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Biomedical subjects

A M Dietrich

Publications and source records attributed to A M Dietrich.

At least 19 recordsLinked to original sources
PubMed2004

Health and aesthetic impacts of copper corrosion on drinking water.

Traditional research has focused on the visible effects of corrosion--failures, leaks, and financial debits--and often overlooked the more hidden health and aesthetic aspects. Clearly, corrosion of copper pipe can lead to levels of copper in the drinking water that exceed health guidelines and cause bitter or metallic tasting water. Because water will continue to be conveyed to consumers worldwide through metal pipes, the water industry has to consider both the effects of water quality on corrosion and the effects of corrosion on water quality. Integrating four key factors--chemical/biological causes, economics, health and aesthetics--is critical for managing the distribution system to produce safe water that consumers will use with confidence. As technological developments improve copper pipes to minimize scaling and corrosion, it is essential to consider the health and aesthetic effects on an equal plane with chemical/biological causes and economics to produce water that is acceptable for public consumption.

Copper↗
PubMed2004

Rating method for evaluating distribution-system odors compared with a control.

A new sensory method was developed and tested at a full-scale water treatment plant. The method evaluates changes in aesthetic water quality during transit in the distribution system. A paired comparison format is used to determine if the odor of a distribution-system sample is different from that of a control sample. The control sample represents the "ideal" water, such as treated water leaving the plant. The method can rapidly determine whether or not a problem exists in the distribution system, and, if one does exist, it allows for characterization of the problem. Over a three-month period a 4-member odor panel evaluated 118 distribution samples by this new procedure. Among the 118 samples tested, 39 samples yielded a consensus among the analysts as to the odor characteristics of the sample; 35 were rated "not different from the control" (about 90%), and only 4 were rated "different from control" (about 10%). The 79 samples for which no consensus was generated had only slight rating differences between analysts and for odor intensity. No taste-and-odor problems were reported by consumers during the time period for this study and the method indicated that no major odor problems existed in the distribution system.

Community Participation↗
PubMed2004

The attribute rating test for sensory analysis.

This new sensory method evaluates the intensity of an odorant by using a modified "paired-comparison" format. It can be applied to any situation for which the odor-causing agent is known and a purified standard is available. The attribute rating test requires that a standard solution of the odorant be prepared at a concentration that is both readily recognized by most individuals and likely to evoke customer complaints. Within an hour individuals can be trained to compare the odor type and intensity of the standard to water samples, then rate the odor in the sample as "not detected," "less than the standard," "equal to standard," or "greater than the standard." The attribute rating test was successfully used by a full-scale water treatment facility to monitor the intensity of geosmin in the source water and to determine the effectiveness of powdered activated carbon for controlling its earthy-odor in treated water.

Carbon↗
PubMed2001

Fate and transport of copper-based crop protectants in plasticulture runoff and the impact of sedimentation as a best management practice.

The fate and distribution of copper-based crop protectants, applied to plasticulture tomato fields to protect against disease, were investigated in a greenhouse-scale simulation of farming conditions in a coastal environment. Following rainfall, 99% of the applied copper was found to remain on the fields sorbed to the soil and plants; most of the soil-bound copper was found sorbed to the top 2.5 cm of soil between the plasticulture rows. Of the copper leaving the agricultural fields, 82% was found in the runoff with the majority, 74%. sorbed to the suspended solids. The remaining copper, 18%, leached through the soil and entered the groundwater with 10% in the dissolved phase and 8% sorbed to suspended solids. Although only 1% copper was found to leave the field, this was sufficient to cause high copper concentrations (average 2102+/-433 microg/L total copper and 189+/-139 microg/L dissolved copper) in the runoff. Copper concentrations in groundwater samples were also high (average 312+/-198 microg/L total copper and 216+/-99 microg/L dissolved copper). Sedimentation, a best management practice for reducing copper loadings. was found to reduce the total copper concentrations in runoff by 90% to a concentration of 245+/-127 microg/L; however, dissolved copper concentrations remained stable, averaging 139+/-55 microg/L. Total copper concentrations were significantly reduced by the effective removal of suspended solids with sorbed copper.

