Trauma Activation and Substance Use in an Urban Trauma Center

Background: Alcohol and drug screens in trauma patients are endorsed by the American College of Surgeons Committee on Trauma. The objective was to determine the characteristics and frequency of alcohol and poly-drug combinations in patients triaged by Trauma Team Activation (TTA) codes. Methods: A retrospective study of a Level I hospital trauma registry was initiated with 14,972 patients of whom 7028 (47%) were Substance Users (SU). There were 10,369 TTA patients: 5396 (52%) were SU, and 4603 (31%) non-TTA patients, of whom 1632 (35.5%) were SU. Inclusion criteria were: age ≥14 years old, blood alcohol level and Urine Drug Screen (UDS) documentation, Injury Severity Score (ISS), TTA code, hospital charges and Length of Hospitalization (LOS). Statistical analyses were performed with one-way ANOVA, Maximum Likelihood chi squared, and Mann-Whitney U tests. Results: The median ISS was 5 for both groups. TTA patients were younger than non-TTA patients (median 33 years versus 41 years). Mortality was significantly higher for TTA (4.7%) than for non-TTA (0.7%) patients. From 2010-2013 to 2014-2018, all substance users had a significant decrease in alcohol only use (58.0% to 42.0%) with an increase in single drug (42.0% to 58.0%) and poly-drug use (36.9% to 63.1%), p < 0.0001. For all SU patients (TTA and non-TTA), the major single drugs used were opiates (19.9%), cannabinoids (THC) (15.2%), benzodiazepines (7.7%), amphetamines (6.6%), and cocaine (2.5%). The major poly-drugs were: opiates/THC (4.7%), opiates/benzodiazepines (4.6%), THC/amphetamines (3.1%), THC/benzodiazepines (2.2%). Conclusions: By trauma activation code designation, the TTA group had most of the positive alcohol and drug screens in this study. Since the change in mandated opioid prescription practices in 2014, this study showed increased poly-drug use (two to six-drug combinations) in urban trauma patients between 2014-2018. Opioids and cannabinoids continued to be the most frequently used drugs singly and in combinations.

Recent laser upgrades at Sandia's Z-backlighter facility in order to accommodate new requirements for magnetized liner inertial fusion on the Z-machine

The Z-backlighter laser facility primarily consists of two high energy, high-power laser systems. Z-Beamlet laser(ZBL)(Rambo et al., Appl. Opt. 44, 2421(2005)) is a multi-kJ-class, nanosecond laser operating at 1054 nm which is frequency doubled to 527 nm in order to provide x-ray backlighting of high energy density events on the Z-machine. Z-Petawatt(ZPW)(Schwarz et al., J. Phys.: Conf. Ser. 112, 032020(2008)) is a petawatt-class system operating at 1054 nm delivering up to 500 J in 500 fs for backlighting and various short-pulse laser experiments(see also Figure 10 for a facility overview). With the development of the magnetized liner inertial fusion(MagLIF) concept on the Z-machine, the primary backlighting missions of ZBL and ZPW have been adjusted accordingly. As a result, we have focused our recent efforts on increasing the output energy of ZBL from 2 to 4 kJ at 527 nm by modifying the fiber front end to now include extra bandwidth(for stimulated Brillouin scattering suppression). The MagLIF concept requires a well-defined/behaved beam for interaction with the pressurized fuel. Hence we have made great efforts to implement an adaptive optics system on ZBL and have explored the use of phase plates. We are also exploring concepts to use ZPW as a backlighter for ZBL driven MagLIF experiments. Alternatively, ZPW could be used as an additional fusion fuel pre-heater or as a temporally flexible high energy pre-pulse. All of these concepts require the ability to operate the ZPW in a nanosecond long-pulse mode, in which the beam can co-propagate with ZBL. Some of the proposed modifications are complete and most of them are well on their way.