Glen A Franklin

Summary

Affiliation: University of Louisville
Country: USA

Publications

  1. ncbi request reprint Incremental increases in organ retrieval after protocol driven change in an organ procurement organization: a 15-year assessment
    Glen A Franklin
    Department of Surgery, 2nd Floor ACB, 550 South Jackson Street, University of Louisville, Louisville, KY 40292, USA
    Am Surg 75:537-43; discussion 543-4. 2009
  2. ncbi request reprint Decreased juvenile arson and firesetting recidivism after implementation of a multidisciplinary prevention program
    Glen A Franklin
    Department of Surgery, Division of Trauma, Burn and Emergency Surgery, University of Michigan, Ann Arbor, Michigan, USA
    J Trauma 53:260-4; discussion 264-6. 2002
  3. ncbi request reprint The driving force in hospital formularies: economics versus efficacy
    Glen A Franklin
    Department of Surgery, Veterans Administration Medical Center and the University of Louisville, Louisville, Kentucky 40292, USA
    Am J Surg 186:55S-60S; discussion 60S-64S. 2003
  4. ncbi request reprint Optimization of donor management goals yields increased organ use
    Glen A Franklin
    Department of Surgery, University of Louisville, Louisville, Kentucky 40202, USA
    Am Surg 76:587-94. 2010
  5. ncbi request reprint Current advances in the surgical approach to abdominal trauma
    Glen A Franklin
    Department of Surgery, University of Louisville School o f Medicine, Louisville, KY 40292, United States
    Injury 37:1143-56. 2006
  6. ncbi request reprint A novel model of pneumonia from intraperitoneal injection of bacteria
    Glen A Franklin
    Veterans Affairs Medical Center, and Department of Surgery, University of Louisville, 2nd Floor ACB, Louisville, KY 40292, USA
    Am J Surg 186:493-9. 2003
  7. ncbi request reprint A comparison of prehospital and hospital data in trauma patients
    Saman Arbabi
    Department of Surgery, University of Michigan Medical Center, Ann Arbor, Michigan, USA
    J Trauma 56:1029-32. 2004
  8. doi request reprint Drug and alcohol use among adolescent blunt trauma patients: dying to get high?
    John M Draus
    Department of Surgery, University of Louisville School of Medicine, Louisville, KY 40202, USA
    J Pediatr Surg 43:208-11. 2008
  9. ncbi request reprint Prevention of bile peritonitis by laparoscopic evacuation and lavage after nonoperative treatment of liver injuries
    Glen A Franklin
    Department of Surgery, University of Louisville, Louisville, Kentucky 40292, USA
    Am Surg 73:611-6; discussion 616-7. 2007
  10. ncbi request reprint Does bronchoalveolar lavage enhance our ability to treat ventilator-associated pneumonia in a trauma-burn intensive care unit?
    Wendy L Wahl
    Department of Surgery, University of Michigan Health System, Ann Arbor 48109 0033, USA
    J Trauma 54:633-8; discussion 638-9. 2003

Collaborators

Detail Information

Publications56

  1. ncbi request reprint Incremental increases in organ retrieval after protocol driven change in an organ procurement organization: a 15-year assessment
    Glen A Franklin
    Department of Surgery, 2nd Floor ACB, 550 South Jackson Street, University of Louisville, Louisville, KY 40292, USA
    Am Surg 75:537-43; discussion 543-4. 2009
    ..Family support and intensivist programs enhanced CR and OTPD. Increases in the number of ECD were noted with increasing age after the introduction of the intensivist program and an increase in transplant center use of these organs...
  2. ncbi request reprint Decreased juvenile arson and firesetting recidivism after implementation of a multidisciplinary prevention program
    Glen A Franklin
    Department of Surgery, Division of Trauma, Burn and Emergency Surgery, University of Michigan, Ann Arbor, Michigan, USA
    J Trauma 53:260-4; discussion 264-6. 2002
    ..The purpose of this study was to determine the value of this trauma burn center prevention program from a financial, clinical, and recidivism perspective...
  3. ncbi request reprint The driving force in hospital formularies: economics versus efficacy
    Glen A Franklin
    Department of Surgery, Veterans Administration Medical Center and the University of Louisville, Louisville, Kentucky 40292, USA
    Am J Surg 186:55S-60S; discussion 60S-64S. 2003
    ..The driving force behind hospital formulary design is often economic, whereas the physician desires variety and efficacy. This review discusses some of the key issues related to drug costs and expenditures...