Adsorption↗
PubMed2001

Injury prevention and control in children.

Injury is the number one cause of death and life-years lost for children. In children, injury mortality is greater than childhood mortality from all other causes combined. Modern injury prevention and control seeks to prevent and limit or control injuries through the 4 Es of injury prevention: engineering, enforcement, education, and economics. Emergency physicians are often placed in a critical role in the lives of individuals, are respected authorities on the health and safety of children and adults, and have daily exposure to high-risk populations. This gives emergency physicians a unique perspective and an opportunity to take an active role in injury control and prevention. Specific methods or strategies for promulgating injury prevention and control in our emergency medicine practices are suggested, ranging from education (for our patients and health professionals); screening and intervention for domestic violence, child maltreatment, drug-alcohol dependency and abuse; data collection; reporting unsafe products; research; legislation; serving in regulatory and governmental agencies; emergency medical services-community involvement; and violence prevention. Emergency physicians can play a significant role in decreasing pediatric injury and its concomitant morbidity and mortality.

Child↗
PubMed2001

Effectiveness of a pediatric trauma team protocol.

OBJECTIVE: To determine the effectiveness of a pediatric trauma triage system and resource allocation for emergency medicine and trauma services. TRAUMA SYSTEM: Two-tier trauma team activation system that triages patients into Level 1 and Level 2 trauma alert categories based on information provided by pre-hospital providers to pediatric emergency physicians at an American College of Surgeons' Level 1 pediatric trauma center in Columbus, Ohio. METHODS: Using the hospital trauma registry database and patient medical records, a retrospective chart review was conducted on all (n = 542) admitted pediatric trauma patients from January 1995 through December 1996. RESULTS: Level 1 patients had a higher median injury severity score and shorter emergency department (ED) length of stay time than Level 2 patients. Level 1 patients were more likely to be admitted to the pediatric intensive care unit and remain for more than 24 hours when compared to Level 2 patients. In addition, Level 1 patients were more likely to have procedures performed (eg, intubation, tube thoracostomy, thoracotomy, diagnostic peritoneal lavage) than Level 2 patients. The mortality rate was significantly higher for Level 1 patients and all ED deaths had been triaged to the Level 1 category. CONCLUSIONS: This pediatric trauma triage system effectively predicts which patients will be more likely to have serious injury. By using a two-tier system, select patients may be managed by a smaller trauma team, thus improving staff utilization and possibly reducing costs while ensuring favorable outcomes.

Child↗
PubMed1998

Emergency medicine in a managed care environment.

Managed care has changed the face of the health care system. Providers who schedule care have responded and modified their systems of delivery and provision of care. The focus has now turned to unscheduled care, such as urgent and emergency services. This market is much more difficult to control and reconstruct. This article discusses the role of emergency medicine within a managed care system and future opportunities.

Consumer Behavior↗
PubMed1997

Frontal cortical atrophy and negative symptoms in patients with chronic alcohol dependence.

It has been suggested that frontal lobe pathology is associated with negative symptoms in patients with chronic alcoholism. In his exploratory study, the authors examined 19 chronic alcoholic inpatients on an alcohol treatment unit and found a significant relationship between severity of frontal atrophy (as measured by CT) and negative symptoms (as measured by the Scale for the Assessment of Negative Symptoms).

Adolescent↗
PubMed1997

Miniature C-arm imaging: an in vitro study of detecting foreign bodies in the emergency department.

STUDY OBJECTIVE: Recently, we have had clinical success detecting foreign bodies (FBs) using a mobile C-arm fluoroscopic device. This study tests its utility to detect FBs of differing densities in soft tissue. DESIGN: Blinded, randomized, controlled in vitro study. METHODS: Two physicians used the Xi-scan mini C-arm to image FBs. Five FBs of differing densities were studied: metal, gravel, glass, wood, and plastic. The FBs were placed into the deep muscles of chicken legs. One hundred observations were made: 50 legs with FBs and 50 legs without FBs. The blinded investigators imaged the legs and determined the presence or absence of FBs. RESULTS: Imaging located 100% of metal, gravel and glass FBs. Plastic and wood could not be consistently detected (sensitivity 0.4, specificity 0.6). CONCLUSIONS: This device accurately detects metal, gravel and glass. Radiolucent (wood) and semiradiopaque (plastic) FBs could not be located reliably. Clinical trials would define utility of this device in saving time, money and radiation exposure.

