Many Black Americans Live in Trauma Care ‘Deserts’

By Dennis Thompson

HealthDay Reporter

FRIDAY, March 8, 2019 (HealthDay News) — Black neighborhoods in America’s three largest cities are much more likely to be located in a “trauma desert,” an area without immediate access to a designated trauma center, a new study finds.

Census data for neighborhoods in New York City, Chicago and Los Angeles revealed that neighborhoods made up of mostly black residents are more often 5 miles or more away from a trauma center, compared with white or Hispanic neighborhoods, researchers said.

“We found that black neighborhoods were the only neighborhoods that were consistently in trauma deserts,” said lead researcher Dr. Elizabeth Tung, an internal medicine and primary care instructor with University of Chicago Medicine.

This means that medical care for stabbings, shootings and beatings is lacking in the urban areas most affected by violent crime, the researchers said.

Tung’s team noted that the rate of violent crime in rural Thurmont, Md., is five victims for every 10,000 people. The rate just 60 miles away, in urban Baltimore, is more than 25 times higher.

“When you think about who needs access to these services, it’s really the poor inner-city neighborhoods, and those are the neighborhoods least likely to have access,” Tung said.

Previous studies have associated urban trauma care deserts — or regions located more than 5 miles from a trauma center — with higher transport times and an increased risk of death, according to background notes in the study published online March 8 in JAMA Network Open.

For the new study, the investigators analyzed data from the 2015 American Community Survey, an annual research effort by the U.S. Census Bureau.

The researchers used the survey to assess the racial makeup of specific neighborhoods in the three largest U.S. cities. They found large proportions of majority-black neighborhoods in Chicago (35 percent) and New York City (21 percent), but not in Los Angeles (3 percent).

The investigators then compared the location of those neighborhoods to the sites of adult level I and level II trauma centers within the three cities.


The findings showed that black-majority neighborhoods were eight times more likely to be located in a trauma care desert in Chicago and five times more likely in Los Angeles. They also were nearly twice as likely in New York City to be in a trauma care desert, in models adjusting for poverty and race.

Interestingly, Hispanic-majority neighborhoods did not consistently have the same problem. They were actually less likely to be located in a trauma care desert in New York City and Los Angeles, and slightly more likely in Chicago, according to the report.

Many “safety net” trauma hospitals in poorer urban areas have shut down or scaled back operations over the years, as welfare and Medicaid funding have tightened, Tung said. This makes emergency care less available to people in those neighborhoods.

Examples include Michael Reese Hospital on the south side of Chicago, which closed in 1991 due to economic hardship, and Martin Luther King Jr. Hospital in Los Angeles, which lost its trauma center designation in 2004, the researchers noted.

On the other hand, activists in New York City rallied around Harlem Hospital and headed off its closure twice, which could explain why the Big Apple’s black communities are not as likely to be in a trauma care desert, Tung said.

It’s not cheap to operate a trauma center, said Dr. Lisa Marie Knowlton, an assistant professor of surgery at Stanford University Medical Center.

“The process of accreditation and maintenance of certification for level I trauma hospitals is a rigorous and costly process, and although many safety-net hospitals in urban settings provide level I care, they are already at financial risk,” said Knowlton, who wrote an editorial accompanying the new study.

“The tremendous cost to the hospital and system for providing care to vulnerable uninsured patients who lack adequate post-discharge resources places any hospital in these urban environments at risk,” Knowlton explained.

Physical proximity isn’t the only measure used to assess an area’s access to emergency care, said Dr. Rade Vukmir, a critical care specialist in Traverse City, Mich., who is also a fellow of the American College of Emergency Physicians.


“The question of how long does it take to get to emergency care is really the underpinning of what we do. In a rural environment, it’s a distance problem,” Vukmir said. “In a suburban and sometimes urban environment, it’s a congestion problem,” as ambulances battle traffic to deliver patients to a hospital.

Tung and Knowlton pointed out that providing better emergency care to neighborhoods in trauma care deserts will involve large-scale policy changes and programs.

