Search

BackgroundImproved understanding of the quality of survival of patients is crucial in evaluating trauma care, understanding recovery patterns and timeframes, and informing healthcare, social, and disability service provision. We aimed to describe the longer-term health status of seriously injured patients, identify predictors of outcome, and establish recovery trajectories by population characteristics.Methods and findingsA population-based, prospective cohort study using the Victorian State Trauma Registry (VSTR) was undertaken. We followed up 2,757 adult patients, injured between July 2011 and June 2012, through deaths registry linkage and telephone interview at 6-, 12-, 24-, and 36-months postinjury. The 3-level EuroQol 5 dimensions questionnaire (EQ-5D-3L) was collected, and mixed-effects regression modelling was used to identify predictors of outcome, and recovery trajectories, for the EQ-5D-3L items and summary score. Mean (SD) age of participants was 50.8 (21.6) years, and 72% were male. Twelve percent (n = 333) died during their hospital stay, 8.1% (n = 222) of patients died postdischarge, and 155 (7.0%) were known to have survived to 36-months postinjury but were lost to follow-up at all time points. The prevalence of reporting problems at 36-months postinjury was 37% for mobility, 21% for self-care, 47% for usual activities, 50% for pain/discomfort, and 41% for anxiety/depression. Continued improvement to 36-months postinjury was only present for the usual activities item; the adjusted relative risk (ARR) of reporting problems decreased from 6 to 12 (ARR 0.87, 95% CI: 0.83-0.90), 12 to 24 (ARR 0.94, 95% CI: 0.90-0.98), and 24 to 36 months (ARR 0.95, 95% CI: 0.95-0.99). The risk of reporting problems with pain or discomfort increased from 24- to 36-months postinjury (ARR 1.06, 95% CI: 1.01, 1.12). While loss to follow-up was low, there was responder bias with patients injured in intentional events, younger, and less seriously injured patients less likely to participate; therefore, these patient subgroups were underrepresented in the study findings.ConclusionsThe prevalence of ongoing problems at 3-years postinjury is high, confirming that serious injury is frequently a chronic disorder. These findings have implications for trauma system design. Investment in interventions to reduce the longer-term impact of injuries is needed, and greater investment in primary prevention is needed.

BACKGROUND:Traumatic injury can lead to loss, suffering and feelings of injustice. Previous research has shown that perceived injustice is associated with poorer physical and mental wellbeing in persons with chronic pain. This study aimed to identify the relative association between injury, compensation and pain-related characteristics and perceived injustice 12-months after traumatic injury. METHODS:433 participants were recruited from the Victorian Orthopedic Trauma Outcomes Registry and Victorian State Trauma Registry, and completed questionnaires at 12-14 months after injury as part of an observational cohort study. Using hierarchical linear regression we examined the relationships between baseline demographics (sex, age, education, comorbidities), injury (injury severity, hospital length of stay), compensation (compensation status, fault, lawyer involvement), and health outcomes (SF-12) and perceived injustice. We then examined how much additional variance in perceived injustice was related to worse pain severity, interference, self-efficacy, catastrophizing, kinesiophobia or disability. RESULTS:Only a small portion of variance in perceived injustice was related to baseline demographics (especially education level), and injury severity. Attribution of fault to another, consulting a lawyer, health-related quality of life, disability and the severity of pain-related cognitions explained the majority of variance in perceived injustice. While univariate analyses showed that compensable injury led to higher perceptions of injustice, this did not remain significant when adjusting for all other factors, including fault attribution and consulting a lawyer. CONCLUSIONS:In addition to the "justice" aspects of traumatic injury, the health impacts of injury, emotional distress related to pain (catastrophizing), and the perceived impact of pain on activity (pain self-efficacy), had stronger associations with perceptions of injustice than either injury or pain severity. To attenuate the likelihood of poor recovery from injury, clinical interventions that support restoration of health-related quality of life, and adjustment to the impacts of trauma are needed.

