2002 Research Prospectus

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NOTE: This content is currently being reviewed and updated.

Contents

• Summary and Highlights
• Funding
• Education
• Facilities and Work Groups
• Collaborators and Specific Projects
• Publication Activity

• Continue the expansion of research productivity by its faculty
• Broaden its foundation of extramural funding
• Serve as a training site for the next generation of leaders in Emergency Medicine research

As documented in the following pages, progress in all three fronts continues to proceed ahead of expectation, and the clinical and laboratory investigators in the Department look forward to another year of growth in 2001.

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In the 1999-2000 academic year, the Department of Emergency Medicine received $1.2M in extramural funding for the conduct of research by its members. This figure brings the cumulative award amount for the past 5 years to $3.6M, making the group one of the most well funded academic departments in the specialty. The composition of the funding base is a healthy mix of federal, private foundation, and industry sponsorship. Sources of revenue have grown to include the National Institute for Alcohol Abuse and Alcoholism, the National Heart, Lung, and Blood Institute, the Centers for Disease Control and Prevention, and the Office of Naval Research. The department’s commitment to clinical trials in the diagnosis and treatment of stroke is responsible for the majority of industrial revenue.

New grants this year include two awards from the United States Department of Health and Human Services to develop new telemedicine and web-based technologies for the provision of emergency medical services to children in the state of Michigan.

Table 1. Sponsored Research Awards, 1995-Present

Table 2. Extramural Funding Sources, 1995-Present*

*Pending for 2000 include Pfizer Pharmaceuticals and the National Telecommunications and Information Agency.

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At the core of the research program in the Department of Emergency Medicine is a commitment to train the next generation of researchers in one of medicine’s youngest specialties. Each year the faculty welcomes research fellows, resident physicians, medical students and undergraduates into their clinical and basic science laboratories as research partners. As Assistant Dean for Student Programs, Dr. Brian Zink is successfully interfacing the Emergency Medicine faculty’s interest in training with the growing number of opportunities available for medical students with a desire to participate in research.

In the past academic year, the University of Michigan became one of several centers nationwide to receive a Clinical Research Curriculum (K30). With this funding, the medical school has assembled a Training Program in Clinical Research. This program specifically targets clinical fellows and junior faculty with an interest in pursuing careers in clinical research. Funding of this project has allowed the fusion of the highly successful Clinical Research Design and Statistical Analysis degree program offered by the School of Public Health with a series of specialized courses on outcomes research, conduct of large-scale clinical trials, and the emerging role of genomics in clinical research. Dr. Younger represents the Department of Emergency Medicine on the faculty advisory committee of this program, and also serves as a research mentor for one of its inaugural fellows.

The departmental commitment to research training extends to junior faculty. Four members have received Masters of Science degrees in Clinical Research Design and Statistical Analysis from the School of Public Health. Two members currently hold Mentored Clinical Scientist Development (K08) Awards from the National Institutes of Health.

Funding for individuals interested in research training are available from a number of sources. For undergraduates at the University of Michigan, several faculty members participate in the Undergraduate Research Opportunity Program (UROP). Two faculty members currently mentor medical students funded through the Summer Research Scholars Program. Last year, the Department was awarded a Resident Research Year grant from the Society of Academic Emergency Medicine, and, through the Emergency Medicine Foundation, is sponsoring a Resident Research Grant recipient during the 2000-2001 academic year. With the support of EMF, Emergency Medicine at Michigan also has had continuous funding for research fellows for the past 5 years. Lastly, Emergency Medicine has sponsored two Robert Wood Johnson Clinical Research Scholars. The table on the following page provides a list of some of the people the Department of Emergency Medicine has had the pleasure to work with over the past few years.

Table 3. Previous Students, Residents, and Postgraduate Fellows trained in the Department of Emergency Medicine

* Indicates participants in the Robert Wood Johnson Clinical Scholars Program.

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MEDICAL SCIENCE RESEARCH BUILDING I FACILITY

Space

The laboratory at MSRB I, 2522 is a 1,000 sq. ft. facility consisting of an operating suite, an animal preparation room and a blood and tissue analysis room. It also contains office space. The laboratory is equipped to perform large animal surgical experiments with general anesthesia, invasive monitoring and analysis of arterial blood gases, electrolytes, and other biochemical parameters.

