Genome-wide analysis reveals selection for important traits in domestic horse breeds.

Intense selective pressures applied over short evolutionary time have resulted in homogeneity within, but substantial variation among, horse breeds. Utilizing this population structure, 744 individuals from 33 breeds, and a 54,000 SNP genotyping array, breed-specific targets of selection were identified using an F(ST)-based statistic calculated in 500-kb windows across the genome. A 5.5-Mb region of ECA18, in which the myostatin (MSTN) gene was centered, contained the highest signature of selection in both the Paint and Quarter Horse. Gene sequencing and histological analysis of gluteal muscle biopsies showed a promoter variant and intronic SNP of MSTN were each significantly associated with higher Type 2B and lower Type 1 muscle fiber proportions in the Quarter Horse, demonstrating a functional consequence of selection at this locus. Signatures of selection on ECA23 in all gaited breeds in the sample led to the identification of a shared, 186-kb haplotype including two doublesex related mab transcription factor genes (DMRT2 and 3). The recent identification of a DMRT3 mutation within this haplotype, which appears necessary for the ability to perform alternative gaits, provides further evidence for selection at this locus. Finally, putative loci for the determination of size were identified in the draft breeds and the Miniature horse on ECA11, as well as when signatures of selection surrounding candidate genes at other loci were examined. This work provides further evidence of the importance of MSTN in racing breeds, provides strong evidence for selection upon gait and size, and illustrates the potential for population-based techniques to find genomic regions driving important phenotypes in the modern horse.

Driving ability, mental illness and psychotropic medication in the elderly

Fitness to drive in elderly drivers is most commonly discussed with a focus on cognitive impairment. Therefore, this article is focussing on mental illness and the use of psychotropic drugs in elderly drivers, which can both interfere with fitness to drive. Based on a detailed literature review and on clinical judgement, we propose signposts and "red flags" to judge the individual risks. Health professionals dealing with elderly patients should in particular be aware of the dangers related to cumulative risks and need to inform the patients appropriately. For medico-legal reasons the information provided to patients must be written down in the medical record. Individual counselling is important as fitness to drive is a complex topic.

Effect of exercise on the mobilization of retinol and retinyl esters in plasma of sled dogs

Fasting dogs do transport vitamin A (VA) in plasma not only as retinol but predominantly as retinyl esters. Contrary to retinol, nothing is known concerning the effects of athletic performance on plasma retinyl ester concentrations. The aim of this study was therefore to examine whether physical stress because of exercise and modification of the oxidative stress by supplementation of alpha-tocopherol influences the concentrations of retinol and retinyl esters in plasma of sled dogs. The study was carried out on 41 trained adult sled dogs, which were randomly assigned into two groups. One group (19 dogs) was daily substituted with 50 mg dl-alpha-tocopheryl acetate per kilogram body weight and the control group (22 dogs) was maintained on a basal diet during 3 months prior to exercise. The plasma concentrations of retinol, retinyl esters, alpha-tocopherol and triglycerides were measured immediately before, directly after and 24 h after exercise. The supplementation of alpha-tocopheryl acetate had no effect on plasma retinol and retinyl ester concentrations at any measurement time point. However, retinyl ester levels doubled in the non-supplemented group immediately after the race (p < 0.001), whereas in the supplemented group similar high levels were observed not until 24 h post-racing (p < 0.001). The high levels of retinyl esters were paralleled to some extent by an increase in plasma triglyceride concentrations, which were significantly higher 24 h post-racing than immediately before (p < 0.001) and after exercise (p < 0.001) in both groups. The increase in retinyl ester concentrations might be indicative of their mobilization from liver and adipose tissue. Whether plasma retinyl esters can be used as an indicator for the extent of nutrient mobilization during and post-exercise in sled dogs remains to be elucidated.

