2, 20.9, 13.3, and 29.7 mL, respectively. The muscle volume of the men was greater than that of the women (all P  less then  0.001), and the fat infiltration ratio was positively correlated with body mass index (all P  less then  0.05). CONCLUSIONS The semi-automated quantified measurement of fatty infiltration of the rotator cuff muscles using magnetic resonance imaging and Slicer software presented excellent consistency. This technique could be an alternative measurement to complement the weak consistency of the Goutallier-Fuchs grading system. However, to reduce the error of measurement, this study evaluated non-pathologic shoulders. Therefore, further study using magnetic resonance imaging of pathologic shoulders is necessary for actual clinical application. LEVEL OF EVIDENCE Level IV, case series, diagnostic study. BACKGROUND Motor vehicular transport (MVT) is a leading cause of injuries globally. Health care regionalization aims at improving patients’ outcomes. OBJECTIVES This study examines the association between trauma center designation levels in the United States and survival of patients with MVT-related injuries. METHODS We used the National Trauma Data Bank 2015 dataset for this retrospective study. We conducted descriptive and bivariate analyses. This was followed by a multivariate analysis to assess the association between trauma center level and survival to hospital discharge. RESULTS One hundred sixty-eight thousand five hundred twenty-four patients were included in this study. The mean age was 39.9 years (±19.5 years) with a male predominance (63.8%). Most patients were taken to level I (55.7%) and level II (35.9%) centers. The overall survival of patients with MVT injuries was 95.3%. Involved patients were occupant (64.8%), motorcyclist (17.3%), and pedestrian (12.7%). After adjusting for confounders, patients sustaining MVT injuries who were taken to level II and III trauma centers were less likely survive compared with those taken to level I centers (odds ratio = 0.89 [95% confidence interval 0.81-0.97] and odds ratio = 0.70 [95% confidence interval 0.59-0.82], respectively). CONCLUSIONS In this study, we identified a survival benefit for patients with MVT injuries when treated at level I compared with level II and III centers. These findings provide additional evidence for the benefit of health care regionalization in the form of trauma center level designation. BACKGROUND The local anesthetic dosages used in the current literature in regional applications of local anesthetics are frequently high for surgical purposes, and there are no sufficient dosage studies for emergency department (ED) management. OBJECTIVES The aim of this study was to determine the success of lower local anesthetic dosages capable of reducing costs and excessive exposure to drugs in pain control in patients with femoral neck fractures (FNFs) in the ED. METHODS Patients ≥65 years of age with FNFs and reporting Wong-Baker Pain Rating Scales scores ≥8 were included in this prospective, interventional study. PLX5622 order Patients underwent ultrasound-guided regional femoral block with 5 mL 2% prilocaine. Pain scores before the procedure and at 30 min and 2 h postprocedure were compared with the Friedman test and Wilcoxon test with Bonferroni correction. RESULTS Forty patients, 20 with intracapsular and 20 with extracapsular FNFs, were enrolled. The initial pain scores of patients with both intra- and extracapsular fractures were 8 (range 8-10). A statistically significant 50% decrease in pain scores was observed in both groups 30 min after the regional block procedure (p  less then  0.001). A statistically significant 75% decrease in pain scores was observed in both groups 2 h after the regional block procedure (p  less then  0.001). No statistically significant difference was determined in the change in 30-min and 2-h pain scores between the groups. CONCLUSIONS The administration of 5 mL 2% prilocaine for pain control in FNFs in elderly patients in the ED can reduce systemic analgesic requirements by establishing effective analgesia in both intracapsular and extracapsular fractures. INTRODUCTION Critically ill children tend to have altered gentamicin pharmacokinetics (PK); and so we carried out an audit of gentamicin use using the estimated peak concentrations (Cmax), trough concentrations (Cmin) and area-under-the-concentration-time curve (AUCs) by Bayesian approach. METHODS Critically ill children with at least one serum gentamicin concentrations available were recruited. We used multiple models Bayesian adaptive control to estimate Cmax, and AUC0-t following each dose. Pediatric risk, injury, failure, loss, end stage renal disease (pRIFLE) criteria was used to identify the incidence of acute kidney injury (AKI). RESULTS Seventy-three children (961 doses and 143 concentrations) were analysed. AUC0-24 was observed to be higher in earlier age groups with a steady decline in older children. Similar changes were observed in Cmax, Cmin and AUC0-24 at steady state. Significantly higher proportions of children in the other age groups were estimated to have Cmax between 5 and 10 mg/L compared to neonates. Neonates had a higher risk of Cmax above 10 mg/L. Patients with augmented renal clearance exhibited lower AUC0-24 and reduced proportion achieving the target AUC0-24 levels. Nearly one-third of children were observed to meet the pRIFLE criteria for AKI. CONCLUSION We observed higher initial doses and peak concentrations of gentamicin in neonates and infants compared to older age groups in critically ill children. Uniformity in the paediatric-specific standard treatment guidelines for gentamicin is the need of the hour. PURPOSE To utilize failure mode and effects analysis (FMEA) to effectively direct the transition from the Elekta microSelectron to the Flexitron high dose-rate afterloader system. MATERIALS AND METHODS Our FMEA was performed in two stages. In the first stage, the lead brachytherapy physicists used FMEA to guide the brainstorming sessions and to identify vulnerabilities during this transition. The second stage of FMEA was carried out 2 months after the clinical release of the Flexitron system. The process map was examined again to further refine and improve the entire process. RESULTS In the first-stage FMEA, 81 process steps were identified. Moreover, 80 failure modes and their categorized causes were recognized. Checklists and data books containing the corresponding applicator information were verified and updated. Next, based on outcomes of our first-stage FMEA, we chose to implement the commissioning process in two phases. The second stage of FMEA identified error-prone steps in our newly updated processes.