OBJECTIVES: To compare 6 month and 12 month health status and functional outcomes between regional major trauma registries in Hong Kong and Victoria, Australia. SUMMARY BACKGROUND DATA: Multicentres from trauma registries in Hong Kong and the Victorian State Trauma Registry (VSTR). METHODS: Multicentre, prospective cohort study. Major trauma patients and aged ≥18 years were included. The main outcome measures were Extended Glasgow Outcome Scale (GOSE) functional outcome and risk-adjusted Short-Form 12 (SF-12) health status at 6 and 12 months after injury. RESULTS: 261 cases from Hong Kong and 1955 cases from VSTR were included. Adjusting for age, sex, ISS, comorbid status, injury mechanism and GCS group, the odds of a better functional outcome for Hong Kong patients relative to Victorian patients at six months was 0.88 (95% CI: 0.66, 1.17), and at 12 months was 0.83 (95% CI: 0.60, 1.12). Adjusting for age, gender, ISS, GCS, injury mechanism and comorbid status, Hong Kong patients demonstrated comparable mean PCS-12 scores at 6-months (adjusted mean difference: 1.2, 95% CI: -1.2, 3.6) and 12-months (adjusted mean difference: -0.4, 95% CI: -3.2, 2.4) compared to Victorian patients. Keeping age, gender, ISS, GCS, injury mechanism and comorbid status, there was no difference in the MCS-12 scores of Hong Kong patients compared to Victorian patients at 6-months (adjusted mean difference: 0.4, 95% CI: -2.1, 2.8) or 12-months (adjusted mean difference: 1.8, 95% CI: -0.8, 4.5). CONCLUSION: The unadjusted analyses showed better outcomes for Victorian cases compared to Hong Kong but after adjusting for key confounders, there was no difference in 6-month or 12-month functional outcomes between the jurisdictions.

The Australian Traumatic Brain Injury Initiative (AUS-TBI) aims to select a set of measures to comprehensively predict and assess outcomes following moderate-to-severe traumatic brain injury (TBI) across Australia. The aim of this article was to report on the implementation and findings of an evidence-based consensus approach to develop AUS-TBI recommendations for outcome measures following adult and pediatric moderate-to-severe TBI. Following consultation with a panel of expert clinicians, Aboriginal and Torres Strait Islander representatives and a Living Experience group, and preliminary literature searches with a broader focus, a decision was made to focus on measures of mortality, everyday functional outcomes, and quality of life. Standardized searches of bibliographic databases were conducted through March 2022. Characteristics of 75 outcome measures were extracted from 1485 primary studies. Consensus meetings among the AUS-TBI Steering Committee, an expert panel of clinicians and researchers and a group of individuals with lived experience of TBI resulted in the production of a final list of 11 core outcome measures: the Functional Independence Measure (FIM); Glasgow Outcome Scale-Extended (GOS-E); Satisfaction With Life Scale (SWLS) (adult); mortality; EuroQol-5 Dimensions (EQ5D); Mayo-Portland Adaptability Inventory (MPAI); Return to Work /Study (adult and pediatric); Functional Independence Measure for Children (WEEFIM); Glasgow Outcome Scale Modified for Children (GOS-E PEDS); Paediatric Quality of Life Scale (PEDS-QL); and Strengths and Difficulties Questionnaire (pediatric). These 11 outcome measures will be included as common data elements in the AUS-TBI data dictionary. Review Registration PROSPERO (CRD42022290954).

The Australian Traumatic Brain Injury Initiative (AUS-TBI) aims to develop a health informatics approach to collect data predictive of outcomes for persons with moderate-severe TBI across Australia. Central to this approach is a data dictionary; however, no systematic reviews of methods to define and develop data dictionaries exist to-date. This rapid systematic review aimed to identify and characterize methods for designing data dictionaries to collect outcomes or variables in persons with neurological conditions. Database searches were conducted from inception through October 2021. Records were screened in two stages against set criteria to identify methods to define data dictionaries for neurological conditions (International Classification of Diseases, 11th Revision: 08, 22, and 23). Standardized data were extracted. Processes were checked at each stage by independent review of a random 25% of records. Consensus was reached through discussion where necessary. Thirty-nine initiatives were identified across 29 neurological conditions. No single established or recommended method for defining a data dictionary was identified. Nine initiatives conducted systematic reviews to collate information before implementing a consensus process. Thirty-seven initiatives consulted with end-users. Methods of consultation were ?roundtable? discussion (n?=?30); with facilitation (n?=?16); that was iterative (n?=?27); and frequently conducted in-person (n?=?27). Researcher stakeholders were involved in all initiatives and clinicians in 25. Importantly, only six initiatives involved persons with lived experience of TBI and four involved carers. Methods for defining data dictionaries were variable and reporting is sparse. Our findings are instructive for AUS-TBI and can be used to further development of methods for defining data dictionaries.