What's in a name? Inflammatory airway disease in racehorses in training

The term 'inflammatory airway disease' (IAD) is often used to describe the syndrome of lower airway inflammation that frequently affects young racehorses in training around the world. In practice, this inflammation is generally diagnosed using a combination of endoscopic tracheal examination, including grading of amounts of mucus present and tracheal wash sampling. However, a recent consensus statement from the American College of Veterinary Internal Medicine concluded that bronchoalveolar lavage (BAL) sampling, rather than tracheal wash (TW) sampling, is required for cytological diagnosis of IAD and that tracheal mucus is not an essential criterion. However, as BAL is a relatively invasive procedure that is not commonly used on racing yards, this definition can only be applied routinely to a biased referral population. In contrast, many practitioners continue to diagnose IAD using endoscopic tracheal examination and sampling. We argue that, rather than restricting the use of the term IAD to phenotypes diagnosed by BAL, it is important to distinguish in the literature between airway inflammation diagnosed by BAL and that identified in the field using TW sampling. We suggest the use of the term brIAD for the former and trIAD for the latter. It is essential that we continue to endeavour to improve our understanding of the aetiology, pathogenesis and clinical relevance of airway inflammation identified in racehorses in training using tracheal examination and sampling. Future studies should focus on investigations of the component signs of airway inflammation.

VIRTOPSY--scientific documentation, reconstruction and animation in forensic: individual and real 3D data based geo-metric approach including optical body/object surface and radiological CT/MRI scanning.

Until today, most of the documentation of forensic relevant medical findings is limited to traditional 2D photography, 2D conventional radiographs, sketches and verbal description. There are still some limitations of the classic documentation in forensic science especially if a 3D documentation is necessary. The goal of this paper is to demonstrate new 3D real data based geo-metric technology approaches. This paper present approaches to a 3D geo-metric documentation of injuries on the body surface and internal injuries in the living and deceased cases. Using modern imaging methods such as photogrammetry, optical surface and radiological CT/MRI scanning in combination it could be demonstrated that a real, full 3D data based individual documentation of the body surface and internal structures is possible in a non-invasive and non-destructive manner. Using the data merging/fusing and animation possibilities, it is possible to answer reconstructive questions of the dynamic development of patterned injuries (morphologic imprints) and to evaluate the possibility, that they are matchable or linkable to suspected injury-causing instruments. For the first time, to our knowledge, the method of optical and radiological 3D scanning was used to document the forensic relevant injuries of human body in combination with vehicle damages. By this complementary documentation approach, individual forensic real data based analysis and animation were possible linking body injuries to vehicle deformations or damages. These data allow conclusions to be drawn for automobile accident research, optimization of vehicle safety (pedestrian and passenger) and for further development of crash dummies. Real 3D data based documentation opens a new horizon for scientific reconstruction and animation by bringing added value and a real quality improvement in forensic science.

Retrospective evaluation of all recorded horse race starts in Switzerland during a four-year period focusing on discipline specific risk factors for clinical events

REASONS FOR PERFORMING THE STUDY: Racetrack injuries are of welfare concern and prevention of injuries is an important goal in many racing jurisdictions. Over the years this has led to more detailed recording of clinical events on racecourses. However, risk factor analyses of clinical events at race meetings have never been reported for Switzerland OBJECTIVE: To identify discipline-specific factors that influence the occurrence of clinical events during race meetings with the ultimate aim to improve the monitoring and safety on racetracks in Switzerland and optimise racehorse welfare. STUDY DESIGN: Retrospective study of horse race data collected by the Swiss horse racing association. METHODS: All race starts (n = 17,670, including 6,198 flat, 1,257 obstacle and 10,215 trot race starts) recorded over a period of four years (2009-2012) were analysed in multivariable mixed effect logistic regression models including horse and racecourse related data. The models were designed to identify discipline specific factors influencing the occurrence of clinical events on racecourses in Switzerland. RESULTS: Factors influencing the risk of clinical events during races were different for each discipline. The risk of a clinical event in trot racing was lower for racing on a Porphyre-sand track than on grass tracks. Horses whose driver was also their trainer had an approximately two times higher risk for clinical events. In obstacle races, longer distances (2401-3300 m and 3301-5400 m respectively) had a protective effect compared to racing over shorter distances. In flat racing, five racecourses reported significantly less clinical events. In all three disciplines, finishing 8th place or later was associated with clinical events. CONCLUSIONS: Changes in management that aim to improve the safety and welfare of racehorses, such as racetrack adaptations, need to be individualised for each discipline.

