome and goal difference, generalized linear model with a logit link function and multiple regression analysis were performed. RESULTS: In the GCC region, home teams tend to have greater likelihood of a favorable outcome (P < 0.001) and higher goal difference (P < 0.001). Temperature difference was identified as a significant explanatory variable when used independently (P < 0.001) or after adjustment for home advantage and team ranking (P < 0.001). The likelihood of favorable outcome for GCC teams increases by 3% for every 1-unit increase in temperature difference. After inclusion of interaction with opposition, this advantage remains significant only when playing against non-GCC opponents. While home advantage increased the odds of favorable outcome (P < 0.001) and goal difference (P < 0.001) after inclusion of interaction term, the likelihood of favorable outcome for a GCC team decreased (P < 0.001) when playing against a stronger opponent. Finally, the temperature and wet bulb globe temperature approximation were found as better indicators of the effect of environmental conditions than absolute and relative humidity or heat index on match outcomes. CONCLUSIONS: In GCC region, higher temperature increased the likelihood of a favorable outcome when playing against non-GCC teams. However, international ranking should be considered because an opponent with a higher rank reduced, but did not eliminate, the likelihood of a favorable outcome.

A global marine sedimentary response to the end-Permian mass extinction: Examples from southern Turkey and the western United States

The end-Permian mass extinction greatly diminished marine diversity and brought about a whole-scale restructuring of marine ecosystems; these ecosystem changes also profoundly affected the sedimentary record. Data presented here, attained through facies analyses of strata deposited during the immediate aftermath of the end-Permian mass extinction (southern Turkey) and at the close of the Early Triassic (southwestern United States), in combination with a literature review, show that sedimentary systems were profoundly affected by: (1) a reduction in biotic diversity and abundance and (2) long-term environmental fluctuations that resulted from the end-Permian crisis. Lower Triassic strata display widespread microbialite and carbonate seafloor fan development and contain indicators of suppressed infaunal bioturbation such as flat-pebble conglomerates and wrinkle structures (facies considered unusual in post-Cambrian subtidal deposits). Our observations suggest that depositional systems, too, respond to biotic crises, and that certain facies may act as barometers of ecologic and environmental change independent of fossil assemblage analyses. Close investigation of facies changes during other critical times in Earth history may serve as an important tool in interpreting the ecology of metazoans and their environment.