BACKGROUND: Traumatic brain injury (TBI) remains a leading cause of death and disability. The National Institute for Health and Clinical Excellence (NICE) guidelines recommend transfer of severe TBI cases to neurosurgical centres, irrespective of the need for neurosurgery. This observational study investigated the risk-adjusted mortality of isolated TBI admissions in England/Wales, and Victoria, Australia, and the impact of neurosurgical centre management on outcomes. METHODS: Isolated TBI admissions (>15 years, July 2005-June 2006) were extracted from the hospital discharge datasets for both jurisdictions. Severe isolated TBI (AIS severity >3) admissions were provided by the Trauma Audit and Research Network (TARN) and Victorian State Trauma Registry (VSTR) for England/Wales, and Victoria, respectively. Multivariable logistic regression was used to compare risk-adjusted mortality between jurisdictions. FINDINGS: Mortality was 12% (749/6256) in England/Wales and 9% (91/1048) in Victoria for isolated TBI admissions. Adjusted odds of death in England/Wales were higher compared to Victoria overall (OR 2.0, 95% CI: 1.6, 2.5), and for cases

Evaluating stroke campaigns and associated behavioural changes is crucial to assess intervention effectiveness and inform future strategies. We aimed to evaluate patient's and bystanders’ foreknowledge of stroke signs and symptoms and their response at stroke onset. We interviewed stroke patients using a validated questionnaire or their bystanders if the stroke patient had disabling stroke. The questionnaire was administered to 165 participants, 142 (86.1%) stroke patients and 23 (13.9%) bystanders. The mean age was 52.6 (SD = 11.7), and male–female ratio was 7:1. Among the participants, 33 (20.1%) had foreknowledge of stroke signs, and of these, 27 (16.5%) were aware of the stroke campaign in Qatar. The behavioural responses at stroke onset included; activating Emergency Medical Services (EMS) ( n = 55, 33.3%), calling friends/relatives ( n = 69, 41.8%), driving to hospital ( n = 33, 20%), waiting for improvement in condition ( n = 21, 12.7%). There was no association of ethnicity, marital status, or campaign awareness with EMS activation. Despite limited community awareness of stroke signs and campaign, help-seeking behaviour through EMS activation was generally high, underscoring the need for focused educational efforts and public health interventions.

Abstract Objectives Protection of the cervical spine is recommended following multisystem injury. In 2021, Ambulance Victoria changed clinical practice guidelines to apply soft collars instead of semi‐rigid collars for suspected cervical spine injury. The aim of this study was to describe associated changes in imaging practices and diagnoses of pressure sores, hospital acquired pneumonia, and spinal cord injury. Methods A retrospective pre‐ and postintervention study was conducted including all consecutive patients that presented to an adult major trauma center in Melbourne, Australia with a cervical collar placed by emergency medical services over two 3‐month periods. Results There were 1762 patients included. A computed tomography (CT) of the cervical spine was performed in 795 (88.4%) patients in the semi‐rigid collar period and 810 (93.8%) in the soft collar period (p = 0.001). Soft collars were associated with higher rates of clearance of the cervical spine in the emergency department (ED) (odds ratio [OR] 4.14; 95% confidence interval [CI]: 3.36–5.09). There were no differences in diagnosis of pressure sores (0.11% vs. 0.23%, p = 0.97) or hospital acquired pneumonia (2.0% vs. 2.7%; p = 0.44) or cervical spinal cord injury (0.45% vs. 0.81%; p = 0.50). Conclusions Following a change from prehospital semi‐rigid collars to soft collars, more patients were investigated with a CT scan and more frequent clearance of the cervical spine occurred in the ED. There were no differences in the rates of spinal cord injuries, pressure sores or hospital acquired pneumonia, but the study was underpowered to detect significant differences. The practice of soft collars for prehospital care of patients with suspected neck injury requires ongoing surveillance.