Contact Information

Susan A. Stern, M.D., Associate Professor, Emergency Medicine Research Laboratory

(734) 615-2765

Techniques and Capabilities

• Fluid percussion brain injury
• Uncontrolled hemorrhagic shock - aortic tear model
• Dye/microsphere method for regional blood flow measurement
• Transit time ultrasound blood flow measurements
• Intracardiac and intravascular monitoring
• Intracranial pressure monitoring
• Brain tissue PO₂, PCO₂, pH and temperature monitoring
• Basic chemistry and ABG analysis
• Serum alcohol measurement

Equipment

• Biopac physiological monitoring system
• Blood gas, oximetry, electrolyte, and metabolite analyzer
• Paratrend 7 brain tissue monitor
• Hewlett Packard UV-Vis spectroscopy system
• Dye-Trak microspheres analysis system
• Fluid-percussion brain injury device
• Anesthesia machines with mechanical ventilator
• Cardiac output computer
• Traverse medical monitor capnometer
• Transonic system ultrasonic flowmeter

KRESGE RESEARCH BUILDING I FACILITY

Space

The laboratory at Kresge I Building has approximately 800 ft² of space and contains surgical and bench space, a rodent behavioral testing room, small meeting area, and an office for research personnel. The principal missions of the laboratory are 1) investigation of acute brain injury in rodent models and 2) examination of the mechanisms of injury associated with natural venoms. Recent work in the laboratory has focused on the role of hyperbaric oxygenation in ischemic and toxic brain injury, and on the role of adenosine in focal cerebral ischemia. The laboratory is also becoming proficient in the development of purified IgG as an innovative therapy for envenomation injury. The laboratory has 3 independent surgical stations equipped with inhalational anesthesia, surgical microscopes, digital physiologic data aquisition, and a laser Doppler flowmeter. Functional outcomes in spatial learning and memory are measured in a Morris water maze. Digital image acquisition and analysis equipment is available for studies of dermal injury.

Contact Information

Dr. Robert Silbergleit, MD

(734) 647-6526

Dr. Hernan Gomez, MD

(734) 763-3593

Techniques and Capabilities

• Global and focal brain ischemia (mouse, rat, gerbil)
• Closed head injury
• Carbon monoxide toxicity
• Hyperbaric resuscitation
• Digital planimetry
• Neuropathology
• Water maze behavioral testing
• Standardized models of spider envenomation
• Protein fractionation
• Development and purification of polyclonal IgG against venoms
• Manufacture of liposomes for transcutaneous drug delivery

Equipment

• Biopac physiological monitoring system
• Perimed laser-Doppler blood flow monitor
• Morris water maze with HVS automated tracking system
• ASI stereotaxic frame
• Cobra Vision stereo microscopes
• Anesthesia machines
• Marine Dynamics research hyperbaric chamber
• Heating pads and body temperature regulating devices

EXTRACORPOREAL LIFE SUPPORT RESEARCH LABORATORY

Space

The Extracorporeal Life Support (ECLS) Research Laboratory is a collaborative effort between the Departments of Surgery, Pediatrics, and Emergency Medicine and is located in a 1200 sq. ft. facility on the 7^th floor of the Kresge I Research Building. The laboratory’s interest is in the pathophysiology and treatment of acute organ failure. Studies in the treatment of lung injury with extracorporeal devices have been federally funded for over 25 years, and have resulted in the clinical realization of extracorporeal life support as a viable means of supporting neonates, children, and adults with otherwise lethal respiratory failure. Dr. John Younger is one of four faculty within the group, and oversees experiments related to the pathophysiology of acute lung injury and the treatment of respiratory failure with liquid ventilation.