Psychological therapies for panic disorder with or without agoraphobia in adults: a network meta-analysis.

BACKGROUND Panic disorder is characterised by the presence of recurrent unexpected panic attacks, discrete periods of fear or anxiety that have a rapid onset and include symptoms such as racing heart, chest pain, sweating and shaking. Panic disorder is common in the general population, with a lifetime prevalence of 1% to 4%. A previous Cochrane meta-analysis suggested that psychological therapy (either alone or combined with pharmacotherapy) can be chosen as a first-line treatment for panic disorder with or without agoraphobia. However, it is not yet clear whether certain psychological therapies can be considered superior to others. In order to answer this question, in this review we performed a network meta-analysis (NMA), in which we compared eight different forms of psychological therapy and three forms of a control condition. OBJECTIVES To assess the comparative efficacy and acceptability of different psychological therapies and different control conditions for panic disorder, with or without agoraphobia, in adults. SEARCH METHODS We conducted the main searches in the CCDANCTR electronic databases (studies and references registers), all years to 16 March 2015. We conducted complementary searches in PubMed and trials registries. Supplementary searches included reference lists of included studies, citation indexes, personal communication to the authors of all included studies and grey literature searches in OpenSIGLE. We applied no restrictions on date, language or publication status. SELECTION CRITERIA We included all relevant randomised controlled trials (RCTs) focusing on adults with a formal diagnosis of panic disorder with or without agoraphobia. We considered the following psychological therapies: psychoeducation (PE), supportive psychotherapy (SP), physiological therapies (PT), behaviour therapy (BT), cognitive therapy (CT), cognitive behaviour therapy (CBT), third-wave CBT (3W) and psychodynamic therapies (PD). We included both individual and group formats. Therapies had to be administered face-to-face. The comparator interventions considered for this review were: no treatment (NT), wait list (WL) and attention/psychological placebo (APP). For this review we considered four short-term (ST) outcomes (ST-remission, ST-response, ST-dropouts, ST-improvement on a continuous scale) and one long-term (LT) outcome (LT-remission/response). DATA COLLECTION AND ANALYSIS As a first step, we conducted a systematic search of all relevant papers according to the inclusion criteria. For each outcome, we then constructed a treatment network in order to clarify the extent to which each type of therapy and each comparison had been investigated in the available literature. Then, for each available comparison, we conducted a random-effects meta-analysis. Subsequently, we performed a network meta-analysis in order to synthesise the available direct evidence with indirect evidence, and to obtain an overall effect size estimate for each possible pair of therapies in the network. Finally, we calculated a probabilistic ranking of the different psychological therapies and control conditions for each outcome. MAIN RESULTS We identified 1432 references; after screening, we included 60 studies in the final qualitative analyses. Among these, 54 (including 3021 patients) were also included in the quantitative analyses. With respect to the analyses for the first of our primary outcomes, (short-term remission), the most studied of the included psychological therapies was CBT (32 studies), followed by BT (12 studies), PT (10 studies), CT (three studies), SP (three studies) and PD (two studies).The quality of the evidence for the entire network was found to be low for all outcomes. The quality of the evidence for CBT vs NT, CBT vs SP and CBT vs PD was low to very low, depending on the outcome. The majority of the included studies were at unclear risk of bias with regard to the randomisation process. We found almost half of the included studies to be at high risk of attrition bias and detection bias. We also found selective outcome reporting bias to be present and we strongly suspected publication bias. Finally, we found almost half of the included studies to be at high risk of researcher allegiance bias.Overall the networks appeared to be well connected, but were generally underpowered to detect any important disagreement between direct and indirect evidence. The results showed the superiority of psychological therapies over the WL condition, although this finding was amplified by evident small study effects (SSE). The NMAs for ST-remission, ST-response and ST-improvement on a continuous scale showed well-replicated evidence in favour of CBT, as well as some sparse but relevant evidence in favour of PD and SP, over other therapies. In terms of ST-dropouts, PD and 3W showed better tolerability over other psychological therapies in the short term. In the long term, CBT and PD showed the highest level of remission/response, suggesting that the effects of these two treatments may be more stable with respect to other psychological therapies. However, all the mentioned differences among active treatments must be interpreted while taking into account that in most cases the effect sizes were small and/or results were imprecise. AUTHORS' CONCLUSIONS There is no high-quality, unequivocal evidence to support one psychological therapy over the others for the treatment of panic disorder with or without agoraphobia in adults. However, the results show that CBT - the most extensively studied among the included psychological therapies - was often superior to other therapies, although the effect size was small and the level of precision was often insufficient or clinically irrelevant. In the only two studies available that explored PD, this treatment showed promising results, although further research is needed in order to better explore the relative efficacy of PD with respect to CBT. Furthermore, PD appeared to be the best tolerated (in terms of ST-dropouts) among psychological treatments. Unexpectedly, we found some evidence in support of the possible viability of non-specific supportive psychotherapy for the treatment of panic disorder; however, the results concerning SP should be interpreted cautiously because of the sparsity of evidence regarding this treatment and, as in the case of PD, further research is needed to explore this issue. Behaviour therapy did not appear to be a valid alternative to CBT as a first-line treatment for patients with panic disorder with or without agoraphobia.