‎This paper concerns aspects of various graphs whose vertex set is a group $G$‎ ‎and whose edges reflect group structure in some way (so that‎, ‎in particular‎, ‎they are invariant under the action of the automorphism group of $G$)‎. ‎The‎ ‎particular graphs I will chiefly discuss are the power graph‎, ‎enhanced power‎ ‎graph‎, ‎deep commuting graph‎, ‎commuting graph‎, ‎and non-generating graph‎.‎My main concern is not with properties of these graphs individually‎, ‎but ‎‎‎‎rather with comparisons between them‎. ‎The graphs mentioned‎, ‎together‎ ‎with the null and complete graphs‎, ‎form a hierarchy (as long as $G$ is‎ ‎non-abelian)‎, ‎in the sense that the edge set of any one is contained in that‎ ‎of the next; interesting questions involve when two graphs in the hierarchy‎ ‎are equal‎, ‎or what properties the difference between them has‎. ‎I also ‎‎‎consider various properties such as universality and forbidden subgraphs‎,‎comparing how these properties play out in the different graphs‎.‎I have also included some results on intersection graphs of subgroups of‎ ‎various types‎, ‎which are often in a ''dual'' relation to one of the other‎ ‎graphs considered‎. ‎Another actor is the Gruenberg--Kegel graph‎, ‎or prime graph‎, ‎of a group‎: ‎this very small graph has a surprising influence over various‎ ‎graphs defined on the group‎.‎Other graphs which have been proposed‎, ‎such as the nilpotence‎, ‎solvability‎, ‎and Engel graphs‎, ‎will be touched on rather more briefly‎. ‎My emphasis is on‎ ‎finite groups but there is a short section on results for infinite groups‎. ‎There are briefer discussions of general $Aut(G)$-invariant graphs‎, ‎and structures other than groups (such as semigroups and rings)‎.‎Proofs‎, ‎or proof sketches‎, ‎of known results have been included where possible‎. ‎Also‎, ‎many open questions are stated‎, ‎in the hope of stimulating further‎ ‎investigation‎.