“Additional state and federal funds should be allocated toward the provision of emergency services, including trauma care, regardless of patients’ ability to pay,” Knowlton said. “Further subsidization of safety-net hospitals providing critical services to high-risk patients in urban settings is warranted.”

Medicaid expansion could prove crucial in expanding funding to struggling urban hospitals, Knowlton added.

WebMD News from HealthDay


SOURCES: Elizabeth Tung, M.D., internal medicine and primary care instructor, University of Chicago Medicine; Lisa Marie Knowlton, M.D., M.P.H., assistant professor of surgery, Stanford University Medical Center, Stanford, Calif.; Rade Vukmir, M.D., critical care specialist, Traverse City, Mich., and fellow, American College of Emergency Physicians; March 8, 2019,JAMA Network Open,  online

Copyright © 2013-2018 HealthDay. All rights reserved.

‘); } else { // If we match both our test Topic Ids and Buisness Ref we want to place the ad in the middle of page 1 if($ .inArray(window.s_topic, moveAdTopicIds) > -1 && $ .inArray(window.s_business_reference, moveAdBuisRef) > -1){ // The logic below reads count all nodes in page 1. Exclude the footer,ol,ul and table elements. Use the varible // moveAdAfter to know which node to place the Ad container after. window.placeAd = function(pn) { var nodeTags = [‘p’, ‘h3′,’aside’, ‘ul’], nodes, target; nodes = $ (‘.article-page:nth-child(‘ + pn + ‘)’).find(nodeTags.join()).not(‘p:empty’).not(‘footer *’).not(‘ol *, ul *, table *’); //target = nodes.eq(Math.floor(nodes.length / 2)); target = nodes.eq(moveAdAfter); $ (”).insertAfter(target); } // Currently passing in 1 to move the Ad in to page 1 window.placeAd(1); } else { // This is the default location on the bottom of page 1 $ (‘.article-page:nth-child(1)’).append(”); } } })(); $ (function(){ // Create a new conatiner where we will make our lazy load Ad call if the reach the footer section of the article $ (‘.main-container-3’).prepend(”); });


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WebMD Health

Childhood Trauma May Harm the Heart Decades Later

MONDAY, Dec. 18, 2017 — Experiencing trauma as a child or teen apparently makes you more susceptible to heart disease.

A new scientific statement from the American Heart Association (AHA) says that people who were abused, bullied, witnessed violence or had other traumatic experiences when they were children or teens are at increased risk for heart disease.

The AHA based its stance on a review of published studies that found a strong association between traumatic experiences in childhood or teen years and the chances of developing conditions such as obesity, high blood pressure or type 2 diabetes in early adulthood.

In turn, those conditions increase the risk for heart and blood vessel diseases, such as coronary artery disease, heart attack and stroke.

The statement was published Dec. 18 in the journal Circulation.

“The real tragedy is that children are exposed to these traumatic experiences in the first place,” Shakira Suglia, who chaired the group that wrote the statement, said in an AHA news release.

“We are talking about children and teens experiencing physical and sexual abuse, and witnessing violence,” she said. “Sadly, the negative consequences of experiencing these events do not end when the experience ends. It lasts many years after exposure.”

Suglia, an associate professor of epidemiology at Emory University in Atlanta, added, “Ideally, we want to prevent these things from happening in the first place as well as preventing the health consequences that arise from having these experiences.”

Nearly 60 percent of Americans report having had a traumatic experience during childhood, according to the AHA.

Along with abuse, neglect and witnessing violence, these experiences can include: parental divorce, separation or death; parental substance abuse; living in a neighborhood with a high crime rate; homelessness; discrimination; poverty; and the loss of a relative or another loved one.

It’s not clear how traumatic experiences affect heart health, but research suggests that behavioral, mental health and biological reactions to elevated stress may all play a role. However, the authors added that the evidence is observational and doesn’t prove cause and effect.

More information

The U.S. Centers for Disease Control and Prevention offers tips to prevent heart disease.

© 2017 HealthDay. All rights reserved.

