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Research Roundup
February 2, 2010, Volume 56, No. 20

Trauma Patients Safe from Mortality Risks Despite “Weekend Effect”

People who are in car crashes or suffer serious falls, gunshot or knife wounds and other injuries at nights or on weekends do not appear to be affected by the same medical care disparities as patients who suffer heart attacks, strokes, cardiac arrests and other time-sensitive illnesses during those “off hours,” according to new research from the University of Pennsylvania School of Medicine. In contrast to previous, multi-hospital studies showing that patients treated for cardiac or neurological emergencies overnight and on weekends are more likely to experience complications and even die than those who come to the hospital on weekdays, the new pilot findings suggest that trauma patients are insulated from this so-called “weekend effect” tied to the time of day in which they’re brought to the hospital.

The new study, which was presented at the Eastern Association for the Surgery of Trauma, points to the trauma system’s unique organization and staffing as a built-in protection for these critically injured patients. A regionalized system involving both ambulance and helicopter transport dictates that trauma patients be brought to facilities that meet strict requirements for round-the-clock staffing and capabilities for emergency medicine, radiology, surgery, and post-operative intensive care. One key differentiator from most other medical and surgical specialties—in which staffing and resources vary on nights and weekends—is that Level 1 trauma centers like the Hospital of the University of Pennsylvania (HUP), where the research was conducted, are required to have an attending trauma surgeon immediately available 24 hours a day, seven days a week, 365 days a year.

“Patients arriving at a hospital with a heart attack or a stroke may find themselves at a facility unable to optimally manage their condition—especially at night and on the weekend. We found that no matter when you are injured, you get the same type of care when you are brought to a trauma center,” said lead author Dr. Brendan G. Carr, an assistant professor in the departments of emergency medicine, and biostatistics and epidemiology.

After studying 4,382 trauma patients cared for at HUP between 2006 and 2008, their findings held for both blunt traumas (car crashes, head injuries or beatings) and penetrating traumas (most often gunshot and knife wounds). In fact, patients who suffered blunt trauma injuries were less likely to die if they presented at night. Among other outcomes studied—time patients spent on ventilators, length of stay in intensive care units, and overall hospital length of stay—the findings showed that trauma patients who presented on nights and weekends may have fared slightly better than those who came to the hospital on weekdays.

Language Structure is Partly Determined by Social Structure

Psychologists at the University of Pennsylvania and the University of Memphis released a study on linguistic evolution that challenges the prominent hypothesis for why languages differ throughout the world.

The study argues that human languages may adapt more like biological organisms than previously thought and that the more common and popular the language, the simpler its construction to facilitate its survival. Although a number of researchers have predicted such relationships between social and language structure, this is the first large-scale statistical test of this idea.

Traditional thinking is that languages develop based upon random change and historical drift. For example, English and Turkish are very different languages based upon histories that separate them in space and time. For years, it has been the reigning assumption in the linguistic sciences.

The report, published in PLoS ONE, offers a new hypothesis, challenging the drift explanation. Dr. Gary Lupyan, a postdoctoral researcher in the department of psychology in Penn’s School of Arts and Sciences, and Dr. Rick Dale, an assistant professor in psychology at the University of Memphis, conducted a large-scale statistical analysis of more than 2,000 of the world’s languages aimed at testing whether certain social environments are correlated with certain linguistic properties.

The researchers found striking relationships between the demographic properties of a language—such as its population and global spread—and the grammatical complexity of those languages. Languages having the most speakers—and those that have spread around the world—were found to have far simpler grammars, specifically morphology, than languages spoken by few people and in circumscribed regions. For example, languages spoken by more than 100,000 people are almost six times more likely to have simple verb conjugations compared to languages spoken by fewer than 100,000 people.

“English, for all its confusing spelling and exceptions—if a baker bakes, what does a grocer do?—has a relatively simple grammar,” Dr. Lupyan said. “Verbs are easy to conjugate and nouns are mostly pluralized by adding ‘s.’ In comparison, a West African language like Hausa has dozens of ways to make nouns plural and in many languages—Turkish, Aymara, Ladakhi, Ainu—verbs like ‘to know’ have to include information about the origin of the speaker’s knowledge. This information is often conveyed using complex rules, which the most widely-spoken languages on earth like English and Mandarin lack.”

Dr. Lupyan and Dr. Dale call this social affect on grammatical patterns the “Linguistic Niche Hypothesis.” Languages evolve within particular socio-demographic niches. Although all languages must be learnable by infants, the introduction of adult learners to some languages (for example, through migration or colonization) means that aspects of a language difficult for adults to learn will be less likely to be passed on to subsequent generations of learners. The result is that languages spoken by more people over larger geographic regions have become morphologically simpler over many generations.

A remaining puzzle is why languages with few speakers are so complex in the first place. One possibility, explored by researchers, is that features such as grammatical gender and complex conjugational systems, while difficult for adult learners to master, may facilitate language learning in children by providing a network of redundant information that can cue children in on the meanings of words and how to string them together.

Important Information Omitted in News Coverage of HPV, Cervical Cancer

In the months surrounding the US Food and Drug Administration’s approval of the human papillomavirus vaccine (HPV), an increase in the volume of news coverage was associated with changes in the public’s knowledge about HPV and cervical cancer. However, a new study reveals that many news stories were missing important information, including the sexually transmitted nature of the disease.

These were among the findings from a study by a research team with the Center of Excellence in Cancer Communication Research (CECCR) at Penn’s Annenberg School for Communication. The team looked at 321 print and broadcast news stories that appeared during a 12-month period in 2006 and conducted a national survey of more than 3,300 individuals to study the nature of news coverage of the HPV vaccine and whether knowledge about HPV was affected by it.

Results of the study, conducted by Penn Annenberg alumna Bridget J. Kelly, former CECCR researchers Amy E. Leader and Danielle J. Mittermaier and Penn professors Robert C. Hornik and Joseph N. Cappella, appeared in the November issue of the journal Patient Education and Counseling.

More than three-quarters of all HPV vaccine news stories said nothing about the sexually transmitted nature of HPV, and nearly 80 percent of all news coverage neglected to report the need for continued cervical cancer screening after vaccination, the survey results showed. Also, about 35 percent of the sample knew about the association between the HPV virus and cervical cancer in the period before May 2006, but by summer of that year, that number had grown to 52 percent. By the final two months of 2006, the number increased to 59 percent.

The news-story-content analysis showed that the vaccine was extensively covered, but “coverage was not always ideal, with the majority of news stories lacking vital pieces of information about the vaccine or HPV prevention,” the authors wrote. “If media content is going to be used in the context of decision-making, then stories need to include accurate and balanced information regarding risks and benefits.”

Half of the story headlines mentioned “cervical cancer” while the term “sexually transmitted infection” or “STI” appeared in only 3.6 percent of the stories. Seventy-three percent of the news stories were from print sources while 27 percent were broadcast. Newspaper stories were more likely than broadcast to stress the need for routine cervical cancer screening after vaccination.

The authors suggest that physicians “must be vigilant about filling in the gaps” from incomplete news stories since people who “focus only on general news stories can miss important information.”


Almanac - February 2, 2010, Volume 56, No. 20