  4. ncbi request reprint Optimization of donor management goals yields increased organ use
    Glen A Franklin
    Department of Surgery, University of Louisville, Louisville, Kentucky 40202, USA
    Am Surg 76:587-94. 2010
    ..Surprisingly, not all standard goals are necessary for optimal organ use. The most significant parameters were the low use of vasopressor agents and oxygenation. Donor management strategies should strive to optimize these goals...
  5. ncbi request reprint Current advances in the surgical approach to abdominal trauma
    Glen A Franklin
    Department of Surgery, University of Louisville School o f Medicine, Louisville, KY 40292, United States
    Injury 37:1143-56. 2006
    ..The authors present their preferred treatment for these three common types of abdominal solid organ injury and present an illustrative case example...
  6. ncbi request reprint A novel model of pneumonia from intraperitoneal injection of bacteria
    Glen A Franklin
    Veterans Affairs Medical Center, and Department of Surgery, University of Louisville, 2nd Floor ACB, Louisville, KY 40292, USA
    Am J Surg 186:493-9. 2003
    ..In an attempt to produce peritonitis by Klebsiella, we found evidence of pneumonia on autopsy and further developed this approach as a new experimental model...
  7. ncbi request reprint A comparison of prehospital and hospital data in trauma patients
    Saman Arbabi
    Department of Surgery, University of Michigan Medical Center, Ann Arbor, Michigan, USA
    J Trauma 56:1029-32. 2004
    ..We hypothesized that ED and Fd physiologic parameters are equally valid predictors of outcomes. In addition, we hypothesized that early field intubation will improve survival compared with later ED intubation...
  8. doi request reprint Drug and alcohol use among adolescent blunt trauma patients: dying to get high?
    John M Draus
    Department of Surgery, University of Louisville School of Medicine, Louisville, KY 40202, USA
    J Pediatr Surg 43:208-11. 2008
    ..We compared injury severity, hospital course, and outcomes between adolescent blunt trauma patients with and without positive toxicology screens...
  9. ncbi request reprint Prevention of bile peritonitis by laparoscopic evacuation and lavage after nonoperative treatment of liver injuries
    Glen A Franklin
    Department of Surgery, University of Louisville, Louisville, Kentucky 40292, USA
    Am Surg 73:611-6; discussion 616-7. 2007
    ..Delayed laparoscopic evacuation of these collections prevents bile peritonitis and decreases inflammatory response and avoiding early operation, which has been implicated in increased death from hemorrhage...
  10. ncbi request reprint Does bronchoalveolar lavage enhance our ability to treat ventilator-associated pneumonia in a trauma-burn intensive care unit?
    Wendy L Wahl
    Department of Surgery, University of Michigan Health System, Ann Arbor 48109 0033, USA
    J Trauma 54:633-8; discussion 638-9. 2003
    ..We hypothesized that BAL would decrease the number of cases of VAP diagnosed and impact our antibiotic use and ventilator days...
  11. doi request reprint Direct peritoneal resuscitation improves obesity-induced hepatic dysfunction after trauma
    Paul J Matheson
    Robley Rex Veteran s Affairs Medical Center, Louisville, KY, USA
    J Am Coll Surg 214:517-28; discussion 528-30. 2012
    ..We hypothesized that obesity-related liver dysfunction could be mitigated with the novel technique of adjunctive direct peritoneal resuscitation (DPR)...
  12. ncbi request reprint Management differences for pediatric solid organ injuries in a rural state
    Brian G Harbrecht
    Department of Surgery, University of Louisville, Louisville, Kentucky, USA
    Am Surg 75:725-9. 2009
    ..In Kentucky, pediatric solid organ injuries are usually managed nonoperatively in both trauma and nontrauma centers, but trauma centers cared for fewer isolated solid organ injuries...
  13. doi request reprint Acute appendicitis--not just for the young
    Brian G Harbrecht
    Department of Surgery, University of Louisville, Louisville, KY, USA
    Am J Surg 202:286-90. 2011
    ..The authors evaluated a statewide experience to assess the effect of age on resource utilization and outcomes for this common disease...
