Background Rural hospitals have variable degrees of involvement within the nationwide trauma system because of differences in resources and operational goals. “Secondary overtriage” refers to the patient who is discharged home shortly after being transferred from another hospital. An analysis of these occurrences is useful to determine the efficiency of the trauma system as a whole. Materials and methods Data was extracted from a statewide trauma registry from 2007–2012 to include those who were: 1) discharged home within 48h of arrival, and 2) did not undergo a surgical procedure. We then identified those who arrived as a transfer prior to being discharged (secondary overtriage) from those who arrived from the scene. Factors associated with transfers were analyzed using a logistic regression. Injuries were classified based on the need of a specific consultant. Time of arrival to ED was analyzed using 8-hour blocks, with the 7AM–3PM block as reference. Results 19,319 patients fit our inclusion criteria of which 1,897 (9.8%) arrived as transfers. Descriptive analysis showed a number of differences between transfers and non-transfers due to our large sample size. Thus, we examined variables that had more clinical significance using logistic regression controlling for age, ISS, the type of injury, blood products given, the time of arrival to initial ER, and whether a CT scan was obtained initially. Factors associated with being transferred were ISS>15, transfusion of PRBC’s, graveyard-shift arrivals, and neurosurgical, spine, and facial injuries. Patients having a CT scan were less likely to be transferred. Conclusions Secondary overtriage may result from the hospital’s limited resources. Some of these limitations are the availability of surgical specialists, blood products, and overall coverage during the “graveyard-shift.” More liberal use of the CT scan may prevent unnecessary transfers.

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Indirectly heated gas liquid and char converters (IHGLCCs) are employed to investigate several means of using or sequestering CO2. As a gasification agent CO2 is used with IHGLCCs to substantially increase gaseous energy output for a given carbonaceous feedstock. IHGLCCs are also used for mild oxidation of coal and for mild pyrolysis of biomass to produce humate type soil amendments. These soil amendments can indirectly sequester CO2 by enhanced plant growth and the atmospheric scrubbing action of plants (photosynthesis-respiration). Results of attempts to convert coal-biomass blends into an activated charcoal that can scrub CO2 and also become useful soil organic carbon are inconclusive as yet but appear promising. Countries that must import oil or have agriculturally depleted lands need “omnivorous” feedstock converters to upgrade available domestic feedstock into fuels, chemicals and chars that serve their energy, agricultural and other needs. The results of exploratory research directed at applying IHGLCC forms of omnivorous feedstock converters to using or sequestering CO2 are reported. IHGLCC technology should also be useful in mitigating potential global greenhouse problems and CO2 and waste disposal problems on space missions.

Imported oil, nuclear and coal now contribute about 55% of the energy the USA consumes, and those forms of energy are under environmental, social and legal scrutiny. There are limits to which non-“clouded” natural gas and renewables can replace these sources. This has motivated the CCTL to pursue R&D on blending domestically available fuels in thermal reactors to produce more useful gaseous or liquid fuels. Feedstock blending results with batch-fed indirectly heated gasifiers (IHGs) were reported at the three previous Turbo Expo meetings. This is a progress report on initial work with a continuously fed IHG scaled to potentially give a gaseous output suitable for a 5–20 kW microturbine or a reciprocating engine. An electric tube furnace is now used rather than a combustor fueled by the residual char or part of the gaseous or liquid output. Some novel features of this current effort are: a) Biomass blends are auger-fed through a reactor tube fabricated out of available components to simulate a conical shape, b) The output gas is filtered and partially cooled by the incoming biomass feedstock, c) The system has been designed to facilitate feedstock blending studies, d) A trap and external heat exchanger condenses the residual tar, water vapor, and volatile metals, e) The char-ash is collected and stored in a pressure vessel, f) Gas output volume is measured with an orifice dividing system and respirometer. The results of runs in a semi-continuously fed system with various biomass particle sizes and with various blends of biomass and coal are presented. The fate of volatile metals contained in the input feedstock is assessed. With the completion of an external hopper-feeder and the replacement of the electric tube furnace by an output gas or charcoal combustor, a later application to microturbines is within reach.

Co-utilization of solid fuels with combustion turbines (CTs) can be accomplished by blending feedstocks in indirectly heated gasifier/liquifiers (IHG/L), Blending could improve the quality and yields of gaseous and liquid fuel outputs and, with gas clean-up (GCU) or liquid distillation, serve valuable societal functions. Gas yields vs. temperature, time and other variables have been obtained using batch fed and continuous fed laboratory scale IHG/Ls using particle sizes suitable for commercial systems. The rates of solids to gas/liquid conversion are mainly dependent upon the heat transfer and diffusion coefficients of the biomass rather than the rate constants for chemical decomposition. Phenomenological engineering formulas are developed for use with biomass that can be treated as a blend of hemicellulose, cellulose and lignin. The main immediate goals are to develop: 1) laboratory scale process development units (PDUs) that can help anticipate results with commercial IHG/L systems, 2) predictive models for estimating gaseous, liquid and char yields when various blends of biomass and other domestic fuels are processed in IHG/Ls and 3) applications of IHG-GCU-CT systems that could drive technology development during periods of low oil and natural gas prices.