Input Price Variation Across Locations and a Generalized Measure of Cost Efficiency

We propose a nonparametric model for global cost minimization as a framework for optimal allocation of a firm's output target across multiple locations, taking account of differences in input prices and technologies across locations. This should be useful for firms planning production sites within a country and for foreign direct investment decisions by multi-national firms. Two illustrative examples are included. The first example considers the production location decision of a manufacturing firm across a number of adjacent states of the US. In the other example, we consider the optimal allocation of US and Canadian automobile manufacturers across the two countries.

Na 1 Nachlass Max Horkheimer, 1 - Korrespondenzen u.a. mit Franz Alexander (p. I 1, 1-205)

1 Brief von Max Horkheimer an Abel, 16.03.1936; 3 Briefe zwischen Hubert Abrahamsohn und Max Horkheimer, 1935-1936, 21.12.1936; 2 Briefe zwischen Emanuel Adler und Max Horkheimer, 12.04.1946, 26.04.1946; 2 Briefe zwischen Max Adler und Max Horkheimer, 16.03.1935, 29.03.1935; 1 Brief von Eva Ahamson an Max Horkheimer, 01.11.1944; 2 Briefe der Aircraft Warning Service Brentwood an Max Horkheimer, Mai 1942; 6 Briefe zwischen Librairie Félix Alcan und Max Horkheimer, 1935, 18.12.1935; 11 Briefe zwischen Franz Alexander und Max Horkheimer, 1938-1940; 2 Briefe zwischen der American Historical Review New York und Max Horkheimer, 01.04.1941, 07.04.1941; 1 Brief von Paul Reiwald an Max Horkheimer, 18.10.1940; 2 Briefe zwischen Helen Manice Alexander und Max Horkheimer, 1936; 2 Briefe zwischen Bernardine Allen und Max Horkheimer, 17.06.1938, 24.06.1938; 1 Brief der Alumni Federation of Columbia University an Max Horkheimer, 21.07.1942; 1 Brief der American Friends Service Comittee an Max Horkheimer, 10.12.1940; 3 Briefe zwischen der American Academy of Political and Social Science Philadelphia und Max Horkheimer, 1939,1940, 16.01.1939; 1 Brief der American Automobile Association Washington an Max Horkheimer, 22.03.1938; 1 Brief der American Association for the Advancement of Science Washington an Max Horkheimer, 16.08.1937; 2 Briefe von Max Horkheimer an den American Consulate General Berlin, 1939; 1 Brief von Max Horkheimer an den American Consulate General Havana, 03.03.1941; 4 Briefe von Max Horkheimer an den American Consul London, 1939-1941; 2 Briefe von Max Horkheimer an den American Consulate General Stuttgart, 1939-1941; 1 Brief von Max Horkheimer an den American Consul Zürich, 1939; 1 Brief von Friedrich Pollock an den American Council of Learned Society, Washington, 27.06.1941; 2 Briefe von Max Horkheimer an die American Friends of German Freedom New York, 1941; 4 Briefe der American Historical Association Washington an Max Horkheimer, 1937-1938; 1 Brief von Max Horkheimer an den American Red Cross Westwood Office, 21.06.1943; 18 Briefe zwschen der American Society for the Prevention of Cruelty to Animals New York und Max Horkheimer, 1936-1941; 1 Brief von Max Horkheimer an die American Women's Volunteer Service Pacific Palisades, 27.07.1942; 23 Briefe zwischen Eugene Anderson und Max Horkheimer, 1937-1941; 2 Briefe zwischen Norah Andreae und Max Horkheimer, 27.10.1944, 09.09.1946; 1 Brief von Rosa Nebel-Schenk, 04.03.1946; 1 Brief von der National Catholic Welfare Conference, 14.08.1944; 12 Briefe zwischen Werner Andreae und Max Horkheimer, 1945-1954; 1 Brief von Julius Marx an Werner Andreae, 10.05.1946, 11.05.1950; 2 Briefe von Josef Messinger an Werner Andreae, 23.10.1946, ohne Datum; 3 Briefe zwischen dem Advokatenbüro Hodler und Max Horkheimer, 1946, 09.05.1946;

