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It is important to limit dwelling infiltration to reduce energy demand and help meet national climate change commitments while concurrently providing sufficient ventilation to deliver adequate indoor air quality. DOMVENT3D is a model of infiltration and exfiltration that assumes a linear pressure distribution over any number of uniformly porous facades and integrates the airflow rate in the vertical plane to predict the theoretically correct airflow rate through them. DOMVENT3D is a new development of an existing two-dimensional model of infiltration that provides more opportunities for investigating a greater number of dwellings than was previously possible. Initial testing suggests that DOMVENT3D is mathematically robust and is suitable for modelling a wide variety of dwelling types and geometries to assist engineers and policy makers.Practical application: The modern building services engineer may be required to model airflow networks in a building to balance the conflicting needs of energy consumption reduction and occupant health. Limiting exfiltration is one method of reducing heat losses from a building and so there is a need to model it accurately. This article presents a new model of infiltration and exfiltration through a uniformly porous facade that can be incorporated within advanced complex airflow network tools or applied using a simple spreadsheet. [ABSTRACT FROM AUTHOR]

Living shorelines aim to enhance the resilience of coastlines to hazards while simultaneously delivering co-benefits such as carbon sequestration. Despite the potential ecological and socio-economic benefits of living shorelines over conventional engineered coastal protection structures, application is limited globally. Australia has a long and diverse coastline that provides prime opportunities for living shorelines using beaches and dunes, vegetation, and biogenic reefs, which may be either natural ('soft' approach) or with an engineered structural component ('hybrid' approach). Published scientific studies, however, have indicated limited use of living shorelines for coastal protection in Australia. In response, we combined a national survey and interviews of coastal practitioners and a grey and peer-reviewed literature search to (1) identify barriers to living shoreline implementation; and (2) create a database of living shoreline projects in Australia based on sources other than scientific literature. Projects included were those that had either a primary or secondary goal of protection of coastal assets from erosion and/or flooding. We identified 138 living shoreline projects in Australia through the means sampled starting in 1970; with the number of projects increasing through time particularly since 2000. Over half of the total projects (59 %) were considered to be successful according to their initial stated objective (i.e., reducing hazard risk) and 18 % of projects could not be assessed for their success based on the information available. Seventy percent of projects received formal or informal monitoring. Even in the absence of peer-reviewed support for living shoreline construction in Australia, we discovered local and regional increases in their use. This suggests that coastal practitioners are learning on-the-ground, however more generally it was stated that few examples of living shorelines are being made available, suggesting a barrier in information sharing among agencies at a broader scale. A database of living shoreline projects can increase knowledge among practitioners globally to develop best practice that informs technical guidelines for different approaches and helps focus attention on areas for further research., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024. Published by Elsevier B.V.)

Ocean warming and acidification threaten the future growth of coral reefs. This is because the calcifying coral reef taxa that construct the calcium carbonate frameworks and cement the reef together are highly sensitive to ocean warming and acidification. However, the global-scale effects of ocean warming and acidification on rates of coral reef net carbonate production remain poorly constrained despite a wealth of studies assessing their effects on the calcification of individual organisms. Here, we present global estimates of projected future changes in coral reef net carbonate production under ocean warming and acidification. We apply a meta-analysis of responses of coral reef taxa calcification and bioerosion rates to predicted changes in coral cover driven by climate change to estimate the net carbonate production rates of 183 reefs worldwide by 2050 and 2100. We forecast mean global reef net carbonate production under representative concentration pathways (RCP) 2.6, 4.5, and 8.5 will decline by 76, 149, and 156%, respectively, by 2100. While 63% of reefs are projected to continue to accrete by 2100 under RCP2.6, 94% will be eroding by 2050 under RCP8.5, and no reefs will continue to accrete at rates matching projected sea level rise under RCP4.5 or 8.5 by 2100. Projected reduced coral cover due to bleaching events predominately drives these declines rather than the direct physiological impacts of ocean warming and acidification on calcification or bioerosion. Presently degraded reefs were also more sensitive in our analysis. These findings highlight the low likelihood that the world's coral reefs will maintain their functional roles without near-term stabilization of atmospheric CO 2 emissions., Competing Interests: The authors declare no competing interest., (Copyright © 2021 the Author(s). Published by PNAS.)