Animals↗
PubMed1996

Injuries to children related to shopping carts.

STUDY OBJECTIVE: To describe the epidemiology of shopping cart-related injuries among children and to consider targeted prevention strategies based on these epidemiologic findings. DESIGN: A consecutive series of patients. SETTING: The emergency department of a large, academic children's hospital. PARTICIPANTS: Sixty-two children treated for shopping cart-related injuries during a 15-month period. RESULTS: Children ranged in age from 4 months to 10 years (mean, 2.8 years). Thirty-three children (53%) were boys. Twelve patients (19%) arrived via ambulance. Forty-nine children (79%) had injuries to the head, including one child admitted to the hospital. Eleven children (18%) had fractures, including 5 (8%) with skull fractures. Nine patients (14%) had lacerations, and 30 patients (48%) had superficial injuries (ecchymoses or abrasions). The most common mechanism of injury was falling out of the carts (58% of children), followed by cart tip-overs (26% of children). Injuries caused by falls from the carts occurred across the entire age range, whereas injuries caused by cart tip-overs were most frequent among children 1 year of age or younger. The sitting position was associated with tip-over injuries, and standing in the cart basket was associated with falling from the cart. CONCLUSIONS: Shopping cart-related injuries cause serious pediatric morbidity, especially among children younger than 5 years of age, and are potentially fatal. Based on identified age-specific mechanisms of injury, currently used prevention strategies are not sufficient. The use of infant seats and restraining belts is an inadequate strategy for prevention of shopping cart-related injuries among children 1 year of age or younger, because cart tip-over is an important mechanism of injury in this age group. Shopping carts should be redesigned to decrease the tip-over hazard. Transportation of children in shopping carts of current design should be prohibited.

Accident Prevention↗
PubMed1995

Epidemiology of shopping cart-related injuries to children. An analysis of national data for 1990 to 1992.

OBJECTIVE: To describe the epidemiologic characteristics of shopping cart-related injuries among children in the United States. DESIGN: A retrospective analysis of data from the National Electronic Injury Surveillance System of the US Consumer Product Safety Commission for 1990 to 1992. RESULTS: An estimated 75,200 shopping cart-related injuries occurred in children younger than 15 years treated in US emergency departments during 1990 to 1992 (95% confidence interval, 57,500 to 92,900). Children younger than 5 years were at highest risk, accounting for 63,200 (84%) of the injuries. A 20% increase was observed in the number of injuries among 0- to 4-year-old children from 1990 to 1992. Fifty-three percent of injured children were male. The head and neck region was the most common anatomic site of injury, accounting for 74% of injuries among children younger than 15 years. An estimated 2000 children (2.7%) younger than 15 years required hospital admission (1.2% in 1990 compared with 3.5% in 1992). Children aged 0 to 4 years accounted for 93% of these hospital admissions. Among 0- to 14-year-old children, fractures accounted for 45% of hospital admissions, followed by internal injury (22%) and concussion (17%). CONCLUSIONS: Injuries related to shopping carts are an important cause of pediatric morbidity, especially among children younger than 5 years. These injuries can also result in death. Shopping carts should be redesigned to decrease the risk of injury to children, and transportation of children in shopping carts of current design should be prohibited.

Accidental Falls↗
PubMed1995

Pediatric patients requiring CPR in the prehospital setting.

