Significant mortality and morbidity were evident at 5 years postinjury. The deterioration in global outcomes observed regardless of age suggests that multiple influences contribute to poorer outcomes. Public health interventions intended to reduce post-acute inpatient rehabilitation mortality and morbidity rates will need to be multifaceted and age-specific.

Abstract:Waste stream characteristics must be understood to tackle waste management problems in Kathmandu Metropolitan City (KMC), Nepal. Three-stage stratified cluster sampling was used to evaluate solid waste data collected from 336 households in KMC. This information was combined with data collected regarding waste from restaurants, hotels, schools and streets. The study found that 497.3 g capita À1 day À1 of solid waste was generated from households and 48.5, 113.3 and 26.1 kg facility À1 day À1 of waste was generated from restaurants, hotels and schools, respectively. Street litter measured 69.3 metric tons day À1. The average municipal solid waste generation rate was 523.8 metric tons day À1 or 0.66 kg capita À1 day À1 as compared to the 320 metric tons day À1 reported by the city. The coefficient of correlation between the number of people and the amount of waste produced was 0.94. Key household waste constituents included 71% organic wastes, 12% plastics, 7.5% paper and paper products, 5% dirt and construction debris and 1%hazardous wastes. Although the waste composition varied depending on the source, the composition analysis of waste from restaurants, hotels, schools and streets showed a high percentage of organic wastes. These numbers suggest a greater potential for recovery of organic wastes via composting and there is an opportunity for recycling. Because there is no previous inquiry of this scale in reporting comprehensive municipal solid waste generation in Nepal, this study can be treated as a baseline for other Nepalese municipalities.

No abstract

This study characterized life expectancy after traumatic brain injury (TBI). The TBI Model Systems (TBIMS) National Database (NDB) was weighted to represent those ≥ 16 years of age completing inpatient rehabilitation for TBI in the United States (US) between 2001 and 2010. Analyses included Standardized Mortality Ratios (SMRs), Cox regression, and life expectancy. The US mortality rates by age, sex, race, and cause of death for 2005 and 2010 were used for comparison purposes. Results indicated that a total of 1325 deaths occurred in the weighted cohort of 6913 individuals. Individuals with TBI were 2.23 times more likely to die than individuals of comparable age, sex, and race in the general population, with a reduced average life expectancy of 9 years. Independent risk factors for death were: older age, male gender, less-than-high school education, previously married at injury, not employed at injury, more recent year of injury, fall-related TBI, not discharged home after rehabilitation, less functional independence, and greater disability. Individuals with TBI were at greatest risk of death from seizures; accidental poisonings; sepsis; aspiration pneumonia; respiratory, mental/behavioral, or nervous system conditions; and other external causes of injury and poisoning, compared with individuals in the general population of similar age, gender, and race. This study confirms prior life expectancy study findings, and provides evidence that the TBIMS NDB is representative of the larger population of adults receiving inpatient rehabilitation for TBI in the US. There is an increased risk of death for individuals with TBI requiring inpatient rehabilitation.

Individual growth curve analysis is a statistically rigorous approach to describe temporal change with respect to the GOS-E at the individual level for participants within the TBIMS NDB. Results indicated that, for individuals in the TBIMS NDB as a group, functional status as measured by the GOS-E initially improves, plateaus, and then begins to decline. Factors such as age at first GOS-E assessment, race, FIM score at rehabilitation admission, and rehabilitation length of stay were found to influence baseline GOS-E scores, as well as the rate and extent of both improvement and decline over time. Additional research may be required to determine the generalizability of these findings and the usefulness of this tool for clinical applications.