The worlds' coral reefs are declining due to the combined effects of natural disturbances and anthropogenic pressures including thermal coral bleaching associated with global climate change. Nearshore corals are receiving increased anthropogenic stress from coastal development and nutrient run-off. Considering forecast increases in global temperatures, greater understanding of drivers of recovery on nearshore coral reefs following widespread bleaching events is required to inform management of local stressors. The west Pilbara coral reefs, with cross-shelf turbidity gradients coupled with a large nearby dredging program and recent history of repeated coral bleaching due to heat stress, represent an opportune location to study recovery from multiple disturbances. Mean coral cover at west Pilbara reefs was monitored from 2009 to 2018 and declined from 45% in 2009 to 5% in 2014 following three heat waves. Recruitment and juvenile abundance of corals were monitored from 2014 to 2018 and were combined with biological and physical data to identify which variables enhanced or hindered early-stage coral recovery of all hard corals and separately for the acroporids, the genera principally responsible for recovery in the short-term (<7 years). From 2014 to 2018, coral cover increased from 5 to 10% but recovery varied widely among sites (0-13%). Hard coral cover typically recovered most at shallower sites that had higher abundance of herbivorous fish, less macroalgae, and lower turbidity. Similarly, acroporid corals recovered most at sites with lower turbidity and macroalgal cover. Juvenile acroporid densities were a good indicator of recovery at least two years after they were recorded. However, recruitment to settlement tiles was not a good predictor of total coral or acroporid recovery. This study shows that coral recovery can be slower in areas of high turbidity and the rate may be reduced by local pressures, such as dredging. Management should focus on improving or maintaining local water quality to increase the likelihood of coral recovery under climate stress. Further, in turbid environments, juvenile coral density predicts early coral recovery better than recruits on tiles and may be a more cost-effective technique for monitoring recovery potential., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Crown Copyright © 2020. Published by Elsevier Ltd. All rights reserved.)

Seeds of Australian species of the seagrass genus Posidonia are covered by a membranous wing that we hypothesize plays a fundamental role in seed establishment in sandy, wave swept marine environments. Dimensions of the seed and membrane were quantified under electron microscopy and micro-CT scans, and used to model rotational, drag and lift forces. Seeds maintain contact with the seabed in the presence of strong turbulence: the larger the wing, the more stable the seed. Wing surface area increases from P. sinuosa < P. australis < P.coriacea correlating with their ability to establish in increasingly energetic environments. This unique seed trait in a marine angiosperm corresponds to adaptive pressures imposed on seagrass species along 7,500 km of Australia's coastline, from open, high energy coasts to calmer environments in bays and estuaries.

Dark-rearing has been found to slow the rate of retinal degeneration in albino P23H but not S334ter mutant rhodopsin transgenic (Tg) rats. Since eye pigmentation has the same protective slowing effect as dark-rearing in RCS rats, we examined whether eye pigmentation has a comparable slowing effect in the different mutant rhodopsin Tg rats. Different lines of albino P23H and S334ter Tg rats on the Sprague-Dawley (SD) background were bred to Long-Evans (LE) rats to produce pigmented Tg rats. These were compared to albino Tg rats at postnatal days of different ages using the outer nuclear layer (ONL) as a morphological measure of photoreceptor number and electroretinogram (ERG) a- and b-wave amplitudes as a measure of retinal function. When compared to albino P23H rats, pigmented P23H rats had a slower rate of degeneration as measured by greater ONL thicknesses and greater ERG a- and b-wave amplitudes. By contrast, pigmented S334ter rats showed no difference in ONL thicknesses or ERG a- and b-wave amplitudes when compared to their albino equivalents. Thus, degeneration of photoreceptors in P23H Tg rats is slowed by eye pigmentation as measured by ONL thickness, while it is not in the S334ter Tg rats. Eye pigmentation also protects functional changes in ERG a- and b-waves for the P23H lines, but not for the S334ter lines., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