Posted: December 2017

Recommended for you – Daily MedNews

Trauma Takes a Toll on Half of U.S. Kids

By Mary Elizabeth Dallas

HealthDay Reporter

TUESDAY, Oct. 24, 2017 (HealthDay News) — Nearly half of American children have faced at least one traumatic experience, such as the death of a parent, witnessing a violent crime or living with someone who is suicidal or abuses drugs or alcohol, new research reveals.

These events can trigger high levels of stress, which can have serious and lasting effects on children’s development, heath and overall well-being, according to researchers at the Johns Hopkins Bloomberg School of Public Health.

They noted, however, that effective parenting, supportive neighbors, involved schools and teaching kids how to be resilient can all help reduce these harmful effects.

“Every child deserves a healthy start,” said Richard Besser, president and CEO of the Robert Wood Johnson Foundation, which funded the research. “A loving home, a good school, a safe neighborhood — these things are the foundation for a long and happy life, yet too many children don’t have them.”

“Too often, children experience trauma that can be devastating,” Besser said in a Robert Wood Johnson Foundation news release.

“But trauma doesn’t have to define a child’s life trajectory. They can be incredibly resilient,” he added. “With policies that help families raise healthy children, and the consistent presence of caring adults in their lives, we can reduce the impact of trauma on children’s health and help them thrive in the face of adversity.”

Overall, 46 percent of U.S. children have faced at least one traumatic experience, and more than 20 percent have faced at least two, the Hopkins researchers found.

When looking at states individually, the analysis found that nearly 40 percent of children in every state had experienced at least one trauma and, in 16 states, at least 25 percent of children had experienced at least two.

The findings came from an analysis of data from the 2016 National Survey of Children’s Health, conducted by the Child & Adolescent Health Measurement Initiative at the Johns Hopkins Bloomberg School of Public Health. The analysis was published in the September/October issue of the journal Academic Pediatrics.


Children who deal with trauma face an increased risk for long-term health issues, including smoking, alcoholism, depression and heart and liver diseases.

The researchers found that 33 percent of children who faced two or more traumatic events had a chronic health condition that required specialized care, compared with about 14 percent of children who never experienced trauma.

The researchers noted that trauma doesn’t discriminate, affecting children of all races, ethnicities and socioeconomic backgrounds. Overall, about 40 percent of white children, 51 percent of Hispanic children and 64 percent of black children experienced one or more traumatic events, the study found.

Traumatic events were more common among low-income families, affecting 62 percent of children whose family income was well below the federal poverty line, compared with 26 percent of children from high-income families.

The age at which children face a trauma matters, according to the researchers.

Preschoolers who had at least two traumatic experiences were more than four times more likely to struggle with managing their emotions, such as staying calm, avoiding distraction and making friends. Meanwhile, children aged 6 to 17 who faced at least two traumatic events were twice as likely as their peers to not be engaged at school, the study showed.

“Traumatic events don’t just affect an individual child — families, neighborhoods and communities all bear the brunt of these difficult circumstances, which add up over time,” said Christina Bethell, with the Child & Adolescent Health Measurement Initiative. “If a child’s stress and unhealed trauma leads to acting out in class, that disruption is felt by the other children in the room as well as the teacher.”

“These impacts require the healing of trauma at a family, community and societal level,” she said.

WebMD News from HealthDay


SOURCE: Robert Wood Johnson Foundation, news release, Oct. 19, 2017

Copyright © 2013-2017 HealthDay. All rights reserved.

WebMD Health

Better Care Could Cut Deaths From Trauma by 20 Percent: Report

FRIDAY June 17, 2016, 2016 — Improved care could prevent one in every five deaths currently lost to traumatic injuries in the United States, a new federal report finds.

Injuries from car crashes, gun violence, falls and other incidents remain the leading cause of death among Americans younger than 46, a committee from the National Academies of Sciences, Engineering and Medicine noted.

Trauma’s aftermath also costs the United States about $ 670 billion in medical care and lost productivity in 2013, the group said.

And with incidents of domestic and international terrorism and “mass casualty” events increasingly in the spotlight, the United States could learn from the military’s response to such incidents, the panel said.