  14. ncbi request reprint Interhospital transfer of blunt multiply injured patients to a level 1 trauma center does not adversely affect outcome
    Adrian T Billeter
    Department of Surgery, University of Louisville School of Medicine, Louisville, KY 40292, USA
    Am J Surg 207:459-66. 2014
    ..Stops at nontrauma centers for severely injured patients are thought to increase deaths and costs, potentially because of unnecessary imaging and indecisive/delayed care of traumatic brain injuries (TBIs)...
  15. ncbi request reprint Use of computed tomography findings and contrast extravasation in predicting the need for embolization with pelvic fractures
    Matthew C Bozeman
    Department of Surgery, University of Louisville School of Medicine, Louisville, Kentucky, USA
    Am Surg 78:825-30. 2012
    ..The presence of contrast extravasation is highly associated with the need for pelvic embolization in patients with pelvic fractures, but its absence does not exclude the need for pelvic angiography...
  16. ncbi request reprint Blunt liver injury in children and adults: is there really a difference?
    W Patrick Klapheke
    Department of Surgery, University of Louisville, Louisville, Kentucky 40292, USA
    Am Surg 74:798-801. 2008
    ..A higher rate of liver-related mortality was seen in the PED population. Overall, PED patients seemed to sustain fewer liver related complications necessitating invasive procedures despite similar injury patterns...
  17. ncbi request reprint Morbid obesity impacts mortality in blunt trauma
    A Britton Christmas
    Department of Surgery, University of Louisville, Louisville, Kentucky, USA
    Am Surg 73:1122-5. 2007
    ....
  18. ncbi request reprint Endogenous IL-10 leads to impaired bacterial clearance and reduced survival in a murine model of chronic peritonitis
    Andreas M Lenz
    Veterans Affairs Medical Center Louisville, Department of Surgery, University of Louisville, 550 South Jackson Street, Louisville, KY 40292, USA
    Cytokine 40:207-15. 2007
    ..We conclude that endogenous IL-10 is detrimental for survival and bacterial clearance in this model of chronic peritonitis...
  19. pmc Direct peritoneal resuscitation accelerates primary abdominal wall closure after damage control surgery
    Jason W Smith
    Department of Surgery, University of Louisville, Louisville, KY 40292, USA
    J Am Coll Surg 210:658-64, 664-7. 2010
    ....
  20. doi request reprint Impact of withdrawal of care and futile care on trauma mortality
    Glen A Franklin
    Department of Surgery, University of Louisville, Louisville, KY 40292, USA
    Surgery 150:854-60. 2011
    ..Additionally, many patients arrive moribund and care provided is likely to be futile. We sought to examine the impact of these situations on TC mortality...
  21. ncbi request reprint Cirrhosis and trauma: a deadly duo
    A Britton Christmas
    Department of Surgery, University of Louisville, Louisville, Kentucky 40292, USA
    Am Surg 71:996-1000. 2005
    ..The necessity of an abdominal operative intervention further amplifies this effect. Trauma and cirrhosis is, in fact, a deadly duo...
  22. doi request reprint Statewide experience with Clostridium difficile colitis in academic and non-academic medical centers
    Brian G Harbrecht
    Department of Surgery, University of Louisville, Louisville, Kentucky, USA
    Surg Infect (Larchmt) 13:88-92. 2012
    ..However, most information on C. difficile colitis is from large tertiary-care medical centers. Whether the community hospital experience is similar to that of large referral centers is unknown...
  23. ncbi request reprint Trauma alters alveolar effector cell apoptosis
    J Jason Hoth
    Department of Surgery, University of Louisville, Louisville, KY 40292, USA
    Surgery 134:631-7; discussion 637-8. 2003
    ..We hypothesize that the lung's immune response to trauma alters alveolar inflammatory cell apoptosis and may contribute to posttrauma pulmonary dysfunction...
  24. ncbi request reprint Decreased neutrophil response in a model of chronic intraperitoneal Klebsiella infection
    Dustin R Woods
    Veterans Affairs Medical Center and Department of Surgery, University of Louisville, Louisville, Kentucky, USA
    Surg Infect (Larchmt) 8:367-76. 2007
    ..Previously, we developed an infection model by intraperitoneal (IP) injection of Klebsiella pneumoniae. The high early mortality rate prompted a study of the effect of gentamicin on the disease course...
  25. ncbi request reprint Is splenectomy after trauma an endangered species?