Contact Information

Dr. John G. Younger, MD, MS

(734) 936-6284

Techniques and Capabilities

• Models of acute lung injury (rat, sheep)
• Hemorrhagic shock induced
• Ventilator-induced
• Complement mediated (cobra venom factor)
• Immune-complex mediated
• Oleic acid induced
• Measures of Lung Function
• Gas exchange
• Dynamic and static lung compliance
• [¹²⁵I]-BSA permeability
• ENaC Activity
• Pulmonary hemodynamics (isolated lung)
• Capillary filtration coefficient (isolated lung)
• Neutrophil content (myeloperoxidase, BAL, morphometric methods)

Other Techniques

• Development of neutropenic models
• Development of complement deficient models
• Liquid ventilation of small and large animals

Equipment

• Biopac physiological monitoring system
• Small animal mechanical ventilators
• Isolated lung perfusion apparatus

The Medical Readiness Trainer

Medical Readiness Trainer Team:

• Dag von Lubitz,
• Thomas Deegan, M.D.
• James Freer, M.D.
• Steffen Heisse
• Lars Schumann
• William Wilkerson, M.D.

The Medical Readiness Trainer (MRT) Project is an ultramodern platform for comprehensive medical training at all levels of proficiency. The MRT integrates Human Patient Simulators (HPS), state of the art telecommunications, and fully interactive virtual reality (VR). Combining these technologies creates a rich situational environment, which realistically simulates the world of clinical medicine, and most of its challenges and stressors. The revolutionary approach to ultra-long distance teletraining won the MRT members the title of the Laureates of the prestigious Year 2000 Computerworld Smithsonian Institution Collection. The MRT is the subject of continuous attention by the media as an innovative solution to a training dilemma of modern medicine: how to educate providers in a simulated situation prior to an actual patient encounter. The model is now in the process of operational refinement as a training platform for the joint training of medical personnel at the Universities of Michigan and Puerto Rico. The MRT has been noted to have potential application to the Virtual Collaborative Clinics, a cooperative of organizations attempting to develop distance medical applications for use in remote sites such as rural areas and outer space. Other countries, both in Europe and South America are also showing interest in joining a network which, once developed, will provide maximum utilization of scarce and expensive resources: expert teachers and human patient simulators. To this end, the MRT team is committed to developing a robust international training model that achieves the highest standard for continuous clinician training and ensures the foremost patient safety.

The Need for A New Training Model

Erosion of medical skills caused by inadequate access to refresher training or to infrequent exposure to acute disease are among the most frequently documented causes of adverse medical outcomes reported at those medical facilities without close affiliation to major medical training centers. Despite continuous growth in the use of the Web-based resources as a platform for continuing medical education, their static nature is also their major drawback in training emergency/trauma medicine skills. Contrary to other medical specialties, both emergency and trauma medicine revolve around the crucial factor of time available to determine the nature of the presenting disease, initial stabilization and management, and, finally, the disposition. Furthermore, each acute case requires virtually instantaneous assembly of widely dispersed anatomical, physiological, and pathological facts into a coherent clinical picture that constitutes the basis for all subsequent activities. It is a dynamic environment, where each clinical decision may affect survival of the patient, and where the clinician must be continuously prepared for the sudden emergence of unpredictable events, which may complicate the management even further. Additional layer of difficulty is added by the fact that neither emergency nor trauma medicine are the domains of a solitary practitioner. Instead, both are based on a closely coordinated interaction of medical teams whose communication- and behavioral skills must be continuously practiced and honed in order to guarantee positive outcomes. Clearly, the old fashioned didactic tools – books, computer media, or lectures are inadequate to provide the required level of training. Even interactive Web-based training currently fails to offer the solution in these situations. All of these traditional methods are devoid of providing the trainee with the "real life" stress and urgency of emergency medicine, nor do they provide the required degree of team training and interaction.

Human Patient Simulators

The advent of Human Patient Simulators (HPS) eliminated most of the current barriers to training emergency medical personnel. The modern HPS devices are life-size manikins whose complex computer-driven systems reproduce virtually all aspects of the relevant physiology and pathophysiology. HPS units correctly respond to the administered drugs, and display the results on standard vital sign monitors – just as a human patient would. Correct anatomy allows execution of several emergency procedures (eg., intubation, insertion of IV lines, chest tubes, or indwelling catheters). The realism of Human Patient Simulators is enhanced even further amplified by the correct chest and heart sounds, presence of anatomically (and pathophysiologically) correct pulses, modifiable responses of the upper respiratory pathway (eg., laryngospasm), etc. Behaving like a human patient, the simulators allow training under extremely realistic conditions, where inappropriate treatment (procedure or drug) may result in death. Moreover, they also allow team training. Hence, skills can be practiced and honed as many times as required without the patient being endangered. The primary drawback of HPS is their cost. For this reason, HPS systems are available only at the most prestigious medical training centers and their use is extremely restricted.