“With the decrease in combat and the need to maintain readiness for trauma care between wars, a window of opportunity now exists to integrate military and civilian trauma systems and view them not separately, but as one,” explained committee chair Dr. Donald Berwick, president emeritus of the Institute for Healthcare Improvement, in Cambridge, Mass.

The committee stressed that prevention is the best way to reduce the impact of trauma. However, it’s also crucial to provide the best possible trauma care when injuries do occur.

The panel estimated that of the nearly 148,000 deaths due to trauma in the United States in 2014, as many as 20 percent — about 30,000 — may have been prevented with top quality care.

It noted that great strides have been made by the U.S. military in trauma care over the last decade in response the large number of casualties during the Iraq and Afghanistan Wars. For example, between 2005 and 2013, the percentage of wounded U.S. military personnel in Afghanistan who died of their injuries fell by nearly 50 percent, the committee said.

In a news release, the panel urged that the White House “lead the integration of military and civilian trauma care to establish a national trauma care system and set an aim to achieve zero preventable deaths after injury.

“In addition, Congress, in consultation with the U.S. Department of Health and Human Services, should help ensure that pre-hospital care, such as emergency medical services, are included as a seamless component of health care delivery, rather than being viewed and paid as merely transportation providers,” they said.

But Berwick said that not all areas of the country, or medical centers, have benefited equally.

“There are serious limitations in the diffusion of [improvements in trauma care] from location to location,” Berwick said in the news release. “Even as the successes have saved many lives, the disparities have cost many lives,” he said.

More information

The U.S. Centers for Disease Control and Prevention offers injury prevention resources.

Posted: June 2016

View comments – Daily MedNews

Trauma Workers at Risk for ‘Compassion Fatigue’

Acknowledging it is a key to coping, researchers say

WebMD News from HealthDay

By Robert Preidt

HealthDay Reporter

FRIDAY, Jan. 15, 2016 (HealthDay News) — The challenges facing trauma care providers can put them at risk for “compassion fatigue” and burnout, a small new study says.

Previous research has found that compassion fatigue can cause trauma team members to feel emotionally exhausted, depressed and anxious. They also may feel like failures professionally, the researchers said.

For this study, 12 trauma team members at a Level 1 trauma center were enrolled in a discussion group. The workers cited on-the-job stress triggers that included child or elder abuse, trauma involving children, cases involving multiple family members, injuries from avoidable situations and “senseless” deaths.

Other causes of stress included dealing with patients’ family members and difficulties with trauma team coordination.

Even though all participants reported low or mild stress levels, three-quarters had moderate to high scores for secondary trauma stress, which is stress caused by experiencing trauma indirectly and includes compassion fatigue.

One-third had a combination of high burnout and low levels of positive experiences helping patients, while another one-quarter had moderate levels of burnout, according to the study in the January issue of the Journal of Trauma Nursing.

“Participants did not feel they experienced compassion fatigue often, and when they did, coping strategies appeared to differ between respondents,” Gina Berg, of the University of Kansas School of Medicine Wichita, and colleagues said in a journal news release.

Even though the participants said compassion fatigue was rare, assessments conducted by the researchers indicated the presence of compassion fatigue and burnout.

“This suggests trauma team members may not be as adept at managing work stressors as well as they perceive,” the researchers wrote.

In order to cope, trauma team members must acknowledge that compassion fatigue occurs and is an expected reality of the profession, Berg and colleagues suggested.

The study participants had no training in managing stress. But they said they felt able to deal with it through methods such as talking with each other and making time for themselves.

WebMD Health

Falls Leading Cause of Serious Head Trauma for Kids, Study Shows

Falls Leading Cause of Serious Head Trauma for Kids

Seatbelts and bike helmets can help prevent severe head injuries, experts say

WebMD News from HealthDay

By Steven Reinberg

HealthDay Reporter

WEDNESDAY, Nov. 12, 2014 (HealthDay News) — A new study of more than 43,000 children finds that falls are the most common cause of head injuries among younger kids.