Movement is fundamental to the ecology and evolutionary dynamics within species. Understanding movement through seed dispersal in the marine environment can be difficult due to the high spatial and temporal variability of ocean currents. We employed a mutually enriching approach of population genetic assignment procedures and dispersal predictions from a hydrodynamic model to overcome this difficulty and quantify the movement of dispersing floating fruit of the temperate seagrass Posidonia australis Hook.f. across coastal waters in south-western Australia. Dispersing fruit cohorts were collected from the water surface over two consecutive years, and seeds were genotyped using microsatellite DNA markers. Likelihood-based genetic assignment tests were used to infer the meadow of origin for seed cohorts and individuals. A three-dimensional hydrodynamic model was coupled with a particle transport model to simulate the movement of fruit at the water surface. Floating fruit cohorts were mainly assigned genetically to the nearest meadow, but significant genetic differentiation between cohort and most likely meadow of origin suggested a mixed origin. This was confirmed by genetic assignment of individual seeds from the same cohort to multiple meadows. The hydrodynamic model predicted 60% of fruit dispersed within 20 km, but that fruit was physically capable of dispersing beyond the study region. Concordance between these two independent measures of dispersal provides insight into the role of physical transport for long distance dispersal of fruit and the consequences for spatial genetic structuring of seagrass meadows., (© 2018 John Wiley & Sons Ltd.)

Tropical reef systems are transitioning to a new era in which the interval between recurrent bouts of coral bleaching is too short for a full recovery of mature assemblages. We analyzed bleaching records at 100 globally distributed reef locations from 1980 to 2016. The median return time between pairs of severe bleaching events has diminished steadily since 1980 and is now only 6 years. As global warming has progressed, tropical sea surface temperatures are warmer now during current La Niña conditions than they were during El Niño events three decades ago. Consequently, as we transition to the Anthropocene, coral bleaching is occurring more frequently in all El Niño-Southern Oscillation phases, increasing the likelihood of annual bleaching in the coming decades., (Copyright © 2018, American Association for the Advancement of Science.)

Human excreta is a low cost source of nutrients vital to plant growth, but also a source of pathogens transmissible to people and animals. We investigated the cost-savings and infection risk of soil transmitted helminths (STHs) in four scenarios where farmers used either inorganic fertilizer or fresh/composted human excreta supplemented by inorganic fertilizer to meet the nutrient requirements of rice paddies in the Red River Delta, Vietnam. Our study included two main components: 1) a risk estimate of STH infection for farmers who handle fresh excreta, determined by systematic review and meta-analysis; and 2) a cost estimate of fertilizing rice paddies, determined by nutrient assessment of excreta, a retailer survey of inorganic fertilizer costs, and a literature review to identify region-specific inputs. Our findings suggest that farmers who reuse fresh excreta are 1.24 (95% CI: 1.13-1.37, p-value<0.001) times more likely to be infected with any STH than those who do not handle excreta or who compost appropriately, and that risk varies by STH type (Ascaris lumbricoides RR = 1.17, 95% CI = 0.87-1.58, p-value = 0.29; Hookworm RR = 1.02, 95% CI = 0.50-2.06, p-value = 0.96; Trichuris trichiura RR = 1.38, 95% CI = 0.79-2.42, p-value = 0.26). Average cost-savings were highest for farmers using fresh excreta (847,000 VND) followed by those who composted for 6 months as recommended by the WHO (312,000 VND) and those who composted for a shorter time (5 months) with lime supplementation (37,000 VND/yr); however, this study did not assess healthcare costs of treating acute or chronic STH infections in the target group. Our study provides evidence that farmers in the Red River Delta are able to use a renewable and locally available resource to their economic advantage, while minimizing the risk of STH infection.

Accurate estimation of connectivity among populations is fundamental for determining the drivers of population resilience, genetic diversity, adaptation and speciation. However the separation and quantification of contemporary versus historical connectivity remains a major challenge. This review focuses on marine angiosperms, seagrasses, that are fundamental to the health and productivity of temperate and tropical coastal marine environments globally. Our objective is to understand better the role of sexual reproduction and recruitment in influencing demographic and genetic connectivity among seagrass populations through an integrated multidisciplinary assessment of our present ecological, genetic, and demographic understanding, with hydrodynamic modelling of transport. We investigate (i) the demographic consequences of sexual reproduction, dispersal and recruitment in seagrasses, (ii) contemporary transport of seagrass pollen, fruits and seed, and vegetative fragments with a focus on hydrodynamic and particle transport models, and (iii) contemporary genetic connectivity among seagrass meadows as inferred through the application of genetic markers. New approaches are reviewed, followed by a summary outlining future directions for research: integrating seascape genetic approaches; incorporating hydrodynamic modelling for dispersal of pollen, seeds and vegetative fragments; integrating studies across broader geographic ranges; and incorporating non-equilibrium modelling. These approaches will lead to a more integrated understanding of the role of contemporary dispersal and recruitment in the persistence and evolution of seagrasses., (© 2016 Cambridge Philosophical Society.)

