Suchergebnisse

Traumatic brain injury is the leading cause of brain injury in our society with 235 per 100,000 inhabitants per year in the European Union and about 500 per 100,000 inhabitants per year in the United States. About 80% of all these events are accounted for as mild cases. At the same time, whiplash-associated disorder is one of the most frequent consequences of motor vehicle related accidents affecting about 300 per 100,000 inhabitants per year in the United States and Western European countries. Both brain injuries are frequently underestimated due to their apparent low severity and because in many cases these symptoms disappear within few weeks. Nevertheless, several patients describe long-lasting discomfort in the absence of detectable alterations with conventional clinical diagnostic tools or imaging studies, such as magnetic resonance imaging (MRI) and computed tomography (CT). Therefore, the mechanism behind the long-lasting manifestations remains unknown. It is within this context that functional imaging techniques, such as positron emission tomography (PET) have the potential to provide insight into the undetected changes related to mild traumatic brain injury and whiplash-associated disorder.

Sulfur mustard (SM) is a strong vesicant agent which has been used in several military conflicts. Large stockpiles still exist to the present day. SM is believed to be a major threat to civilian populations because of the persistent asymmetric threat by non-state actors, such as terrorist groups, its easy synthesis and handling and the risk of theft from stockpiles. Following an asymptomatic interval of several hours, acute SM exposure produces subepidermal skin blisters, respiratory tract damage, eye lesions and bone marrow depression. Iranian victims of SM exposure during the Iran-Iraq (1984-1988) war were treated at intensive care units of 3 Munich hospitals. All 12 patients were injured following aerial attacks with SM filled bombs, which exploded in a distance between 5 and 30m. All patients soon noted an offensive smell of garlic, addle eggs or oil roasted vegetables. No individual protective equipment was used. Eye itching and skin blistering started 2h after SM exposure. Some patients complained of nausea, dizziness and hoarseness. 4h after exposure, most patients started vomiting. Eye symptoms worsened and most patients suffered from temporary blindness due to blepharospasm and lid oedema. Additionally, pulmonary symptoms such as productive cough occurred. Patients were transferred to Munich 4-17 days after SM exposure. On admission all patients showed significant skin blistering and pigmentation. Conjunctivitis and photophobia were the major eye symptoms. Pulmonary symptoms, including productive cough were persistent. Bronchoscopy revealed massive inflammation of the trachea with signs of necrosis. 3 patients needed tracheotomy. Chest X-ray did not yield abnormal observations. This presentation summarizes the experience of treating SM victims in Munich and discusses therapeutic implications.

7‐11 November 2010, Tenth International Congress on Drug Therapy in HIV Infection, Glasgow, UK

IntroductionInjury severity measurement is integral to meaningful benchmarking and injury prevention strategies. Numerous injury mortality prediction methods have been developed and advanced, however, no consensus on the best model has been reached.
Objectives and ApproachThe International Collaborative Effort (ICE) on Injury Statistics propose to develop a set of trauma mortality models for use in diverse settings by deriving and validating models with data from member countries including Wales, Australia, New Zealand and USA. The ICE team will create a definitive list of injuries required to identify trauma patients using ICD-10 codes. Models will be developed using Welsh data then validated with data from other member nations. The outcomes of interest are in-hospital and 30-day mortality. Models will be used for country benchmarking by comparing the distribution of injury severity and outcomes between nations.
ResultsInitial results from replicating the model published by Wada, et al., as closely as possible using 348,433 cases held in SAIL for the years 2000 to 2013 achieved an AUROC value of 0.908 (95% CI 0.905-0.911). This model included 38 injury indicator variables, age, sex and comorbidity score. From 2009 onwards, the estimated number of deaths exceeded the actual number of deaths indicating improving risk adjusted survival. We aim to further enhance these models with additional covariates by linking with critical care data to enable us to determine the level of support patients received during their hospital stay, linking with laboratory data to provide indications of multiple organ dysfunction, acute physiological response and infection, and with GP data to incorporate measures of frailty.
Conclusion/ImplicationsUsing multi-sourced population based linked data allows us to develop a suite of enhanced mortality models for use in observational and interventional research. Applying these methods to data from different countries will allow comparisons to be made of trends in severity and outcomes and support collaborative research.

Unintentional injury is now the principle cause of child death in developed nations, and the prevention of it has become a key focus of health professionals. This paper presents a sociological/philosophical enquiry into child accident prevention discourse and its implications for practice. With a critical distillation of major child accident prevention literature spanning the last two decades, significant findings, recommendations and themes are identified. It is observed which preventative measures have been deemed successful, with the placement of strategies into the appropriate 'E' category - education, engineering, enforcement, and environment. This process demonstrates the difficulties with and paradoxes inherent in the notion of accident prevention and buttresses a central hypothesis: that the child accident or injury in risk society is simultaneously predictable and random; knowable at a statistical level but enigmatic at an individual one. The accident, previously configured as unpredictable and inexplicable, has become wholly subject to risk society's raison d'etre, the laws of probability, and is thus rendered predictable and preventable on a magnified scale.

