8 research outputs found
Costal cartilage fracture in blunt thoracic trauma: missed diagnosis with unclear clinical impact
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The performance of English provincial psalmody c.1690-c.1840
Get PDFProvincial English Anglican and nonconformist church music, commonly known as psalmody, underwent profound changes during the eighteenth and early nineteenth centuries. In 1700 the music in most parish churches was limited to a few
unaccompanied metrical psalm tunes, sung slowly and unrhythmically by an apathetic congregation. Attempts at reform led to the introduction of organs and choirs of charity children in towns, and to the growth of a florid, distinctive style of vernacular music in less affluent rural areas. This was often composed and taught by itinerant singing masters and was Performed by a mixed group of singers and instrumentalists. It continued to flourish in country parishes until it was gradually ousted by the Oxford Movement in the mid nineteenth century. Similar developments occurred later in nonconformity with more congregational participation.
This thesis discusses the available musical and literary sources and places psalmody in its historical and musical
context,before tracing developments within the
Anglican and nonconformist traditions. The organisation, size and vocal range of choirs is considered but the main focus is on the use of voices and instruments. The problems
of the correct allocation of parts is investigated in some detail, because this has important: performance implications and was further complicated when instruments
began to be introduced in the later 1700s. The scoring of large-scale instrumental pieces is also analysed. Finally, the didactic introductions of psalmody tune books are
examined since,until the mid eighteenth century,they provided essential performance instructions on tempi, dynamics,ornamentation and voice production.
The main purpose, of this dissertation is to gain a better understanding of psalmody during the eighteenth and early nineteenth centuries, in order to inform modern performance and to provide evidence that will stimulate further research.
A music anthology and two CDs containing music recordings
and a database are included
Scanning the aged to minimize missed injury: An Eastern Association for the Surgery of Trauma multicenter study.
No full textBACKGROUND: Despite the high incidence of blunt trauma in older adults, there is a lack of evidence-based guidance for computed tomography (CT) imaging in this population. We aimed to identify an algorithm to guide use of a pan-scan (head/cervical spine [C-spine]/torso) or a selective scan (head/C-spine ± torso). We hypothesized that a patient\u27s initial history and examination could be used to guide imaging.
METHODS: We prospectively studied blunt trauma patients 65 years or older at 18 Level I/II trauma centers. Patients presenting \u3e24 hours after injury or who died upon arrival were excluded. We collected history and physical elements and final injury diagnoses. Injury diagnoses were categorized into CT body regions of head/C-spine or Torso (chest, abdomen/pelvis, and thoracolumbar spine). Using machine learning and regression modeling as well as a priori clinical algorithms based, we tested various decision rules against our data set. Our priority was to identify a simple rule, which could be applied at the bedside, maximizing sensitivity and negative predictive value (NPV) to minimize missed injuries.
RESULTS: We enrolled 5,498 patients with 3,082 injuries. Nearly half (n = 2,587 [47.1%]) had an injury within the defined CT body regions. No rule to guide a pan-scan could be identified with suitable sensitivity/NPV for clinical use. A clinical algorithm to identify patients for pan-scan, using a combination of physical examination findings and specific high-risk criteria, was identified and had a sensitivity of 0.94 and NPV of 0.86. This rule would have identified injuries in all but 90 patients (1.6%) and would theoretically spare 11.9% (655) of blunt trauma patients a torso CT.
CONCLUSION: Our findings advocate for head/C-spine CT in all geriatric patients with the addition of torso CT in the setting of positive clinical findings and high-risk criteria. Prospective validation of this rule could lead to streamlined diagnostic care of this growing trauma population.
LEVEL OF EVIDENCE: Diagnostic Tests or Criteria; Level II
Scanning the aged to minimize missed injury: An EAST multicenter study.
No full textBACKGROUND: Despite the high incidence of blunt trauma in older adults, there is a lack of evidence-based guidance for computed tomography (CT) imaging in this population. We aimed to identify an algorithm to guide use of a Pan-Scan (Head/C-spine/Torso) or a Selective Scan (Head/C-spine ± Torso). We hypothesized that a patient\u27s initial history and exam could be used to guide imaging.
METHODS: We prospectively studied blunt trauma patients aged 65+ at 18 Level I/II trauma centers. Patients presenting \u3e24 h after injury or who died upon arrival were excluded. We collected history and physical elements and final injury diagnoses. Injury diagnoses were categorized into CT body regions of Head/C-spine or Torso (chest, abdomen/pelvis, and T/L spine). Using machine learning and regression modeling as well as a priori clinical algorithms based, we tested various decision rules against our dataset. Our priority was to identify a simple rule which could be applied at the bedside, maximizing sensitivity (Sens) and negative predictive value (NPV) to minimize missed injuries.