The MRT Teletraining Model

The Medical Readiness Trainer (MRT) team of the Department of Emergency Medicine at the University of Michigan solved these obstacles by developing a system of HPS remote control, and fusing the remotely controlled simulator with the fully interactive video-teleconferencing Internet-based system. The solutions (shown on the appended photographs and figures) devised by the MRT allow the trainee located virtually anywhere in the world to control the simulator from afar. The trainee can now practice skills of medical management, leadership, and team interaction without having physical access to the simulator, and yet face the same challenges as if the HPS was standing in the same room! Moreover, the MRT solution allows inclusion of an expert teacher as the director of each training exercise irrespectively of the teacher’s location. For example, the simulator may be located in Ann Arbor, MI, the trainees in New Delhi, while the expert teachers instructing on the techniques of airway management may be sitting at his or her office at the Schools of Medicine of the University of Michigan in Ann Arbor. All activities happen in real time, all participants (trainees and teachers) see the same pattern of vital signs on their monitors, and all hear the same dialogue and the same heart sounds. Whenever needed, the teacher can stop the simulator and provide additional instruction, whenever faults are discovered, the same scenario can be run over and over again until full mastery is attained.

Today’s Demonstration

HUMAN PATIENT SIMULATION AND VIRTUAL REALITY

While HPS units provide an unprecedented flexibility in training encounters with real patients without risk of injury to the patient, the element of "environmental setting" shown to play an essential role in training of effective medical performance has been always missing. Providers of emergency and trauma medical care work frequently within very stressful and austere environments characterized by a number of stressors that are typically absent in the classical hospital setting. Accident or disaster scenes, sick bays of ships at sea, helicopters, or field hospitals during humanitarian relief operations provide some of the best known examples of such settings. In order to acclimatize medical personnel to such environments, the Medical readiness Trainer Team placed the HPS unit within a virtual reality (VR) environment (CAVE). The CAVE generates appropriate physical surroundings of or the training scenario (eg., ED , a field, a ship at sea, or OR), fills it with pertinent sounds, and can, if required, expose the trainees to entirely unexpected distracting events such as fires, loss of electrical power, earthquakes, sea gales, etc. The MRT is now in the process of devising a system that will allow introduction of olfactory stimuli as well. This addition will provide our students with the "total environmental exposure", and allow practice in a setting as closely resembling that of a real life situation as is possible outside real life activities. Since CAVE environments are quite expensive (from $ 1 million up), very few universities have such facilities (it is estimated that there are 60 CAVES in the world). In order to bypass this limitation, MRT performed a series of successful demonstrations using a portable VR system based on the pioneering computer/optical technology developed jointly by the University of Strathclyde in Scotland and Ethereal Technologies in Ann Arbor. The system, known as VIZ4D allows generation of a 3-dimensional object whose viewing, contrary to the CAVE, does not require special devices (e.g., goggles). VIZ4D-generated image is probably the closest to holographic projection, development of which is still in progress. Combination of HPS, VIZ4D and Internet2 permits linking of all elements of the MRT over very long distances (up to several thousands of miles). This will allow execution of advanced training sessions at locations characterized by less well poorly developed technical/inadequate training facilities such as frequently encountered in rural and remote regions, or poor countries of the Third World.

	Human Patient Simulator in the CAVE. Apart from the HPS and training personnel, all physical elements in this environment are "virtual". The setting is that of the ER patient bay at the Department of Emergency Medicine at the University of Michigan.

Another example of CAVE generated environment: a detailed rendition of a Sick bay aboard the USCG Cutter "Forward". The sickbay is capable of faithful reproduction of ship’s movements. Its "rolls" can be controlled by the training expert. The body on the cot to the left (or port side) of the bay represents world’s first VR rendition of a badly burned human (bit-map image). In another revolutionary approach, the MRT team is now working on developing a computer generated physiology simulator which, combined with the depicted patient, will provide world’s first full VR model of burns adequate both for advanced training of senior medical personnel and for research.

