Byron L. Davis

Recent outcomes in the treatment of burn injury in the United States: a report from the American Burn Association Patient Registry.

This article reports outcomes of 6417 patients treated during 1991-1993 in 28 burn centers. Data were gathered by use of the ABAs computerized patient registry. Mean burn size was 14.1% total body surface area. There were 6087 survivors (95.9%); mortality rate among patients with inhalation injury was 29.4%. A probit analysis was used to construct a series of survival curves; the LA50 (which is defined as the burn size lethal to 50% of patients) for young adults was 81% total body surface area. Mean length of hospital stay was 13.5 days. Total mean charges were

Early prediction of prolonged ventilator dependence in thermally injured patients

39,533, with resource utilization related to clinical comorbidity factors and length of stay. No reliable method could be found to predict survival on admission. Mean charges for the most intensive diagnosis-related group (No. 472) exceeded

Resuscitation of thermally injured patients with oxygen transport criteria as goals of therapy

198,000 per patient. Pooled data and related summary statistics used in this study have some limitations, which are discussed. Additional accurate information regarding the outcomes of thermal injury treatment is needed by the burn care community.

World-System Structure and Change An Analysis of Global Networks and Economic Growth across Two Time Periods

BACKGROUND Recent studies suggest that when prolonged ventilator dependence (PVD) can be predicted in trauma or intensive care unit patients, early tracheostomy may reduce hospital stay and improve utilization of resources. This study was performed to develop criteria predictive of PVD (> 14 days) in burn patients. METHODS We reviewed burn patients aged > or =16 years admitted between 1990 and 1994 who required ventilator support for > or =3 days. Using the variables full-thickness burn size, age, inhalation injury, and worst PaO2/FiO2 on ventilator day 3, an equation predicting PVD was created using logistic regression. The equation was tested by applying it to 1995 patients. RESULTS When a probability of >0.5 was considered predictive of PVD, the equation correctly predicted PVD in 82% of 1990 to 1994 patients (n = 110) and 90% of 1995 patients (n = 29). CONCLUSION PVD in burn patients can be predicted using objective variables in the early postburn period. Predictions can be used to select patients for prospective studies of early tracheostomy.

Performance Management, Managerial Citizenship and Worker Commitment: A Study of the United States Postal Service with Some Global Implications

Resuscitation from shock based on oxygen transport criteria has been widely used in trauma and surgical patients, but has not been examined in thermally injured patients. To study the possible efficacy of this type of resuscitation, the oxygen transport characteristics of burn resuscitation were studied in nine adults, of whom six had inhalation injuries, with a mean burn size of 45% total body surface area and a mean age of 33.4 years, who were resuscitated based on oxygen transport criteria. Pulmonary artery balloon flotation catheters were placed and hemodynamic and oxygen transport parameters (Fick method) were measured hourly for 6 hours. Patients received fluid boluses in addition to resuscitation calculated by the Parkland formula, until the pulmonary artery wedge pressure reached 15 mm Hg, after which dobutamine infusions (5 micrograms/kg/min) were initiated. Cardiac index increased from 2.51 to 6.57 L/min/m2 (p < 0.05), whereas systemic vascular resistance fell from 1534 to 584 dyne sec/cm5 (p < 0.05). Oxygen delivery (DO2I) and oxygen consumption (VO2I) indexes increased significantly during the study period (573 +/- 47 to 1028 +/- 57, and 132 +/- 8 to 172 +/- 16 ml/min/m2, respectively; p < 0.05). VO2I appeared dependent on DO2I at levels of DO2I less than 800 ml/min/m2. In this study, depressed cardiovascular function in patients with burn injuries responded to volume loading and inotropic support much as it does in patients with shock of other etiologies. Whether oxygen transport-based resuscitation is effective in improving survival or the incidence of multiple organ failure is unknown and will need to be evaluated in randomized trials.

Family and economic growth : A world-system approach and a cross-national analysis

The authors establish in an empirical way structure and change in world-system structure in two periods, 1960 to 1965 and 1970 to 1975, as that structure is operationalized by key international networks. The interplay between global and national domains of analyses is examined with respect to the national-level consequences of strong, weak, and intermediate ties for the noncore countries of the world. When taken together, the dynamics studied permit an examination of the central themes of world-system theory and network approaches in general, while identifying future agendas for sociological theorizing and research.

Change Scores, Composites and Reliability Issues in Cross-National Development Research

This exploratory study of the US Postal Service examines worker perceptions of ‘management citizenship’ in a high performance workplace, and assesses the impact of management citizenship on worker commitment. Qualitative data from employee narratives show many workers view performance management practices as unjust and at a disjuncture with perceived organizational and broader societal goals. Especially salient are issues of worker voice, equity and the non-universalistic treatment of employees by managers. Worker perceptions vary across race and gender. Effects of such perceptions on the organizational commitment of workers have been insuf.ciently studied, but regression analyses show that net of other predictors, worker perceptions of management citizenship are consequential to organizational commitment, as are the intersection of their gender and race for black women, and worker views of workplace heterogeneity, colleague citizenship and personal citizenship in the organization. The implications of these .ndings are drawn out generally and globally, with a focus on ameliorative management citizenship strategies.

Human Capital Issues in the Use of Information Technology in Education

Family research in sociology has concentrated on the national-level determinants of family structure and process. The approach we propose, in contrast, reverses the causal ordering to consider the effects of family characteristics on national outcomes, especially economic growth. This effort is further stimulated by neglect in the sociology of national development literature, where the plausible impact of the family on economic development has been ignored. The modified world-system perspective that we present links the institution of the family to modernization and the developmental profile of nations. We use cross-national data to test this perspective and demonstrate that the family is a vital, but differential contributor to national development around the world.

Inhaled nitric oxide versus conventional therapy: Effect on oxygenation in ARDS

While a number of researchers of world development examine social change using composite measures as indicators, there is a relative paucity of research on the reliability of these change score composites over time. We construct two development composites based simply on factor analysis, one economic and one social, and then perform reliability analysis on these two development composites at two discrete points in time (i.e. 1970 and 1985) and their change over the 15-year period defined by their beginning and ending points. Despite evidence of reliable beginning and ending points, change in composites over time yield markedly different patterns of reliability. We conclude that if composite indicators of development are used in cross-national research to assess change, the reliabilities of their change should be addressed directly in addition to the reliabilities of their beginning and ending points. The risk of not doing so is faulty inferences with respect to theory.

Theorizing and Rethinking Linkages Between the Natural Environment and the Modern World-System: Deforestation in the Late 20th Century

Local technological applications and their implications for human capital depend not only on the local environment, but also on successively larger social structures. In a world with a complex international division of labor, events in distant countries now intimately affect the nation, states, cities, and social institutions. Indeed, the long-term effects of the chaotic world economy of the 1970s still ripple through the United States. They impact the national output, national indebtedness, the shift from federal to local responsibilities, and the overbureaucratization and fast-paced technology of the megainstitutions where livelihoods are made and the quality of life is determined. The authors elaborate these themes, working from the most macroscopic or global level to the most microscopic or local level of social organization, and tie their discussion to data on international-, national-, and state-level trends. The authors explore a single but representative local case, which documents the impact of these megaforces on an educational institution.