Na 1 Nachlass Max Horkheimer, 2 - Korrespondenzen u.a. an Raymond Aron (p. I 1, 206-333)

16 Briefe zwischen Ruth Nanda Anshen und Max Horkheimer, 1938-1941; 5 Briefe zwischen Peter Appel und Max Horkheimer, 1937; 1 Drucksache der Arbeitsgemeinschaft Sozialistischer Ärzte in Hessen, Juli 1949; 1 Brief der Arbeitsgemeinschaft für Soziale Betriebsgestaltung in Heidelberg an Max Horkheimer, 18.10.1949; 2 Briefe zwischen Lois Archer und Max Horkheimer, 24.07.1947, 04.08.1947; 2 Briefe zwischen Camille Arnaud und Max Horkheimer, 03.03.1946, 22.03.1946; 39 Briefe zwischen Raymond Aron und Max Horkheimer, 1935-1938; 2 Briefe zwischen Ruth Arrau und Max Horkheimer, 28.06.1949, 10.10.1949; 3 Briefe zwischen S. Aufhauser und Max Horkheimer, 1939-1941, 16.04.1941; 8 Briefe zwischen der Zeitschrift 'Aufbau' und Max Horkheimer, 1944-1944; 3 Briefe zwischen der Automobile Club of New York und Max Horkheimer, 1937, 10.08.1937;

Na 1 Nachlass Max Horkheimer, 44 - Korrespondenzen u.a. mit Marthe Roth (p. I 21, 313-463)