Currently, the MRT represents arguably one of the best-equipped simulation-based medical training sites in the country. It’s facilities include CAVE and VIZ4D systems, 3 METI Adult Human Patient Simulators and 1 METI Pediatric Human Patient Simulator, and a comprehensive advance computing and telecommunications equipment including Internet2 connectivity, permitting ultra-lomg distance training based on multiple, voice-coordinated video streams and remote control of HPS devices. US Army’s Tank Command in Warren, MI agreed to put at the disposal of the MRT three "HUMVEEs" to be used as field deployable full capacity training stations that will combine all advantages of HPS, VR, and advanced telecommunications and open unprecedented flexibility in providing advanced medical training "anytime, anywhere." Close collaboartion with the University of Puerto Rico School of Medicine (UPRSM, Drs. J. Hawayek and R. Gonzales) allows the MRT to experiment in the environment of foreign language and culture, and in settings of frequently less-than-optimal telecommunication facilities (rural areas of PR) made even more difficult by a very long communication distance over water. Collaboration with UPRSM allowed MRT to develop the fundamental principles governing our approach to ultra-long distance medical education and training.

BRAIN INJURY GROUP

The Brain Injury Group is a collaborative research group comprised of physicians and research nurses from Emergency Medicine, Neurology, Neurosurgery, Radiology and Anesthesia at the UMMC and St Joseph Mercy Hospital-Ann Arbor. The specific aim of the group is to design and implement internally funded clinical research projects and conduct industry sponsored clinical trials pertaining to the care of adult patients with, or at risk of, stroke. With clinical research infrastructure in place at the University of Michigan Medical Center and St. Joseph Mercy Hospital in Ann Arbor, Hurley Medical Center in Flint, and Foote Memorial Hospital in Jackson, the group has an enrollment base of over 200,000 patients per year in southeastern Michigan.

Specific interests of the group include prevention of stroke through improved management of new-onset atrial fibrillation, a key risk factor in the development of stroke; rapid diagnosis of brain ischemia and injury using new technologies such as xenon computed tomography; rapid return of brain blood flow with angioplastic, thrombolytic and anti-platelet therapies; and a variety of anti-inflammatory techniques to prevent reperfusion injury, such as the blockade of adherence of inflammatory cells at sites of injury within the brain.

Contact Information

Dr. Philip A. Scott, MD

(734) 763-6370

UNIVERSITY OF MICHIGAN

INJURY RESEARCH CENTER

Injury is the leading cause of potential years of life lost in the United States, at a cost to society in the hundreds of billions of dollars. The goal of the University of Michigan Injury Research Center (UMIRC) is to decrease injury morbidity and mortality through generating and disseminating knowledge, conducting and promoting education, and informing policy makers. A particular emphasis of the Center is alcohol and other drugs, and their role in kinetic and thermal injury. Other research interests of the Center include: the acute toxic effects of alcohol and other drugs (poisoning or overdose); the effect of age on injury; and gender differences and injury. UMIRC will accomplish its goals through research, education, mentoring programs, and by working with and informing local, state and federal agencies.

The Center is based in the Department of Emergency Medicine and was initiated in July 1997. It is composed of core faculty and associate faculty from the fields of emergency medicine, the behavioral sciences, public health, pediatrics, surgery, and pharmacology. UMIRC is engaged in epidemiological, clinical and laboratory research. Research addresses injury prevention, acute care of the injured patient, and laboratory studies on the pathophysiology of injury. Educational activities include a freshman seminar offered through the College of Literature, Science and the Arts and an Injury Fellowship Program. The Injury Fellowship Program is designed to provide trainees with research expertise in injury control and substance use/abuse, and clinical expertise in the diagnosis and treatment of substance-related injuries. The Center’s multidisciplinary bench-to-bedside approach will result in knowledge that can be used to reduce the burden of this major health problem.

Director: Ronald F. Maio, D.O., M.S.