RESULTS: We enrolled 5,498 patients with 3,082 injuries. Nearly half (47.1%, n = 2,587) had an injury within the defined CT body regions. No rule to guide a Pan-Scan could be identified with suitable Sens/NPV for clinical use. A clinical algorithm to identify patients for Pan-Scan, using a combination of physical exam findings and specific high-risk criteria, was identified and had a Sens of 0.94 and NPV of 0.86 This rule would have identified injuries in all but 90 patients (1.6%) and would theoretically spare 11.9% (655) of blunt trauma patients a torso CT.
CONCLUSIONS: Our findings advocate for Head/Cspine CT in all geriatric patients with the addition of torso CT in the setting of positive clinical findings and high-risk criteria. Prospective validation of this rule could lead to streamlined diagnostic care of this growing trauma population.
LEVEL OF EVIDENCE: Level 2, Diagnostic Tests or Criteria
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Primary repair versus resection for American Association for the Surgery of Trauma grades I and II colon injuries: Does the management approach really matter? An Eastern Association for the Surgery of Trauma multicenter trial
No full textBACKGROUNDThe management of traumatic low-grade (American Association for the Surgery of Trauma [AAST] grades I and II) colon injuries has evolved. Recent data suggest that primary repair (PR) or resection over colostomy decreases morbidity and mortality. However, data comparing patients undergoing PR versus resection with anastomosis (RWA) are lacking. We hypothesized that patients presenting with low-grade colon injuries undergoing PR would have fewer postoperative complications than patients undergoing RWA. METHODSThis was a retrospective, multicenter analysis of all patients presenting with AAST grades I and II colon injuries to 32 Level 1 trauma centers from 2011 to 2021. Based on operative documentation, patients were dichotomized into two groups, those who underwent PR or RWA. Outcomes included length of stay, infectious complications, and mortality. Multivariate logistic regression was performed to determine the independent effect of operative technique on outcomes. RESULTSA total of 2,022 patients met the inclusion criteria for this study. Most were young (36 [24-44] years), male (79.6%), and presented after penetrating trauma (58.2%). A total of 1,013 patients presented with a grade I injury, while 1,009 patients presented with a grade II injury. Furthermore, 1,314 patients underwent PR, and 708 underwent RWA. While there was no difference in Injury Severity Score between PR and RWA, RWA was associated with more adverse outcomes including surgical site infections, suture line failure/leak, fascial dehiscence, and a longer hospital length of stay (all p < 0.001). When controlling for mechanism of injury, AAST grade, Injury Severity Score, and number of intra-abdominal injuries RWA were independently associated with more infectious complications including superficial, deep, and organ space surgical site infections. CONCLUSIONResection with anastomosis was independently associated with more adverse outcomes including multiple infectious complications and longer hospital length of stay compared with PR, suggesting that low-grade colon injuries can be safely managed with PR alone. LEVEL OF EVIDENCETherapeutic/Care Management; Level III
Primary repair versus resection for American Association for the Surgery of Trauma grades I and II colon injuries: Does the management approach really matter? An Eastern Association for the Surgery of Trauma multicenter trial.
No full textBACKGROUND: The management of traumatic low-grade (American Association for the Surgery of Trauma [AAST] grades I and II) colon injuries has evolved. Recent data suggest that primary repair (PR) or resection over colostomy decreases morbidity and mortality. However, data comparing patients undergoing PR versus resection with anastomosis (RWA) are lacking. We hypothesized that patients presenting with low-grade colon injuries undergoing PR would have fewer postoperative complications than patients undergoing RWA.
METHODS: This was a retrospective, multicenter analysis of all patients presenting with AAST grades I and II colon injuries to 32 Level 1 trauma centers from 2011 to 2021. Based on operative documentation, patients were dichotomized into two groups, those who underwent PR or RWA. Outcomes included length of stay, infectious complications, and mortality. Multivariate logistic regression was performed to determine the independent effect of operative technique on outcomes.
RESULTS: A total of 2,022 patients met the inclusion criteria for this study. Most were young (36 [24-44] years), male (79.6%), and presented after penetrating trauma (58.2%). A total of 1,013 patients presented with a grade I injury, while 1,009 patients presented with a grade II injury. Furthermore, 1,314 patients underwent PR, and 708 underwent RWA. While there was no difference in Injury Severity Score between PR and RWA, RWA was associated with more adverse outcomes including surgical site infections, suture line failure/leak, fascial dehiscence, and a longer hospital length of stay (all p \u3c 0.001). When controlling for mechanism of injury, AAST grade, Injury Severity Score, and number of intra-abdominal injuries RWA were independently associated with more infectious complications including superficial, deep, and organ space surgical site infections.
CONCLUSION: Resection with anastomosis was independently associated with more adverse outcomes including multiple infectious complications and longer hospital length of stay compared with PR, suggesting that low-grade colon injuries can be safely managed with PR alone.
LEVEL OF EVIDENCE: Multicenter Retrospective Comparative Study; Level III