2 Briefe und 1 Lebenslauf von Max Horkheimer an Arthur Rosenberg, 1939, 1941; 2 Briefe zwischen Kurt Rosenfeld und Karl Brandt, 22.04.1937, 27.04.1937; 5 Briefe von Kurt Rosenfeld an Max Horkheimer, 1937-19378; 4 Brief und Beilage an Kurt Rosenfeld, 1937-1943; 11 Briefe zwischen Hans W. Rosenhaupt und Max Horkheimer, 1935, 1941, 1942, 1947; 4 Briefe zwischen Samuel I. Roseman und Max Horkheimer, 1939, 03.01.1940; 2 Briefe zwischen J. Rosenstock und Max Horkheimer, 15.07.1946; 2 Briefe zwischen Joseph Adolphe Rosenthal und Max Horkheimer, 09.04.1941, 08.05.1941, sowie Briefwechsel mit Sophie Ries; 2 Briefe zwischen Sophie Ries und Max Horkheimer, 08.05.1941, 11.05.1941; 1 Brief von Max Horkheimer an Lore Woedthke, 08.05.1941; 2 Briefe zwischen Morris Rosenthal und Max Horkheimer, 01.10.1935, 04.10.1935; 1 Brief von Max Horkheimer an das Rosenwald Capital Outlay Fund New York, 30.01.1940; 1 Brief B. Lifschitz an Marthe Roth, 21.04.1937; 1 Brief von Chamorel et Simond an Marthe Roth, 11.06.1937; 1 Brief von F.K. Sung an Marthe Roth, 24.06.1937; 12 Briefe zwischen Marthe Roth und Max Horkheimer, Juli 1937-1938, sowie Briefwechsel mit Louis Vogt; 4 Briefe zwischen Louis Vogt und Max Horkheimer, 10.08.1937, 1937; 1 Brief von Max Horkheimer an Dr. Rothen, 31.01.1935; 1 Umzugsmitteilung von Hans Rothmann; 2 Briefe zwischen Richard C. Rothschild und Max Horkheimer, 11.05.1940, 13.05.1940; 4 Briefe zwischen Ludwig Rothschild, Hilde Rothschild und Max Horkheimer, 1936-15.09.1939; 2 Briefe zwischen S. Rothschildt und Max Horkheimer, 23.11.1940, 29.11.1940; 4 Brief zwischen J. S. Roucek und Max Horkheimer, 1941; 1 Brief von Joseph Rovan an Max Horkheimer, 11.05.1948; 2 Brief zwischen Wilmina Rowland und Max Horkheimer, 13.03.1949, 11.04.1949; 2 Briefe zwischen dem Royal Automobile Club und Max Horkheimer, 26.08.1937, 22.09.1937; 2 Briefe zwischen Royal Motors Inc. und Max Horkheimer, 05.02.1940, 06.03.1940; 1 Beitrag von Nina Rubinstein zur Soziologie des Fremden; 1 Brief von Theodor W. Adorno an Rudd, 09.09.1940; 1 Brief von Jay Rumney an Goldstein, 18.06.1936; 20 Briefe und Beilage zwischen Jay Rumney und Max Horkheimer, 1934- 1937, 1949 sowie Briefwechsel mit D. Mitrany; 3 Briefe zwischen D. Mitrany und Max Horkheimer, 01.12.1937, 1937; 3 Briefe von Theodor W. Adorno an Dagobert D. Runes, 1941; 1 Brief und 1 Beilage von N. Waterman an Georg Rusche, 03.05.1939; 12 Briefe und Beilage zwischen Georg Rusche und Max Horkheimer, 1939-1942 sowie Briefwechsel mit N. Waterman; 1 Brief von N. Waterman an Georg Rusche, 03.04.1939; 2 Briefe zwischen N. Waterman und Max Horkheimer, 21.04.1939, 05.05.1939; 1 Brief von Ruth an Max Horkheimer;

The preparticipation sports physical examination and wilderness athletes

Every fifth unintentional injury treated at a healthcare facility in industrialized nations is associated with sports or physical exercise. Though the benefits of exercise on health status are well documented and, for most individuals, far outweigh the risks, participation in sports and exercise programs does carry a risk of injury, illness, or even death. In an effort to decrease these risks most institutions in the United States, and in the industrialized world, require a pre-participation physical examination for all athletes competing in organized or scholastic sports or exercise programs. Over the last ten years the popularity of outdoor or wilderness sports has increased enormously. Traditional outdoor sports such as skiing and hiking are more popular than ever and sports that did not exist 10 to 15 years ago, such as adventure racing or mountain biking, are now multimillion dollar enterprises. This genre of sport appeals to a broad spectrum of individuals and combines the traditional risks of physical activity and exertion with the remoteness and exposure associated with wilderness environments. Wilderness athletes include people of all ages and of both genders. The main causes of morbidity are musculoskeletal injuries and gastrointestinal illnesses; the main causes of mortality are falls and cardiac events. By placing these causes in a Haddon Matrix, preventative strategies have been found and recommendations made specifically for the preparticipation physical examination, which include education about the causes of morbidity and mortality in wilderness athletes, instruction about preventing and treating these injuries and illnesses, and screening of athletes at risk for cardiovascular accidents. Through these measures the risk of injuries, illnesses and deaths in wilderness athletes can be decreased through out the world. ^