Neuronal plasticity is a fundamental factor in cognitive outcome following traumatic brain injury. Brain-derivedneurotrophic factor (BDNF), a member of the neurotrophin family, plays an important role in this process. While thereare many ways to measure cognitive outcome, general cognitive intelligence is a strong predictor of everyday decisionmaking,occupational attainment, social mobility and job performance. Thus it is an excellent measure of cognitive outcomefollowing traumatic brain injury (TBI). Although the importance of the single-nucleotide polymorphisms polymorphism oncognitive function has been previously addressed, its role in recovery of general intelligence following TBI is unknown. Wegenotyped male Caucasian Vietnam combat veterans with focal penetrating TBI (pTBI) (n = 109) and non-head injuredcontrols (n = 38) for 7 BDNF single-nucleotide polymorphisms. Subjects were administrated the Armed Forces QualificationTest (AFQT) at three different time periods: pre-injury on induction into the military, Phase II (10–15 years post-injury, andPhase III (30–35 years post-injury). Two single-nucleotide polymorphisms, rs7124442 and rs1519480, were significantlyassociated with post-injury recovery of general cognitive intelligence with the most pronounced effect at the Phase II timepoint, indicating lesion-induced plasticity. The genotypes accounted for 5% of the variance of the AFQT scores,independently of other significant predictors such as pre-injury intelligence and percentage of brain volume loss. Thesedata indicate that genetic variations in BDNF play a significant role in lesion-induced recovery following pTBI. Identifying theunderlying mechanism of this brain-derived neurotrophic factor effect could provide insight into an important aspect ofpost-traumatic cognitive recovery.

In the aftermath of the killing at Virginia Tech on April 16, 2007, a vast amount of media coverage has been dedicated to the personal accounts of those affected by the disaster. Guided by the presumption that a subject's account of what he or she observes and feels faithfully reflects reality, the uncritical elevation of experience naturalizes accounts of injury produced by the event itself. Framed by Joan W. Scott's examination of the evidence of experience, I consider how foundational treatments of experience are used to narrate the disaster, effectively leading to its dehistoricization. In response, I propose a reading of the event that considers the question, "What does it means to be injured?" as a starting point for historicizing experience.

Analysis of occupational injuries and fatalities within the wild-catch Australian Commercial Fishing Industry (ACFI) is complicated by fishing crew (masters, deckhands etc) classification as workers being dependent upon the applicable occupational health and safety, and worker's compensation legislation of the relevant State or Territory. While fishing vessels are considered a workplace consistently across all State's and Territories Work Health and Safety (WHS) / Occupational Health and Safety (OHS) jurisdiction's legislation, the people who work on them may not be deemed to be workers or employees as per state and territory workers compensation legislation. The exclusion of fishing crew as workers subsequently results in lack of worker's compensation insurance data to analyse. Whilst designated marine incidents are required to be reported to the Australian Maritime Safety Authority (AMSA), it is recognised that severe under-reporting is present across the industry. Differences in both the definition of 'work-related' incidents, and data coding, between OHS and industry regulatory bodies means the ability to consolidate the various relevant datasets and literature is limited.

A substantial minority of patients who survive an acquired brain injury develop a state of sympathetic hyperactivity that can persist for weeks or months, consisting of periodic episodes of increased heart rate and blood pressure, sweating, hyperthermia, and motor posturing, often in response to external stimuli. The unifying term for the syndrome—paroxysmal sympathetic hyperactivity (PSH)—and clear diagnostic criteria defined by expert consensus were only recently established. PSH has predominantly been described after traumatic brain injury (TBI), in which it is associated with worse outcomes. The pathophysiology of the condition is not completely understood, although most researchers consider it to be a disconnection syndrome with paroxysms driven by a loss of inhibitory control over excitatory autonomic centres. Although therapeutic strategies to alleviate sympathetic outbursts have been proposed, their effects on PSH are inconsistent between patients and their influence on outcome is unknown. Combinations of drugs are frequently used and are chosen on the basis of local custom, rather than on objective evidence. New rigorous tools for diagnosis could allow better characterisation of PSH to enable stratification of patients for future therapeutic trials. ; GM is funded by the Research Foundation, Flanders as senior clinical investigator. DKM is supported by the National Institute for Healthcare Research (NIHR), UK, through the Acute Brain Injury and Repair theme of the Cambridge NIHR Biomedical Research Centre and a NIHR Senior Investigator Award, and is supported by a European Union Framework Program 7 grant (CENTER-TBI; grant agreement no. 602150).

Objective: This study aimed to assess the perception of risk of low-back injury of individuals from four groups: office/administrative employees, dental workers (dentists/dental hygienists), firefighters, and undergraduate students. Background: The concept of worker's perception of injury risk has been used to set safe material-handling limits and to determine compliance with health and safety regulations but has not been used to identify perceptual differences among occupations or potential deficiencies in risk awareness. Method: Participants ( N = 232) were presented with eight images of different low-back postures/tasks and were required to rate their perceived magnitude of low-back risk on a scale from 0 ( no risk) to 10 ( extreme risk). Results: Office/administrative and dental workers rated postures higher than firefighters and students. Individuals from all groups perceived kyphotic postures as having a higher low-back risk than lordotic postures. Further, office and dental workers, compared to firefighters and students, perceived sitting postures to have a relatively higher level of risk, likely due to these postures being typically adopted by these individuals at work. No relationship between previous low-back pain and risk rating was observed in this study. Conclusion: Low-back injury risk perception varies between occupations/groups and may be a result of different exposures. Application: The results of this study can potentially be used to implement occupation-specific training programs to ensure that the scientific research regarding low-back injuries is being properly conveyed to employees across all sectors.