Both nociception and punishment signals have been used in robotics. However, the potential for using these negatively valenced types of reinforcement learning signals for robot learning has not been exploited in detail yet. Nociceptive signals are primarily used as triggers of preprogrammed action sequences. Punishment signals are typically disembodied, i.e., with no or little relation to the agent-intrinsic limitations, and they are often used to impose behavioral constraints. Here, we provide an alternative approach for nociceptive signals as drivers of learning rather than simple triggers of preprogrammed behavior. Explicitly, we use nociception to expand the state space while we use punishment as a negative reinforcement learning signal. We compare the performance-in terms of task error, the amount of perceived nociception, and length of learned action sequences-of different neural networks imbued with punishment-based reinforcement signals for inverse kinematic learning. We contrast the performance of a version of the neural network that receives nociceptive inputs to that without such a process. Furthermore, we provide evidence that nociception can improve learning-making the algorithm more robust against network initializations-as well as behavioral performance by reducing the task error, perceived nociception, and length of learned action sequences. Moreover, we provide evidence that punishment, at least as typically used within reinforcement learning applications, may be detrimental in all relevant metrics.

During 2015-2016, record temperatures triggered a pan-tropical episode of coral bleaching, the third global-scale event since mass bleaching was first documented in the 1980s. Here we examine how and why the severity of recurrent major bleaching events has varied at multiple scales, using aerial and underwater surveys of Australian reefs combined with satellite-derived sea surface temperatures. The distinctive geographic footprints of recurrent bleaching on the Great Barrier Reef in 1998, 2002 and 2016 were determined by the spatial pattern of sea temperatures in each year. Water quality and fishing pressure had minimal effect on the unprecedented bleaching in 2016, suggesting that local protection of reefs affords little or no resistance to extreme heat. Similarly, past exposure to bleaching in 1998 and 2002 did not lessen the severity of bleaching in 2016. Consequently, immediate global action to curb future warming is essential to secure a future for coral reefs.

Creating large conservation zones in remote areas, with less intense stakeholder overlap and limited environmental information, requires periodic review to ensure zonation mitigates primary threats and fill gaps in representation, while achieving conservation targets. Follow-up reviews can utilise improved methods and data, potentially identifying new planning options yielding a desirable balance between stakeholder interests. This research explored a marine zoning system in north-west Australia-a biodiverse area with poorly documented biota. Although remote, it is economically significant (i.e. petroleum extraction and fishing). Stakeholder engagement was used to source the best available biodiversity and socio-economic data and advanced spatial analyses produced 765 high resolution data layers, including 674 species distributions representing 119 families. Gap analysis revealed the current proposed zoning system as inadequate, with 98.2% of species below the Convention on Biological Diversity 10% representation targets. A systematic conservation planning algorithm Maxan provided zoning options to meet representation targets while balancing this with industry interests. Resulting scenarios revealed that conservation targets could be met with minimal impacts on petroleum and fishing industries, with estimated losses of 4.9% and 7.2% respectively. The approach addressed important knowledge gaps and provided a powerful and transparent method to reconcile industry interests with marine conservation.

Temperatures within shallow reefs often differ substantially from those in the surrounding ocean; therefore, predicting future patterns of thermal stresses and bleaching at the scale of reefs depends on accurately predicting reef heat budgets. We present a new framework for quantifying how tidal and solar heating cycles interact with reef morphology to control diurnal temperature extremes within shallow, tidally forced reefs. Using data from northwestern Australia, we construct a heat budget model to investigate how frequency differences between the dominant lunar semidiurnal tide and diurnal solar cycle drive ~15-day modulations in diurnal temperature extremes. The model is extended to show how reefs with tidal amplitudes comparable to their depth, relative to mean sea level, tend to experience the largest temperature extremes globally. As a consequence, we reveal how even a modest sea level rise can substantially reduce temperature extremes within tide-dominated reefs, thereby partially offsetting the local effects of future ocean warming.