STUDY OBJECTIVE: To determine the outcome of pediatric patients with prehospital cardiopulmonary arrest. DESIGN: Chart review of all patients with prehospital cardiopulmonary arrest who were subsequently admitted to a pediatric emergency department from January 1988 to January 1993. Cardiopulmonary arrest was considered to have been present if assisted ventilation and chest compressions were performed on an apneic, pulseless patient. SETTING: Pediatric ED. PARTICIPANTS: Pediatric patients in prehospital cardiac arrest. RESULTS: In all, 95 patients were identified. Fifty-six had initial hospital care at the pediatric ED (primary patients). The remaining 39 were transported to the pediatric ED after initial care of another institution (secondary patients). Forty-one percent of patients were younger than 1 year. Most arrests were respiratory in origin; asystole was the most common dysrhythmia. Fifteen patients (27%) survived to discharge. Fourteen of the survivors had return of spontaneous circulation before ED arrival. Thirty-three patients were in arrest on ED arrival; in 16 (48%) of these, return of spontaneous circulation subsequently developed in the ED, and 1 survived to discharge. Two survivors, including the survivor with return of spontaneous circulation in the ED, had severe neurologic sequelae. Ten (26%) of the secondary patients survived. All survivors had return of spontaneous circulation before arrival in the ED. Two survivors had severe neurologic sequelae. CONCLUSION: Most successfully resuscitated pediatric arrest victims are resuscitated in the prehospital setting and do not suffer severe neurologic injury. Most patients who present to the ED in continued arrest and survive to discharge have severe neurologic injury.

Age Factors↗
PubMed1995

Pediatric cervical-spine immobilization: achieving neutral position?

This study was designed to evaluate prospectively the ability of current spine-immobilization devices to achieve radiographic-neutral positioning of the cervical spine in pediatric trauma patients. All trauma patients who required spinal immobilization and a lateral cervical spine radiograph were included in the study. A lateral cervical spine radiograph was obtained while the child was immobilized. The Cobb angle (C2-C6) was measured using a handheld goniometer. The method of immobilization, age at injury, and Cobb angle were compared. One hundred and eighteen patients with an average age of 7.9 years were enrolled. The majority were males (71%). The most frequent mechanisms of injury included motor vehicle accidents (35%) and falls (32%). The average Glascow Coma Scale score was 14. Although 31% of the children complained of neck pain, 92% were without neurologic deficits. The Cobb angles ranged from 27 degree kyphosis to 27 degree lordosis, and only 12 of the patients presented in a neutral position (0 degrees). Greater than 5 degrees of kyphosis or lordosis was observed in 60% of the children. Thirty-seven percent of the patients had 10 degrees or greater angulation. The most frequent methods of immobilization included a collar, backboard, and towels (40%), and a collar, backboard, and blocks (20%), but these techniques provided < 5 degrees kyphosis or lordosis in only 45% and 26% of the children respectively. No single method or combination of methods of immobilization consistently placed the children in the neutral position.(ABSTRACT TRUNCATED AT 250 WORDS)

Age Factors↗
PubMed1995

Circumferential pressure as a rapid method to assess intraosseous needle placement.

This study was done to determine whether the application of circumferential pressure about an intraosseous (IO) site can be used as a rapid method to detect incorrect placement of an IO needle. We used a prospective, randomized, controlled canine tibial IO model. According to random assignment, IO needles were placed either intramedullary (correct placement) or extramedullary (incorrect placement) in the anteromedial tibias of 12 euthanized mongrel dogs. Neonatal blood pressure cuffs were placed contiguously above and below the IO needles. One-liter bags of solution were connected to the IO needles via blood tubing. The gravity-dependent rate of flow at each site was measured with and without the blood pressure cuffs inflated to 120 mmHg. Eleven IO needles were correctly placed and 13 were incorrectly placed. Following inflation of the blood pressure cuffs, the mean percent decrease in flow was 48% for the correctly placed IO needles, and 95% for the incorrectly placed IO needles. A two-way repeated measure of analysis of variance was significant between groups (P = 0.006), and a significant interaction was found between groups and flow rates over time (P = 0.043). We conclude that circumferential pressure about an IO infusion site can be used as a rapid method to detect incorrect placement of the IO needle.

Animals↗
PubMed1994

Intraosseous adenosine. As effective as peripheral or central venous administration?