    Brian G Harbrecht
    Department of Surgery, University of Louisville, Louisville, Kentucky 40292, USA
    Am Surg 74:410-2. 2008
    ..As laparoscopic techniques for elective splenectomy become more common, the changing indication for splenectomy has important ramifications for surgical education and training...
  26. doi request reprint Video-assisted thoracoscopy as an important tool for trauma surgeons: a systematic review
    Adrian T Billeter
    Hiram C Polk Jr M D Department of Surgery and Price Institute of Surgical Research, University of Louisville School of Medicine, Louisville, KY 40292, USA
    Langenbecks Arch Surg 398:515-23. 2013
    ..The usefulness of VATS for treatment of complications after chest trauma has been demonstrated by several authors. However, there is an ongoing debate about the optimal timing of VATS...
  27. ncbi request reprint Flail chest injury: are we making any progress?
    Robert M Cannon
    Department of Surgery, University of Louisville, Louisville, Kentucky, USA
    Am Surg 78:398-402. 2012
    ..0001) and intensive care unit length of stay (P < 0.0001). The mortality associated with flail chest has greatly improved; however, the rate of pneumonia remains high. Further efforts at pneumonia prevention are thus warranted...
  28. ncbi request reprint Physician extenders impact trauma systems
    A Britton Christmas
    Department of Surgery, University of Louisville, Louisville, Kentucky 40292, USA
    J Trauma 58:917-20. 2005
    ..We undertook this review to assess the effectiveness of these individuals in meeting the goals of the work hour restrictions and whether they impact other hospital and patient outcomes...
  29. ncbi request reprint Prophylactic antibiotics adversely affect nosocomial pneumonia in trauma patients
    J Jason Hoth
    Department of Surgery, University of Louisville School of Medicine, Kentucky 40292, USA
    J Trauma 55:249-54. 2003
    ..This retrospective study was conducted to assess the effect that prolonged prophylactic antibiotic use has on the development of nosocomial pneumonia and antibiotic use complications...
  30. ncbi request reprint Impact of hollow viscus injuries on outcome of abdominal gunshot wounds
    Brady T Harris
    Department of Surgery, University of Louisville, Louisville, Kentucky 40292, USA
    Am Surg 75:378-84. 2009
    ..Primary repair of HVI is preferred although no survival disadvantage is seen in other forms of repair in marginally stable patients. Definitive repair at the initial operation decreases complications...
  31. ncbi request reprint Hospital cost is reduced by motorcycle helmet use
    Mary Margaret Brandt
    Department of Surgery, Division of Trauma, Burn and Emergency Surgery, University of Michigan Health System, Ann Arbor 48109, USA
    J Trauma 53:469-71. 2002
    ..The purpose of this study was to identify the impact of motorcycle helmet use on patient outcomes and cost of hospitalization, in a state with a mandatory helmet law...
  32. ncbi request reprint The need for early angiographic embolization in blunt liver injuries
    Wendy L Wahl
    Division of Trauma Burn and Emergency Surgery, Department of Surgery, University of Michigan Health System, Ann Arbor, Michigan 48109 0033, USA
    J Trauma 52:1097-101. 2002
    ..Although nonoperative management of blunt liver injury (BLI) has become standard practice, adjuncts to nonoperative therapy, such as angiographic embolization, have not been well characterized...
  33. doi request reprint Catastrophic gastrointestinal injury due to battery acid ingestion
    Deanna D H Franke
    Forensic Toxicology Program, University of Louisville School of Medicine, Louisville, Kentucky, USA
    J Emerg Med 40:276-9. 2011
    ..Due to the corrosive properties of these substances, tissue injury caused by oral exposure can lead to severe esophageal and gastrointestinal burns...
  34. ncbi request reprint Can we make training in surgical critical care more attractive?
    J David Richardson
    Department of Surgery, University of Louisville, School of Medicine, Louisville, Kentucky 40292, USA
    J Trauma 59:1247-8; discussion 1248-9. 2005
  35. ncbi request reprint Selective management of blunt hepatic injuries including nonoperative management is a safe and effective strategy
    Ashley Britton Christmas
    School of Medicine in Louisville, Department of Surgery, University of Louisville, Kentucky 40298, USA
    Surgery 138:606-10; discussion 610-1. 2005
    ..This review assesses the outcome of operative and nonoperative management of liver injury after blunt trauma...