For children under the age of 2, falls accounted for 77 percent of head injuries. For kids aged 2 to 12, falls caused 38 percent of head injuries, the researchers said.

Many of these serious brain injuries result from car and bicycle accidents, said lead researcher Dr. Nathan Kuppermann, a professor in the departments of emergency medicine and pediatrics at the University of California, Davis School of Medicine.

“Bike helmets and seatbelts can save your kid’s brain,” he said.

Among kids who suffered a head injury in a car accident, fewer than half were wearing a seatbelt. Children injured in bicycle accidents were wearing helmets less than 20 percent of the time, Kuppermann said.

Among teens aged 13 to 17, head injuries were most often caused by assaults, sports and car crashes, the researchers added.

The study did not include concussions, which are injuries that jostle the brain, but rather injuries that cause bleeding in the brain, he said.

“The study gives a picture of how children suffer serious head injuries, and how often they get CT scans and how often they undergo brain surgery,” Kuppermann said.

The report was published Nov. 13 in the New England Journal of Medicine.

Dr. John Kuluz, director of traumatic brain injury and neurorehabilitation at Miami Children’s Hospital, said, “According to the U.S. Centers for Disease Control and Prevention, deaths among children from car accidents has dropped 40 percent.”

That decline is largely the result of seatbelts and air bags, he said. In addition, there are fewer severe head injuries being seen in emergency rooms. The majority of head injuries (98 percent) seen are “mild,” Kuluz said.

Among the children in the study, nearly 16,000 (37 percent overall) had a CT scan: 32 percent of those under 2 years of age; 32 percent of those aged 2 to 12; and 53 percent of those aged 13 to 17.

Kuluz said that fewer CT scans are being done, especially among younger children whose brains are more likely to be damaged by radiation.

In all, 7 percent of those who had CT scans had a traumatic brain injury and another 3 percent had skull fractures, the investigators found.

The most common injuries were various types of brain bleeds, with half of the children having several types of head injuries. Among all the children in the study, 78 died (0.2 percent).

Of the children with traumatic brain injury, 17 percent had brain operations and 43 percent of those had more than one procedure, the study noted.

For the study, the researchers used data collected from 2004 to 2006 from emergency departments in 25 U.S. hospitals.

WebMD Health

Older Black Trauma Patients Fare Better Than Whites in ER: Study

Race and Older Trauma Patients in the ER

Researchers found older white trauma patients were 20 percent more likely to die

WebMD News from HealthDay

Even the elderly and those who had more severe

By Robert Preidt

HealthDay Reporter

WEDNESDAY, May 28, 2014 (HealthDay News) — Older black trauma patients are 20 percent more likely to survive their injuries than their white peers are, a new study shows.

The finding is surprising because studies typically show that black trauma patients have worse outcomes than whites, the Johns Hopkins University School of Medicine researchers noted.

For the study, the investigators analyzed in-hospital death rates among nearly 1.1 million trauma patients treated at U.S. hospitals from 2003 through 2010. Among patients aged 16 to 64, blacks were 20 percent more likely to die than whites. However, among patients aged 65 and older, whites were 20 percent more likely to die than blacks, the team found.

“We have long found it vexing that minority patients consistently do worse, even in treatment for trauma that seems to leave little room for bias,” study leader Dr. Adil Haider, an associate professor of surgery, said in a Hopkins news release.

“And although we still see the disparity in younger black patients, we were surprised to find in this study that older black trauma patients were more likely to survive their injuries,” he added.

Far more of the older patients suffered blunt trauma injuries — mainly from traffic accidents and falls — while younger patients were much more likely to have gunshot or stab wounds.

The researchers also found that nearly all of the older patients (99.4 percent) had insurance, many of them through Medicare. This high percentage of coverage means that all older patients have better access to health care, which helps “level the playing field” among older patients of different races, Haider said.

Another possible reason for the finding is that black patients have worse outcomes from disease and injury throughout their lives, so they have what the researchers called a “healthy survivor bias.”

“There are well-documented disparities in access to health care for younger black patients, so it is possible that black patients who make it to age 65 have potentially reached that age stronger and healthier than their white counterparts of a similar age,” study co-author and surgical resident Dr. Caitlin Hicks said in the news release.