OBJECTIVE: The purpose of this study was to determine if intraosseous administration of adenosine is effective and, if so, to establish therapeutic dosage criteria for the intraosseous route compared with peripheral or central intraosseous route compared with peripheral or central venous routes. RESEARCH DESIGN: Randomized, unblinded, cross-over, within-animal control study. SETTING: University hospital in Ohio. SUBJECTS: Thirty newly weaned piglets. SELECTION PROCEDURE: Consecutive sample. INTERVENTIONS: Thirty newly weaned pigs were transesophageally (n = 26) or transvenously (n = 4) paced at a cycle length that was 10% longer than the Wenckebach threshold. The minimum effective dose of adenosine necessary to induce atrioventricular block during pacing was recorded for peripheral venous, central venous, and intraosseous routes. MEASUREMENTS AND RESULTS: The baseline resting heart rate and Wenckebach thresholds were not statistically different between subjects or between different routes of administration. The intraosseous route required a minimum effective dose of 127 micrograms/kg. Using a log transformation, the difference between central venous and peripheral venous doses was found to be statistically significant. The intraosseous dose was not statistically different from the central venous or peripheral venous doses. CONCLUSION: The intraosseous route is an effective way of administering adenosine. The peripheral venous dose required to achieve atrioventricular block is higher than the central venous dose and the intraosseous dose is intermediary to the central venous and peripheral venous doses.

Adenosine↗
PubMed1994

Head trauma in children with congenital coagulation disorders.

Bleeding is the most frequent cause of death in children with congenital coagulation disorders, and intracranial (IC) hemorrhage accounts for the majority of mortality in all age groups. Even minor head trauma may produce significant IC pathology. Immediate diagnosis and rapid medical management are mandatory if morbidity and mortality are to be minimized. Although computed tomographic (CT) scans provide accurate diagnostic information, reliable criteria for the use of this expensive technology in children with hemophilia and von Willebrand's disease have not been defined. In this study the clinical symptoms and the time of initial assessment and therapy of head-injured children with congenital coagulopathies were evaluated and correlated with CT findings. Between 1985 and 1992, 123 patients with hemophilia A, hemophilia B, or von Willebrand's's disease received follow-up at this institution. One hundred nine episodes of head injury were recorded in 43 patients, and 66 CT scans were obtained. The most frequent mechanism of injury was a simple fall at play (62%). Only 5 patients had an IC injury demonstrable with CT (4.5% of 110 episodes). Vomiting was reported in 4 of 5 patients with IC hemorrhage (ICH), and all 5 presented with an altered mental status (Glasgow coma scale [GCS] (mean) = 10) and focal neurological deficit. These findings were infrequently observed (vomiting, 5 of 105; GCS (mean) = 15; neurological deficits 0 of 105) in children who either did not undergo CT or whose CT scan results were normal.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1993

Pediatric head injuries: can clinical factors reliably predict an abnormality on computed tomography?

STUDY OBJECTIVE: To assess clinical features that might reliably predict the need for computed tomography (CT) imaging in pediatric head trauma. DESIGN/SETTING/TYPE OF PARTICIPANT: Prospective cohort of 324 head CT scans performed on 322 consecutive trauma patients at an urban children's hospital. RESULTS: Sixty-two percent of patients were male. The mean age was 7.1 years (10 days to 20.6 years); half were less than 5 years of age. The two most frequent mechanisms of injury were falls (32%) and motor vehicle accidents (25%). Abnormalities were detected in 74 scans. Intracranial injuries were apparent in 39 patients (12%); 16 had a concomitant fracture. An isolated cranial abnormality was observed on 35 scans (11%). Loss of consciousness, amnesia for the event, a Glasgow Coma Scale (GCS) of less than 15, and the presence of a neurologic deficit were more common in children with intracranial injury (P < .05). Vomiting, seizures, and headache were not discriminating clinical features. No single characteristic consistently identified the children with an intracranial injury. Of the 195 children who were neurologically intact (GCS, 15) at the time of presentation, 11 (5%) had evidence of intracranial pathology on CT scan. CONCLUSION: This study demonstrates a poor correlation between the clinical symptoms of significant traumatic brain injury and findings on CT.

Adolescent↗