A Lagrangian particle tracking model driven by a regional ocean circulation model was used to investigate the seasonally varying connectivity patterns within the shelf circulation surrounding the 300 km long Ningaloo Reef in Western Australia (WA) during 2009-2010. Forward-in-time simulations revealed that surface water was transported equatorward and offshore in summer due to the upwelling-favorable winds. In winter, however, water was transported polewards down the WA coast due to the seasonally strong Leeuwin Current. Using backward-in-time simulations, the subsurface transport pathways revealed two main source regions of shelf water reaching Ningaloo Reef: (1) a year-round source to the northeast in the upper 100 m of water column; and (2) during the summer, an additional source offshore and to the west of Ningaloo in depths between ~30 and ~150 m. Transient wind-driven coastal upwelling, onshore geostrophic transport and stirring by offshore eddies were identified as the important mechanisms influencing the source water origins. The identification of these highly time-dependent transport pathways and source water locations is an essential step towards quantifying how key material (e.g., nutrients, larvae, contaminants, etc.) is exchanged between Ningaloo Reef and the surrounding shelf ocean, and how this is mechanistically coupled to the complex ocean dynamics in this region.

Background: Seagrasses are clonal marine plants that form important biotic habitats in many tropical and temperate coastal ecosystems. While there is a reasonable understanding of the dynamics of asexual (vegetative) growth in seagrasses, sexual reproduction and the dispersal pathways of the seeds remain poorly studied. Here we address the potential for a predominantly clonal seagrass, P. australis, to disperse over long distances by movement of floating fruit via wind and surface currents within the coastal waters of Perth, Western Australia. We first simulated the dominant atmospheric and ocean forcing conditions that are known to disperse these seagrass seeds using a three-dimensional numerical ocean circulation model. Field observations obtained at 8 sites across the study area were used to validate the model performance over ~2 months in summer when buoyant P. australis fruit are released into the water column. P. australis fruit dispersal trajectories were then quantified throughout the region by incorporating key physical properties of the fruit within the transport model. The time taken for the floating fruit to release their seed (dehiscence) was incorporated into the model based on laboratory measurements, and was used to predict the settlement probability distributions across the model domain., Results: The results revealed that high rates of local and regional demographic connectivity among P. australis meadows are achieved via contemporary seed dispersal. Dispersal of seeds via floating fruit has the potential to regularly connect meadows at distances of 10s of kilometres (50% of seeds produced) and infrequently for meadows at distances 100 s km (3% of seeds produced)., Conclusions: The spatial patterns of seed dispersal were heavily influenced by atmospheric and oceanographic conditions, which generally drove a northward pattern of connectivity on a regional scale, but with geographical barriers influencing finer-scale connectivity pathways at some locations. Such levels of seed dispersal infer greater levels of ecological and genetic connectivity and suggest that seagrasses are not just strongly clonal.

Although the oceans play a fundamental role in shaping the distribution and function of coral reefs worldwide, a modern understanding of the complex interactions between ocean and reef processes is still only emerging. These dynamics are especially challenging owing to both the broad range of spatial scales (less than a meter to hundreds of kilometers) and the complex physical and biological feedbacks involved. Here, we review recent advances in our understanding of these processes, ranging from the small-scale mechanics of flow around coral communities and their influence on nutrient exchange to larger, reef-scale patterns of wave- and tide-driven circulation and their effects on reef water quality and perceived rates of metabolism. We also examine regional-scale drivers of reefs such as coastal upwelling, internal waves, and extreme disturbances such as cyclones. Our goal is to show how a wide range of ocean-driven processes ultimately shape the growth and metabolism of coral reefs.