NONLINEAR TIME SERIES/SYSTEM ANALYSIS (STATE-SPACE, DYNAMICS, INTERVENTION, RESILIENCE, KALMAN)

A discussion of nonlinear dynamics, demonstrated by the familiar automobile, is followed by the development of a systematic method of analysis of a possibly nonlinear time series using difference equations in the general state-space format. This format allows recursive state-dependent parameter estimation after each observation thereby revealing the dynamics inherent in the system in combination with random external perturbations.^ The one-step ahead prediction errors at each time period, transformed to have constant variance, and the estimated parametric sequences provide the information to (1) formally test whether time series observations y(,t) are some linear function of random errors (ELEM)(,s), for some t and s, or whether the series would more appropriately be described by a nonlinear model such as bilinear, exponential, threshold, etc., (2) formally test whether a statistically significant change has occurred in structure/level either historically or as it occurs, (3) forecast nonlinear system with a new and innovative (but very old numerical) technique utilizing rational functions to extrapolate individual parameters as smooth functions of time which are then combined to obtain the forecast of y and (4) suggest a measure of resilience, i.e. how much perturbation a structure/level can tolerate, whether internal or external to the system, and remain statistically unchanged. Although similar to one-step control, this provides a less rigid way to think about changes affecting social systems.^ Applications consisting of the analysis of some familiar and some simulated series demonstrate the procedure. Empirical results suggest that this state-space or modified augmented Kalman filter may provide interesting ways to identify particular kinds of nonlinearities as they occur in structural change via the state trajectory.^ A computational flow-chart detailing computations and software input and output is provided in the body of the text. IBM Advanced BASIC program listings to accomplish most of the analysis are provided in the appendix. ^

SEVERE HEAD TRAUMA, EMERGENCY TRANSPORT, AND PATIENT OUTCOME

Trauma and severe head injuries are important issues because they are prevalent, because they occur predominantly in the young, and because variations in clinical management may matter. Trauma is the leading cause of death for those under age 40. The focus of this head injury study is to determine if variations in time from the scene of accident to a trauma center hospital makes a difference in patient outcomes.^ A trauma registry is maintained in the Houston-Galveston area and includes all patients admitted to any one of three trauma center hospitals with mild or severe head injuries. A study cohort, derived from the Registry, includes 254 severe head injury cases, for 1980, with a Glasgow Coma Score of 8 or less.^ Multiple influences relate to patient outcomes from severe head injury. Two primary variables and four confounding variables are identified, including time to emergency room, time to intubation, patient age, severity of injury, type of injury and mode of transport to the emergency room. Regression analysis, analysis of variance, and chi-square analysis were the principal statistical methods utilized.^ Analysis indicates that within an urban setting, with a four-hour time span, variations in time to emergency room do not provide any strong influence or predictive value to patient outcome. However, data are suggestive that at longer time periods there is a negative influence on outcomes. Age is influential only when the older group (55-64) is included. Mode of transport (helicopter or ambulance) did not indicate any significant difference in outcome.^ In a multivariate regression model, outcomes are influenced primarily by severity of injury and age which explain 36% (R('2)) of variance. Inclusion of time to emergency room, time to intubation, transport mode and type injury add only 4% (R('2)) additional contribution to explaining variation in patient outcome.^ The research concludes that since the group most at risk to head trauma is the young adult male involved in automobile/motorcycle accidents, more may be gained by modifying driving habits and other preventive measures. Continuous clinical and evaluative research are required to provide updated clinical wisdom in patient management and trauma treatment protocols. A National Institute of Trauma may be required to develop a national public policy and evaluate the many medical, behavioral and social changes required to cope with the country's number 3 killer and the primary killer of young adults.^