“This is an important finding in racial disparities research that we need to look into and learn from,” she added.

The study was published online May 28 in the journal JAMA Surgery.

WebMD Health

Shopping Doesn’t Help in Face of Trauma, Researchers Say

Shopping Doesn’t Help in Face of Trauma, Researchers Say

Study of people continually faced with rocket attacks found compulsive spending made stress worse

WebMD News from HealthDay

Study of people continually faced with rocket

By Robert Preidt

HealthDay Reporter

FRIDAY, Sept. 27 (HealthDay News) — Some people go shopping in an attempt to cope with the stress of traumatic events, but it actually makes things worse, according to a small, new study.

The researchers found that traumatic events cause more stress for materialistic people and that they are more likely to spend compulsively as a result. These people tend to have lower self-esteem than others, according to Ayalla Ruvio, an assistant professor of marketing at Michigan State University.

“When the going gets tough, the materialistic go shopping,” Ruvio said in a university news release. “And this compulsive and impulsive spending is likely to produce even greater stress and lower well-being. Essentially, materialism appears to make bad events even worse.”

The researchers surveyed 139 people from a southern Israeli town that was targeted by rocket attacks for about six months in 2007, and 170 people from another Israeli town that was not under attack.

When faced with a deadly threat, highly materialistic people reported higher levels of post-traumatic stress symptoms and impulsive and compulsive shopping than those who were less materialistic, according to the study recently published in the Journal of the Academy of Marketing Sciences.

“The relationship between materialism and stress may be more harmful than commonly thought,” Ruvio said.

Post-traumatic stress can be triggered by a wide range of events, including traffic crashes, natural disasters and criminal attacks, the researchers noted.

The investigators also surveyed 855 Americans about their levels of materialism and fear of death. The findings revealed that materialistic people are more likely to try to relieve the fear of death through impulsive and out-of-control spending.

The study results suggest that low self-esteem and fear of death may drive materialism’s intensifying effect on extreme stress, according to the release. Future studies should examine the link between stress and materialism in different contexts, Ruvio said.

WebMD Health

PC | Trauma Review

As the video game industry continues to expand, many developers are searching for new and different ways to use interactive sights and sounds to spark an emotional reaction in the player. Trauma tries to be such a game, using a series of photorealistic images to immerse you in the dreams of an accident victim. And so you explore this woman’s psyche by clicking from one node to the next, Myst style, while searching for photographs and using mouse gestures to “solve puzzles.” Those words deserve the quotation marks because these aren’t puzzles. Each of Trauma’s four scenes tells you exactly what to do with minimal effort–though you might argue that approaching this game as a traditional puzzle adventure misses the point. Perhaps Trauma is solely meant to inspire introspection or reflection on a particular theme. Unfortunately, it fails in this endeavor as well. There is plenty of visual and thematic allegory, but it doesn’t coalesce into an evocative whole. Trauma is a tiny slice of nothing: 45 minutes or less of clicking for a high price of $ 6.99.

All that clicking, down the drain.

Trauma opens with a combination of live-action scenes and montages of images from within the game. A young woman and her passengers enter her vehicle, and she drives off. The car’s headlights and taillights are depicted on the street as disembodied beams, and an entanglement of red and white intimates a serious accident. Then: a close-up of a closed eyelid; a shot of her face, covered by a breathing mask; close-ups of X-rays; and other brief images. The game menu then unfolds, and you select one of four vignettes that explore the survivor’s dreams as she lays in a hospital bed, each a heavy-handed metaphor for some aspect of her life. A teddy bear crushed under an enormous weight; a ghostly figure rushing away, just out of reach; a lonely path that always ends exactly where it started. The themes are quickly obvious: lost childhood, the never-ending search for parental approval, and the like.