Core Faculty:

• Kristen L. Barry, Ph.D., Department of Psychiatry
• Frederic Blow, Ph.D., Department of Psychiatry
• Sally Guthrie, Pharm.D., College of Pharmacy
• Elizabeth Hill, Ph.D., Department of Emergency Medicine
• Jean Shope, Ph.D., UM Transportation Institute

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The list of ongoing projects within the Department of Emergency Medicine reflects the broad range of clinical and laboratory interests of the faculty. Funded projects are the result of years of preliminary work and demonstrate the growing expertise of our investigators. Internally funded projects give insight into the various new directions the group is headed. An essential part of the group’s success is its large group of collaborators, shown in table 4. On the following pages are descriptions of some of the work currently being conducted by our faculty.

Table 4. Research Collaborators with the Department of Emergency Medicine

• University of Michigan
• School of Medicine
• Department of Internal Medicine
• Division of Cardiology
• Department of Neurology
• Department of Pathology
• Department of Pediatrics
• Division of Pediatric Critical Care
• Department of Psychiatry
• Department of Radiology
• Department of Surgery
• Division of Surgical Critical Care
• Section of Pediatric Surgery
• Section of Neurosurgery
• The Trauma Burn Center
• School of Public Health
• Department of Health Behavior and Health Education
• Department of Health Management of Policy
• College of Engineering
• Department of Bioengineering
• Center for Statistical Consultation and Research
• University of Michigan Transportation Research Institute
• East Carolinas University
• School of Medicine
• Department of Emergency Medicine
• University of Arizona
• School of Medicine
• Department of Emergency Medicine
• University of Mississippi
• School of Medicine
• Department of Anatomy
• Ohio State University
• School of Medicine
• Department of Emergency Medicine
• University of South Alabama
• School of Medicine
• Department of Physiology

Tailored Alcohol Measures in the Emergency Department

Investigators:

• Frederic Blow, Ph.D.
• Ronald Maio D.O., M.S.
• Kristen Barry, Ph.D.
• Victor Strecher, Ph.D.
• Maureen Walton, Ph.D.

Funding: National Institute on Alcohol Abuse and Alcoholism (NIAAA)

Reducing death and disability caused by alcohol-related intentional and unintentional injury is a national health status goal. Acute alcohol intoxication is implicated in up to 50% of all injuries. The goal of this research is to test the effectiveness of an innovative, tailored brief intervention system using new technologies to reduce alcohol use and alcohol-related problems among injured hazardous drinkers treated in the ED.

Preventing Adolescent Alcohol-Related Injury

Investigators:

• Ronald Maio, D.O., M.S
• Jean Shope, Ph.D.
• Frederic Blow, Ph.D.
• Mary Ann Gregor, M.H.S.A
• James Weber, D.O.
• Michele Nypaver, M.D.

Funding: Centers for Disease Control and Prevention (CDC)

Injury is a major cause of adolescent mortality and morbidity, and alcohol is frequently associated with these injuries. Alcohol programs and messages for adolescents have been delivered in homes, churches, schools, and communities in an effort to develop community-wide norms regarding alcohol use by adolescents. However, interventions to prevent alcohol use/misuse and alcohol related problems are needed for use in the ED. The specific objectives of this project are to develop a computer-based ED intervention to prevent alcohol use/misuse among adolescents and to test the efficacy of this intervention using a randomized controlled trial among injured adolescents presenting to the ED.

Emergency Medical Services Outcomes Project (EMSOP)

Investigators: Ronald Maio, D.O.

Funding: National Highway Traffic Safety Administration (NHTSA)

The primary goal is to support and facilitate EMS outcomes research and evaluation to be conducted by the broad EMS community. Using an expert panel, the project will identify areas of focus form EMS outcomes, and will develop the tools and methodology to conduct research and evaluation of the effectiveness of out-of-hospital emergency medical care. The project will disseminate the information developed to the broad EMS community, and, in so doing will stimulate EMS outcomes research that will improve the delivery of pre-hospital care.

Increasing Emergency Physicians’ Knowledge of Elder Abuse with an Educational Intervention

Investigators: Robert McCurren M.D.

Ronald Maio D.O., M.S.

Elizabeth Hill Ph.D.