Automorphisms of shift spaces and the Higman--Thompson groups: the one-sided case, Discrete Analysis 2021:15, 35 pp. Symbolic dynamics is the study of dynamical systems of the following kind, known as _shift spaces_. One takes an alphabet $\Sigma$ of "symbols" and a closed (in the product topology) shift-invariant subset $X$ of $\Sigma^{\mathbb Z}$ or $\Sigma^{\mathbb N}$ and looks at iterations of the shift applied to $X$. An important particular case is to take a single infinite sequence $x$ and to let $X$ be the closure of the orbit of $x$. Another case, more relevant to this paper, is the _full shift_, where one takes $X$ to consist of all sequences. An _automorphism_ of a shift space is a shift-invariant homeomorphism of $X$ to itself. Typically, such homeomorphisms are quite hard to construct, so the automorphism groups of shift spaces tend to be "small" in some sense. For example, the automorphism group of the space $\{0,1\}^{\mathbb N}$ is the cyclic group of order 2, with the two shift-invariant automorphisms being the identity and the map that interchanges 0s and 1s. (That said, once the alphabet is larger than this, the groups contain free groups, but they are nevertheless much smaller than the group of all homeomorphisms of $\{0,1\}^{\mathbb N}$. For example, they have to be countable.) However, determining the automorphism groups is quite hard (even the result just mentioned is a genuine theorem and not simply an exercise), and this has led to an active research area. This paper concerns automorphims of the full shift in the one-sided case (the authors have a companion paper that deals with the two-sided case, which is genuinely different in various ways). Something of the flavour of the paper is conveyed by the following non-trivial example of a shift-invariant automorphism of the space $\{0,1,2\}^{\mathbb N}$, which it is more convenient to think of as $\{0,1,2\}^{-\mathbb N}$ -- that is, as the space of sequences $(\dots,x_{-2},x_{-1},x_0)$. To any such sequence one applies a _synchronous transducer_, which is a finite-state automaton that works as follows. At any one moment it is looking at some term $x_{-n}$ and is in some state $q$ that belongs to a set $Q=\{q_1,\dots,q_r\}$. It then sets $y_{-n}$ to be equal to $\phi(x_{-n},q)$, changes to a new state $\pi(x_{-n},q)$, and turns its attention to the next term $x_{-(n-1)}$. As soon as one tries to imagine using this idea, one runs into a problem: how does the process start? Or rather, since it doesn't really start -- it has always been going on -- how do we ever know what state it is in? The answer is that some transducers have a special property, one that is definitely not shared by an arbitrary transducer, which is that for some $k$ the state that they are in by the time they reach $x_{-n}$ depends only on the terms $x_{-n-1},x_{-n-2},\dots,x_{-n-k}$ and not on the state they were in when they were looking at $x_{-n-k}$. Such transducers are called _strongly synchronizing_. Given a strongly synchronizing transducer, one obtains a well-defined map, and if its inverse is also strongly synchronizing, in which case it is called _bi-synchronizing_, then it is then easy to see that it is a shift-invariant homeomorphism. A concrete example of such a transducer is the following. Write $(q,a)\to (r,b)$ to mean that if the transducer is in state $q$ and sees $a$, then it will change state to $r$ and write $b$ (and then move to the next term). Then the instructions are $(q_0,0)\to(q_0,0)$ $(q_0,1)\to(q_2,1)$ $(q_0,2)\to(q_1,2)$ $(q_1,0)\to(q_0,1)$ $(q_1,1)\to(q_2,0)$ $(q_1,2)\to(q_1,2)$ $(q_2,0)\to(q_1,2)$ $(q_2,1)\to(q_2,1)$ $(q_2,2)\to(q_0,0)$ One can check that this is strongly synchronizing. For instance, if it ever encounters a 1, it will go into state $q_2$. Less trivially, if it encounters 00 then it will go into state $q_0$ and if it encounters 02, then it will go into state $q_1$. One of the main results of this paper is to show that the group of automorphisms of the one-sided shift on $X_n^{\mathbb N}$ (where $X_n$ is a set of size $n$) embeds naturally into the outer automorphism group of any one of the _Higman-Thompson groups_ $G_{n,r}$, which can be defined as follows. Let $1\leq r

Abstract Background Early control of haemorrhage and optimisation of physiology are guiding principles of resuscitation after injury. Improved outcomes have been previously associated with single, timely interventions. The aim of this study was to assess the association between multiple timely life-saving interventions (LSIs) and outcomes of traumatic haemorrhagic shock patients. Methods A retrospective cohort study was undertaken of injured patients with haemorrhagic shock who presented to Alfered Emergency & Trauma Centre between July 01, 2010 and July 31, 2014. LSIs studied included chest decompression, control of external haemorrhage, pelvic binder application, transfusion of red cells and coagulation products and surgical control of bleeding through angio-embolisation or operative intervention. The primary exposure variable was timely initiation of ≥ 50% of the indicated interventions. The association between the primary exposure variable and outcome of death at hospital discharge was adjusted for potential confounders using multivariable logistic regression analysis. The association between total pre-hospital times and pre-hospital care times (time from ambulance at scene to trauma centre), in-hospital mortality and timely initiation of ≥ 50% of the indicated interventions were assessed. Results Of the 168 patients, 54 (32.1%) patients had ≥ 50% of indicated LSI completed within the specified time period. Timely delivery of LSI was independently associated with improved survival to hospital discharge (adjusted odds ratio (OR) for in-hospital death 0.17; 95% confidence interval (CI) 0.03–0.83; p = 0.028). This association was independent of patient age, pre-hospital care time, injury severity score, initial serum lactate levels and coagulopathy. Among patients with pre-hospital time of ≥ 2 h, 2 (3.6%) received timely LSIs. Pre-hospital care times of ≥ 2 h were associated with delayed LSIs and with in-hospital death (unadjusted OR 4.3; 95% CI 1.4–13.0). Conclusions Timely completion of LSI when indicated was completed in a small proportion of patients and reflects previous research demonstrating delayed processes and errors even in advanced trauma systems. Timely delivery of a high proportion of LSIs was associated with improved outcomes among patients presenting with haemorrhagic shock after injury. Provision of LSIs in the pre-hospital phase of trauma care has the potential to improve outcomes.