Purpose The Berlin poly-trauma definition (BPD) has proven to be a valuable way of identifying patients with at least a 20% risk of mortality, by combining anatomical injury characteristics with... Show morePurpose The Berlin poly-trauma definition (BPD) has proven to be a valuable way of identifying patients with at least a 20% risk of mortality, by combining anatomical injury characteristics with the presence of physiological risk factors (PRFs). Severe isolated injuries (SII) are excluded from the BPD. This study describes the characteristics, resource use and outcomes of patients with SII according to their injured body region, and compares them with those included in the BPD. Methods Data were extracted from the Dutch National Trauma Registry between 2015 and 2019. SII patients were defined as those with an injury with an Abbreviated Injury Scale (AIS) score >= 4 in one body region, with at most minor additional injuries (AIS <= 2). We performed an SII subgroup analysis per AIS region of injury. Multivariable linear and logistic regression models were used to calculate odds ratios (ORs) for SII subgroup patient outcomes, and resource needs. Results A total of 10.344 SII patients were included; 47.8% were ICU admitted, and the overall mortality was 19.5%. The adjusted risk of death was highest for external (2.5, CI 1.9-3.2) and for head SII (2.0, CI 1.7-2.2). Patients with SII to the abdomen (2.3, CI 1.9-2.8) and thorax (1.8, CI 1.6-2.0) had a significantly higher risk of ICU admission. The highest adjusted risk of disability was recorded for spine injuries (10.3, CI 8.3-12.8). The presence of >= 1 PRFs was associated with higher mortality rates compared to their poly-trauma counterparts, displaying rates of at least 15% for thoracic, 17% for spine, 22% for head and 49% for external SII. Conclusion A severe isolated injury is a high-risk entity and should be recognized and treated as such. The addition of PRFs to the isolated anatomical injury criteria contributes to the identification of patients with SII at risk of worse outcomes. Show less
The research presented in this thesis falls within a relatively new scientific field of research: Industrial Ecology, which is concerned with studying society’s metabolism to analyze the causes of... Show moreThe research presented in this thesis falls within a relatively new scientific field of research: Industrial Ecology, which is concerned with studying society’s metabolism to analyze the causes of environmental problems and indicate possibilities for more sustainable management of materials. The research is aimed at developing a dynamic substance flow-stock model that can be used to estimate future resource availability, emissions and waste streams. The developed model extends the currently available SFA models in three respects. Firstly, by combining flows and stocks. Secondly, it combines physical and economic elements. And thirdly, it operates at two levels: those of products and substances. The model has been applied to two case studies aimed at evaluating the economic and environmental consequences of the developments of lead flows and stocks and investigating the potential long-term impact of the use of platinum in fuel cell technology. The main outcome of the lead model suggests that in the Netherlands the amount of lead available for recycling is expected to exceed its demand. If comparable developments can be detected on a larger scale, the landfill and incineration streams might increase at the expense of recycling and consequently an increase in emissions. The outcome of the platinum model suggests that the identified resources of platinum will be depleted before the end of the century if no additional measures are taken. Moreover, the increased production of platinum will not have major consequences for the co-produced copper cycle. For nickel, the supply from platinum ores is expected to exceed its demand, which will have profound consequences for both the primary mining and the recycling of nickel. Show less
Family businesses are experiencing a revival in the German economy. In the face of the challenges of globalization and the ongoing relocation of production facilities, home base oriented... Show moreFamily businesses are experiencing a revival in the German economy. In the face of the challenges of globalization and the ongoing relocation of production facilities, home base oriented enterprises meet with increasing attention and gain in importance. Family-owned enterprises have indeed been neglected in the past, a fact which shows clearly also in business economics research. But this was also due to the family businesses, or the owner families, respectively, failing to open up. In the present paper, the author succeeded in winning high-ranking representatives of producing family businesses as interview partners. The discussions and the subsequent analyses both of the topics discussed and of the theoretical context serve to provide a new and intriguing picture of family-owned enterprises on their international growth path to world market leaders. Show less