David Treloar, M.D.

Funding: Emergency Medicine Foundation Resident Research Award

Non-accidental injury is an increasingly recognized clinical entity among elderly patients presenting to the Emergency Department. An important barrier to the appropriate care of this disease is a high rate of misdiagnosis. This project will develop and test an education intervention to increase awareness of elder abuse and improve its diagnosis and treatment in the Emergency Department.

The Potentiating Effect of Alcohol on Liver and Spleen Injury

Investigators: Susan Stern M.D.

Funding: Internal

Recent studies, using global measures of injury severity, have shown that, contrary to popular opinion, alcohol potentiates injury following a motor vehicle crash (MVC). Using previously collected data with the addition Organ Injury Severity Scaling Scores, the investigators will determine to what degree alcohol potentiates liver and spleen injury in MVC patients. Chronic alcohol use and its interaction with acute alcohol use and crash severity will also be analyzed.

Alcohol, Other Drugs and Non-Occupant Motor Vehicle Crash Injury

Investigators: James Weber, D.O.

Funding: Internal

Little is known regarding the acute and chronic drug use characteristics of pedestrians or bicyclists that are involved in motor vehicle crashes. This information is important in developing strategies for prevention of these injuries as well as their effective and efficient treatment. Using prospectively collected data, this study will determine the frequency of acute alcohol and other drug use among non-occupant MVC victims, their chronic alcohol and drug use and the relationship of these characteristics to injury severity, crash characteristics and crash culpability.

Domestic Violence and Alcohol Abuse/Dependence Among Women Admitted to a Trauma Service.

Investigators: David Melnick MD

Funding: Internal

The population of women who sustain a severe injury and are admitted to a general surgery service may highlight a group at high risk for Domestic Violence (DV). Alcohol Abuse/Dependency among victims of DV may also be a significant factor in the injury process. This study is the first to look at DV among admitted female trauma patients and is the first step in developing screening and intervention strategies for DV among admitted trauma patients.

Understanding Injury: Health Behaviors and Conflict

Investigators: Frederic C. Blow, Ph.D.

Funding: Internal

The goal of this preliminary study is to learn more about risk factors for injury and conflict among injured patients in the UM Hurley Emergency Department (ED). The specific aim is to assess health and health habits (including injury, alcohol use, smoking, depressed feelings), disagreements with others, and alcohol and drug experiences among patient seeking treatment at UM Hurley ED for injuries. We hope to use the findings from this study to develop future intervention studies directed at preventing injury and interpersonal conflict.

Injury Alcohol and Drugs: A Modern Epidemic

Investigators:

The use of alcohol and drugs are frequently associated with injury, and injury is a leading cause of death in our society and responsible for more years of productive life lost than cancer or heart disease. The funds from this grant will be used to further develop and refine a course, "Injury Alcohol and Drugs: A Modern Epidemic", UC 151, that has been presented as a first year seminar, to University of Michigan undergraduates, in 1998 and 1999. This course studies how society has addressed the problem of alcohol, drugs and injury through a broad-based approach that includes the medical, behavioral, social and engineering sciences.

Fatigue in Air Medical Helicopter Pilots on Rotating Shift Schedules: Measurement and Characterization

Investigators: Robert Silbergleit, M.D.

Funding: Foundation for Aeromedical Research and the UM OVPR

The objective of this project is to quantify the risks of fatigue in emergency helicopter AMS pilots and to determine the shift rotation schedule that minimizes those risks. We are measuring patterns of alertness in on duty pilots with ambulatory electrophysiological and visual monitoring techniques. The amount of sleep obtained off duty during shift rotation related circadian disruptions is determined by actigraphy. Self reported data on shift related effects on the physical and emotional well-being of pilots and their families is also being collected. This project is also developing new methods of measuring performance decrements associated with fatigue; and analyzing characteristics of AMS crash data with respect to circadian rhythms and the newly determined patterns of alertness.

A Multicenter, Open-label, Controlled Clinical Study to Evaluate the Safety and Efficacy of Xenon/CT Quantitative Cerebral Blood Flow for Early Prediction of the Presence and Localization of Cerebral Infarction.

Investigators: Susan Hickenbottom, MD