  36. ncbi request reprint Early VATS for blunt chest trauma: a management technique underutilized by acute care surgeons
    Jason W Smith
    Department of Surgery, University of Louisville, Louisville, KY, USA
    J Trauma 71:102-5; discussion 105-7. 2011
    ..Our acute care surgeon (ACS) group aggressively treats complications of penetrating chest trauma with VATS, and our results suggested that the early use of VATS by ACS should be expanded...
  37. ncbi request reprint An analysis of risk-taking behavior among adolescent blunt trauma patients
    David S Foley
    Department of Surgery, University of Louisville School of Medicine, Kentucky 40202, USA
    J Ky Med Assoc 107:170-5. 2009
    ..The impact of risk-taking behavior among adolescent blunt trauma patients is not fully appreciated. This study examined the relationship between adolescent risk-taking behaviors, the resultant injury severity, and outcome for blunt trauma...
  38. doi request reprint Sequential improvements in organ procurement increase the organ donation rate
    Adrian T Billeter
    Department of Surgery, Price Institute of Surgical Research, School of Medicine, University of Louisville, 511 South Floyd Street, Louisville, KY 40202, United States
    Injury 43:1805-10. 2012
    ..The purpose of this article is to propose how sequentially introduced measures can increase organ donation rates as well as improve organ procurement...
  39. ncbi request reprint Decreasing regional neurosurgical workforce-a blueprint for disaster
    Brian G Harbrecht
    Department of Surgery, University of Louisville, 550 S Jackson Street, Louisville, KY 40292, USA
    J Trauma 68:1367-72; discussion 1372-4. 2010
    ..Although many institutions have been individually affected by shortages of NS providing care to injured patients, data on regional changes in NS availability and the effect on patient care are limited...
  40. ncbi request reprint Thoracotomy for blunt trauma: traditional indications may not apply
    Jason J Hoth
    Department of Surgery, University of Louisville School of Medicine, Louisville, Kentucky 40292, USA
    Am Surg 69:1108-11. 2003
    ..Since the majority of such patients have multicavitary injuries that require prior operation and are commonly coagulopathic, caution should be exercised when deciding whether to proceed with thoracotomy based solely on chest tube output...
  41. doi request reprint Traumatic injury may be a predisposing factor for cerebrovascular accident
    Jodi B Wojcik
    Trauma Institute, University of Louisville Hospital, Louisville, Kentucky 40202, USA
    J Trauma Nurs 20:139-43; quiz 144-5. 2013
    ..Several statistically significant differences between the groups were identified. On the basis of these results, trauma appears to be an independent, nonmodifiable risk factor for CVA. ..
  42. doi request reprint To pump or not to pump: a comparison of machine perfusion vs cold storage for deceased donor kidney transplantation
    Robert M Cannon
    Department of Surgery, University of Louisville School of Medicine, Louisville, KY 40204, USA
    J Am Coll Surg 216:625-33; discussion 633-4. 2013
    ..This study was undertaken to evaluate the impact of machine perfusion on early kidney transplant function in the United States...
  43. doi request reprint Necrotizing peripheral vasculitis/vasculopathy following the use of cocaine laced with levamisole
    Russell W Farmer
    Department of Surgery, University of Louisville, Kentucky, USA
    J Burn Care Res 33:e6-e11. 2012
    ..Peripheral vasculitis/vasculopathy with severe necrosis resembling Coumadin necrosis is a relatively recently recognized sequelae from levamisole-adulterated cocaine use...
  44. ncbi request reprint Tertiary care centers: a strategy for fiscal survival
    Jorge L Rodriguez
    Department of Surgery, University of Louisville, Louisville, KY 40201, USA
    Surgery 134:684-9; discussion 689-90. 2003
    ..We assessed the financial outcome of these strategies and attempted to identify those that maintain a balance between cost and reimbursement...
  45. ncbi request reprint Methamphetamine laboratory explosions: a new and emerging burn injury
    Ariel P Santos
    Department of Surgery, Epidemiology and Statistics Training CREST Program, University of Louisville, Louisville, Kentucky 40292, USA
    J Burn Care Rehabil 26:228-32. 2005
    ..It also is associated with lack of insurance coverage and poor follow-up after injury. This injury has a significant impact not only on patients but also on the healthcare system...