We present a three-dimensional hydrodynamic-biogeochemical model of a wave-driven coral-reef lagoon system using the circulation model ROMS (Regional Ocean Modeling System) coupled with the wave transformation model SWAN (Simulating WAves Nearshore). Simulations were used to explore the sensitivity of water column carbonate chemistry across the reef system to variations in benthic reef metabolism, wave forcing, sea level, and system geomorphology. Our results show that changes in reef-water carbonate chemistry depend primarily on the ratio of benthic metabolism to the square root of the onshore wave energy flux as well as on the length and depth of the reef flat; however, they are only weakly dependent on channel geometry and the total frictional resistance of the reef system. Diurnal variations in pCO(2), pH, and aragonite saturation state (Ω(ar)) are primarily dependent on changes in net production and are relatively insensitive to changes in net calcification; however, net changes in pCO(2), pH, and Ω(ar) are more strongly influenced by net calcification when averaged over 24 hours. We also demonstrate that a relatively simple one-dimensional analytical model can provide a good description of the functional dependence of reef-water carbonate chemistry on benthic metabolism, wave forcing, sea level, reef flat morphology, and total system frictional resistance. Importantly, our results indicate that any long-term (weeks to months) net offsets in reef-water pCO(2) relative to offshore values should be modest for reef systems with narrow and/or deep lagoons. Thus, the long-term evolution of water column pCO(2) in many reef environments remains intimately connected to the regional-scale oceanography of offshore waters and hence directly influenced by rapid anthropogenically driven increases in pCO(2).

Purpose: To assess structural, functional, and visual behavioral relationships in mutant rhodopsin transgenic (Tg) rats and to determine whether early optokinetic tracking (OKT) visual experience, known to permanently elevate visual thresholds in normal rats, can enhance vision in rats with photoreceptor degeneration., Methods: Eight lines of pigmented Tg rats and RCS rats were used in this study. OKT thresholds were tested at single ages (1, 2, 3, 4, and 6 months) in naïve groups of rats, or daily in groups that began at eye-opening (P15) or 10 days later (P25). Electroretinogram (ERG) response amplitudes were recorded after OKT testing, and outer nuclear layer (ONL) thickness measurements were then obtained., Results: OKT thresholds, when measured at a single time point in naïve Tg lines beginning at P30, did not decline until months after significant photoreceptor loss. Daily testing of Tg lines resulted mostly with OKT thresholds inversely related to photoreceptor degeneration, with rapid degenerations resulting in sustained OKT thresholds for long periods despite the rapid photoreceptor loss. Slower degenerations resulted in rapid decline of thresholds, long before the loss of most photoreceptors, which was even more pronounced when daily testing began at eye opening. This amplified loss of function was not a result of testing-induced damage to the rod or cone photoreceptors, as ERG amplitudes and ONL thicknesses were the same as untested controls., Conclusions: The unexpected lack of correlation of OKT testing with photoreceptor degeneration in the Tg rats emphasizes the need in behavioral therapeutic studies for careful analysis of visual thresholds of experimental animals prior to therapeutic intervention.

Aims: Excessive lipid accumulation in Bruch's membrane (BrM) is a hallmark of ageing, the major risk factor for age-related macular degeneration (AMD). Retinal pigment epithelial (RPE) cells may utilise reverse cholesterol transport (RCT) activity to move lipid into BrM, mediated through ATP-binding cassette A1 (ABCA1) and scavenger receptor BI (SR-BI)., Methods: ABCA1 expression was assessed by reverse transcription polymerase chain reaction (RT-PCR) and western blotting of human RPE cell extracts. Lipid transport assays were performed using radiolabelled photoreceptor outer segments (POS). ABCA1 and SR-BI expression was examined in normal mouse eyes by immunofluorescence staining. BrMs of ABCA1 and SR-BI heterozygous mice were examined microscopically., Results: Human RPE cells expressed ABCA1 mRNA and protein. The ABCA1 and SR-BI inhibitor glyburide (also known as glibenclamide) abolished basal transport of POS-derived lipids in RPE cells in the presence of high-density lipoprotein. Mouse retina and RPE expressed ABCA1 and SR-BI. SR-BI was highly expressed in RPE. BrMs were significantly thickened in SR-BI heterozygous mice, but not in ABCA1 heterozygous mice., Conclusion: RPE cells express ABCA1 and SR-BI. This implies a significant role for SR-BI and ABCA1 in lipid transport and RCT in the retina and RPE.

Six cases of pancreatoduodenectomy performed for combined injuries of the pancreas, duodenum, and/or distal common duct are reported. Pancreatoduodenectomy is indicated when there is extensive destruction of the pancreatic head in conjunction with major injuries of the duodenum, distal common duct, and/or retropancreatic portal vein, necessitating complete division of the pancreatic head. Reconstruction is best achieved by end-to-end pancreatiocieiunostomy, end-to-side choledochojejunostomy, antrectomy, and vagotomy.