You interact with these scenes by clicking on various hot spots within attractive, photorealistic images that give the impression of moving about an actual place. This interaction is similar to how you move about in Myst and its ilk. As you click about, the woman narrates in an affected, emotionless manner; comments on the scenes; and gives you the solution to reach one of the level’s four different endings. Photos are scattered about these areas. Some depict moments from the woman’s past, while others introduce you to Trauma’s single interesting gameplay element: mouse gestures. By swiping the mouse downward, you can zoom out. By swiping it to the right, you move to the node on the right. You also learn vital gestures that let you interact with certain views. One of them allows you to lift heavy objects; another clears underbrush out of your way. There are four such gestures, and each level introduces one of them.

That is actually a lot of description for what turns out to be hardly anything worth talking about. Each vignette has one main ending that you reach by performing (in the right place) the special gesture the level introduces to you. It takes about five minutes to click around, find the solution, and perform it; thus, the first time through, it takes about 20 minutes to complete Trauma. Each vignette has three alternate endings, however, that are uncovered by performing the gestures you learn elsewhere. Finding every photograph and seeing every additional ending might take another 20 or 25 minutes, meaning you can see Trauma in its entirety in less than an hour, with time to spare. And you won’t find doing so a challenge. The photos and voice-overs tell you exactly what you need to do and where. Trauma requires no thought whatsoever.

While it takes the form of a traditional point-and-click adventure, Trauma clearly isn’t intended to be a “game” as we normally think of them but rather a work of interactive fiction. There’s room, and an audience, for entertainment like this, and much of it is worthwhile. The Path, Linger in Shadows, and other experiences have experimented with the medium’s power to engage players in atypical ways. Trauma wants you to get lost within its heroine’s dreams and remembrances. It doesn’t want to challenge your problem-solving skills; it wants to challenge your emotions. And it fails. This woman is a shadow. You know nothing about her at the outset, and you emerge from Trauma knowing little more. The voice acting is emotionally distant. The woman is an actor reading a script, not a victim struggling to survive. There is no triumph in seeing her overcome her adversity because there is no connection between you and her. Trauma’s themes are universal. Perhaps it intends for you to examine your own life as if it were you in that hospital room. But its ham-fisted metaphors and detached lead character discourage such analysis.

It is nice to look at Trauma’s photos and vignettes. Maple trees dot an office park; a lonely road twists into the distance. Surreal sights, such as a crane lifting a giant heart, punctuate the levels, but to what end? The symbols are so smack-you-on-the-head obvious that there’s no sense of mystery. The lead character and storytelling are so aloof that there is no emotional involvement. The way you interact with the game is too simple to encourage thoughtfulness. And the environments–highways, thickets–are too prosaic to promote reverie. Trauma doesn’t have much to say, and it takes almost no time to say it. At $ 6.99, it’s a waste of time and money.

GameSpot’s Reviews

Teena Marie’s Autopsy Reveals No Signs Of Trauma

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Teena Marie Autopsy Shows No Signs of Trauma

for a toxicology report that may uncover the real reason behind her death, however police found no illegal drugs at Marie’s home. Marie died at the age of 54. She is known as the ‘Ivory Queen of Soul,’ after being the first white female singer signed to
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Anti-Inflammatory Drugs in Asthma (Progress in Inflammation Research)

For some years, international guidelines on the management of asthma have stressed the importance of early intervention with anti-inflammatory drugs to prevent acute asthma exacerbations and to avert chronic inflammatory damage to the airway. Introduced by a broad survey of the targets for anti-inflammatory drugs, this book proceeds to bring together the most recent research into the mechanisms and clinical benefits of presently-available anti-inflammatory treatments including corticosteroids,

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See Yourself In The Third Person Without Drugs Or Major Bodily Trauma

Have you ever wanted to see yourself from above? Behind? Ever wanted to see yourself as other see you? Try this Instructable that creates a 3rd person view of your own person by attaching a camera to a head mounted display. You’ll see yourself – and
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Novel Drug Delivery Systems (Drugs and the Pharmaceutical Sciences)

A comprehensive treatment of the science, technology, and regulation of rate-controlled administration of therapeutic agents, with coverage of the basic concepts, fundamental principles, biomedical rationales, and potential applications. This revised and updated edition (first in 1982) incorporates

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