  46. pmc Broad-based general surgery training is a model of continued utility for the future
    William G Cheadle
    Department of Surgery, University of Louisville School of Medicine, Louisville, KY 40292, USA
    Ann Surg 239:627-32; discussion 632-6. 2004
    ..Our faculty includes surgeons with both broad-based and narrowly focused practices. In light of duty-hour restrictions and proposed changes in surgical training, we assessed the results of this model over an extended period...
  47. ncbi request reprint Operative fixation of chest wall fractures: an underused procedure?
    J David Richardson
    Department of Surgery, University of Louisville School of Medicine, Louisville, Kentucky 40202, USA
    Am Surg 73:591-6; discussion 596-7. 2007
    ....
  48. ncbi request reprint Emergence of resistant microbes in critical care units is transient, despite an unrestricted formulary and multiple antibiotic trials
    Glen A Franklin
    Department of Surgery, University of Louisville, Louisville, KY 40292, USA
    Surg Infect (Larchmt) 3:135-44. 2002
    ..Antimicrobial resistance data were compared among the surgical intensive care unit (SICU), medical intensive care unit (MICU), and burn unit (BNU)...
  49. doi request reprint Physician-delivered malnutrition: why do patients receive nothing by mouth or a clear liquid diet in a university hospital setting?
    Glen A Franklin
    Departments of Surgery and Medicine, University of Louisville, Louisville, Kentucky 40202, USA
    JPEN J Parenter Enteral Nutr 35:337-42. 2011
    ..Traditional practices of placing patients nil per os (NPO) or on clear liquid diet (CLD) deter delivery of optimal nutrition care and are not always supported by sound physiologic principles...
  50. ncbi request reprint Cardiac impalement from a rib after blunt trauma
    William R Wrightson
    Department of Surgery, University of Louisville, Louisville, Kentucky 40292, USA
    Am Surg 73:465-7. 2007
    ..The diagnosis, surgical approach, and course of the patient are discussed...
  51. ncbi request reprint The utility of D-dimer levels in screening for thromboembolic complications in burn patients
    Wendy L Wahl
    Trauma Burn Center, University of Michigan Health System, 1500 East Medical Center Drive, Ann Arbor, Michigan 48109 0033, USA
    J Burn Care Rehabil 23:439-43. 2002
    ..7 days. D-dimer levels were elevated in 86% of DVT patients at week 1, with a negative predictive value of 94%. The evaluation of elevated D-dimer levels at week 1 may be a useful screening tool for detecting DVT in the burn population...
  52. ncbi request reprint Acute management of exercise treadmill-associated injuries in children
    Gregory H Borschel
    Department of Surgery, University of Michigan, Ann Arbor, Michigan, USA
    J Trauma 55:130-4. 2003
    ..Exercise treadmills have grown in popularity in the past few years. The addition of this type of equipment in the home offers opportunity for injury, particularly in children...
  53. doi request reprint Obesity-induced hepatic hypoperfusion primes for hepatic dysfunction after resuscitated hemorrhagic shock
    Paul J Matheson
    Department of Surgery, University of Louisville, Louisville, KY 40292, USA
    Surgery 146:739-47; discussion 747-8. 2009
    ..We hypothesized that obesity further aggravates liver dysfunction by reduced hepatic perfusion following resuscitated hemorrhagic shock (HEM)...
  54. doi request reprint The evolving management of venous bullet emboli: a case series and literature review
    Keith R Miller
    University of Louisville, Department of Surgery, Louisville, KY 40292, United States
    Injury 42:441-6. 2011
    ..Review of the literature focusing on the reported management of these injuries, comparison of techniques of management, as well as the evolving role of endovascular techniques in the management of bullet emboli is provided...
  55. ncbi request reprint Systemic inflammation after trauma
    Andreas Lenz
    Veterans Affairs Medical Center, Louisville, USA
    Injury 38:1336-45. 2007
    ..The purpose of this review is therefore to describe the immunological events after trauma and to introduce important mediators and pathways of the inflammatory immune response...
  56. ncbi request reprint Motorcycle helmets and head injuries in Kentucky, 1995-2000
    W Jay Christian
    Kentucky Injury Prevention and Research Center, University of Kentucky, USA
    J Ky Med Assoc 101:21-6. 2003
    ..Kentucky's failure to require mandatory helmet use may increase incidence of TBI and severe head injuries among motorcyclists, and cost state government millions of dollars to pay for care for uninsured or Medicaid patients...