The object of this article is to assess the value of human serum albumin (HSA) in the initial resuscitation of hypotensive trauma victims. Thirty-six patients (mean age = 30 years) in shock from trauma who underwent laparotomies were randomly assigned to either Ringer's lactate solution (RL) resuscitation or 4% HSA in RL resuscitation. Both groups received approximately 8L of test fluid and 6U of washed red cells. The only death in the study occurred in a patient assigned to the RL group. Two patients in each group required mechanical ventilation for longer than 24 hours. No differences were noted in a battery of pulmonary function tests performed daily for 5 days. These results demonstrate that HSA is not essential in this clinical setting for safe and effective resuscitation.

We studied 128 patients admitted over a 12 1/2-year period to the Cook County Hospital Trauma Unit with acute subdural hematoma (ASDH): 82 were admitted directly and 46 were admitted after transfer from another hospital; 59% of the entire group died and only 27% obtained a functional recovery. As a group, the transferred patients, who suffered delays of several hours before receiving definitive surgical care, fared significantly worse than the patients with equivalent trauma who were admitted directly. The mortality of the transferred patients was 76%, compared to 50% of the direct admit patients. The outcome was also worse for transfer patients who experienced a 'lucid interval' or with alcohol intoxication. We conclude that the delays associated with failure to admit patients with ASDH directly to a head trauma center cause an excessive mortality and morbidity which could potentially be avoided by proper triage.

One possible cause of pulmonary failure after trauma is the type of asanguinous fluid used for resuscitation, i.e., crystalloid or colloid. To investigate this issue, patients having a laparotomy for trauma randomly received either Ringer's lactate (RLS) alone or Ringer's lactate with albumin (ALB). Both groups received washed red cells. Test fluids and red cells were given before and during operation to restore vital signs and hematocrit to normal. Pulmonary function tests were performed for 5 days after operation. One hundred and forty-one cases were studied (84 RLS, 57 ALB). The volume of asanguinous resuscitation fluid infused was 5.37 +/- 3.38 liters (-x +/- SD) for RLS and 5.87 +/- 3.05 liters for ALB. ALB cases received 213 +/- 130 gm of albumin. Red cell transfusions were 1.5 +/- 2.9 units for RLS and 2.0 +/- 3.1 for ALB. Six patients died (three RLS, there ALB). Three RLS and six ALB patients received intermittent mandatory ventilation or continous positive air pressure after operation. Pulmonary function results were not significantly different between the two groups for any parameter on any day after operation. Results of a randomized trial in human subjects of resuscitation with crystalloid and colloid solutions for acute trauma requiring laparotomy did not reveal significant differences in (1) survival rate, (2) incidence of pulmonary failure, or (3) postoperative pulmonary function.

Twenty-three patients with thirty-one disruptions of the intestines due to blunt abdominal trauma are reviewed. The bowel disruptions occurred in the stomach (2 perforations), duodenum (9), proximal jejunum (18), and sigmoid colon (2). The causes of injury, diagnostic difficulties, delays in treatment, associated trauma, surgical correction, and results are analyzed. Deaths (4) and complications (6) are presented in detail. Intestinal disruptions can be due to a variety of types of blunt trauma, with the automobile being the most common etiologic agent. The bowel can perforate anywhere in its course. Intestinal perforations are often associated with severe injuries which will probably be the determining factors in survival. Persistence, particularly repeated physical examination, is required for the diagnosis of bowel injury. Routine diagnostic tests for duodenal injury are not reliable. Retroperitoneal hematomas around the duodenum must be explored. The injuries themselves are easy to repair, and repair is secure when performed at the primary operation. Prophylactic antibiotics are recommended.

Two hundred forty-six patients admitted to the Trauma Unit of Cook County Hospital with penetrating neck wounds have been reviewed. A policy of mandatory neck exploration combined with a systematic approach to resuscitation and a diagnostic evaluation including neck and chest X-rays, endoscopy, and arteriography has been employed. The study has revealed a high incidence of negative neck explorations (63%) but minimal morbidity (less than 1%), no mortality, and a brief duration of hospitalization in the negative exploration group. Patients with positive explorations had an 8% morbidity and a 9% mortality rate. In addition, 13 of the patients with positive explorations had clinically negative wounds which might have been overlooked if selective management had been utilized in this series. We conclude that a policy of mandatory neck exploration is justified and advisable for patients sustaining penetrating neck injuries.