Cerebrovascular accidents complicating transcatheter aortic valve implantation: frequency, timing and impact on outcomes

Cerebrovascular accidents (CVA) are considered among the most serious adverse events after transcatheter aortic valve implantation (TAVI). The objective of the present study was to evaluate the frequency and timing of CVA after TAVI and to investigate the impact on clinical outcomes within 30 days of the procedure.

782 consecutive construction work accidents: who is at risk? A 10-year analysis from a Swiss university hospital trauma unit

BACKGROUND: Mortality and morbidity are particularly high in the building industry. The annual rate of non-fatal occupational accidents in Switzerland is 1,133 per 100,000 inhabitants. METHODS: Retrospective analysis of the electronic database of a university emergency centre. Between 2001 and 2011, 782 occupational accidents to construction workers were recorded and analysed using specific demographic and medical keywords. RESULTS: Most patients were aged 30-39 (30.4%). 66.4% of the injured workers were foreigners. This is almost twice as high as the overall proportion of foreigners in Switzerland or in the Swiss labour market. 16% of the Swiss construction workers and 8% of the foreign construction workers suffered a severe injury with ISS >15. There was a trend for workers aged 60 and above to suffer an accident with a high ISS (p = 0.089). CONCLUSIONS: As in other European countries, most patients were in their thirties. Older construction workers suffered fewer injuries, although these tended to be more severe. The injuries were evenly distributed through the working days of the week. A special effort should be made that current health and safety measures are understood and applied by foreign and older construction workers.

Virtopsy -- noninvasive detection of occult bone lesions in postmortem MRI: additional information for traffic accident reconstruction

In traffic accidents with pedestrians, cyclists or motorcyclists, patterned impact injuries as well as marks on clothes can be matched to the injury-causing vehicle structure in order to reconstruct the accident and identify the vehicle which has hit the person. Therefore, the differentiation of the primary impact injuries from other injuries is of great importance. Impact injuries can be identified on the external injuries of the skin, the injured subcutaneous and fat tissue, as well as the fractured bones. Another sign of impact is a bone bruise. The bone bruise, or occult bone lesion, means a bleeding in the subcortical bone marrow, which is presumed to be the result of micro-fractures of the medullar trabeculae. The aim of this study was to prove that bleeding in the subcortical bone marrow of the deceased can be detected using the postmortem noninvasive magnetic resonance imaging. This is demonstrated in five accident cases, four involving pedestrians and one a cyclist, where bone bruises were detected in different bones as a sign of impact occurring in the same location as the external and soft tissue impact injuries.

Influence of Information and Instructions on Human Behavior in Tunnel Accidents: A Virtual Reality Study

Human behavior is a major factor modulating the consequences of road tunnel accidents. We investigated the effect of information and instruction on drivers' behavior as well as the usability of virtual environments to simulate such emergency situations. Tunnel safety knowledge of the general population was assessed using an online questionnaire, and tunnel safety behavior was investigated in a virtual reality experiment. Forty-four participants completed three drives through a virtual road tunnel and were confronted with a traffic jam, no event, and an accident blocking the road. Participants were randomly assigned to a control group (no intervention), an informed group who read a brochure containing safety information prior to the tunnel drives, or an informed and instructed group who read the same brochure and received additional instructions during the emergency situation. Informed participants showed better and quicker safety behavior than the control group. Self-reports of anxiety were assessed three times during each drive. Anxiety was elevated during and after the emergency situation. The findings demonstrate problematic safety behavior in the control group and that knowledge of safety information fosters adequate behavior in tunnel emergencies. Enhanced anxiety ratings during the emergency situation indicate external validity of the virtual environment.

The long arm of time pressure at work: Cognitive failure and commuting near-accidents

This study tests whether cognitive failures mediate effects of work-related time pressure and time control on commuting accidents and near-accidents. Participants were 83 employees (56% female) who each commuted between their regular place of residence and place of work using vehicles. The Workplace Cognitive Failure Scale (WCFS) asked for the frequency of failure in memory function, failure in attention regulation, and failure in action execution. Time pressure and time control at work were assessed by the Instrument for Stress Oriented Task Analysis (ISTA). Commuting accidents in the last 12 months were reported by 10% of participants, and half of the sample reported commuting near-accidents in the last 4 weeks. Cognitive failure significantly mediated the influence of time pressure at work on near-accidents even when age, gender, neuroticism, conscientiousness, commuting duration, commuting distance, and time pressure during commuting were controlled for. Time control was negatively related to cognitive failure and neuroticism, but no association with commuting accidents or near-accidents was found. Time pressure at work is likely to increase cognitive load. Time pressure might, therefore, increase cognitive failures during work and also during commuting. Hence, time pressure at work can decrease commuting safety. The result suggests a reduction of time pressure at work should improve commuting safety.

Injury severity and mortality of adult zebra crosswalk and non-zebra crosswalk road crossing accidents: a cross-sectional analysis

PRINCIPALS Over a million people worldwide die each year from road traffic injuries and more than 10 million sustain permanent disabilities. Many of these victims are pedestrians. The present retrospective study analyzes the severity and mortality of injuries suffered by adult pedestrians, depending on whether they used a zebra crosswalk. METHODS Our retrospective data analysis covered adult patients admitted to our emergency department (ED) between 1 January 2000 and 31 December 2012 after being hit by a vehicle while crossing the road as a pedestrian. Patients were identified by using a string term. Medical, police and ambulance records were reviewed for data extraction. RESULTS A total of 347 patients were eligible for study inclusion. Two hundred and three (203; 58.5%) patients were on a zebra crosswalk and 144 (41.5%) were not. The mean ISS (injury Severity Score) was 12.1 (SD 14.7, range 1-75). The vehicles were faster in non-zebra crosswalk accidents (47.7 km/n, versus 41.4 km/h, p<0.027). The mean ISS score was higher in patients with non-zebra crosswalk accidents; 14.4 (SD 16.5, range 1-75) versus 10.5 (SD13.14, range 1-75) (p<0.019). Zebra crosswalk accidents were associated with less risk of severe injury (OR 0.61, 95% CI 0.38-0.98, p<0.042). Accidents involving a truck were associated with increased risk of severe injury (OR 3.53, 95%CI 1.21-10.26, p<0.02). CONCLUSION Accidents on zebra crosswalks are more common than those not on zebra crosswalks. The injury severity of non-zebra crosswalk accidents is significantly higher than in patients with zebra crosswalk accidents. Accidents involving large vehicles are associated with increased risk of severe injury. Further prospective studies are needed, with detailed assessment of motor vehicle types and speed.

Risk Factors for Intracranial Haemorrhage in Accidents Associated with the Shower or Bathtub

BACKGROUND There has been little research on bathroom accidents. It is unknown whether the shower or bathtub are connected with special dangers in different age groups or whether there are specific risk factors for adverse outcomes. METHODS This cross-sectional analysis included all direct admissions to the Emergency Department at the Inselspital Bern, Switzerland from 1 January 2000 to 28 February 2014 after accidents associated with the bathtub or shower. Time, age, location, mechanism and diagnosis were assessed and special risk factors were examined. Patient groups with and without intracranial bleeding were compared with the Mann-Whitney U test.The association of risk factors with intracranial bleeding was investigated using univariate analysis with Fisher's exact test or logistic regression. The effects of different variables on cerebral bleeding were analysed by multivariate logistic regression. RESULTS Two hundred and eighty (280) patients with accidents associated with the bathtub or shower were included in our study. Two hundred and thirty-five (235) patients suffered direct trauma by hitting an object (83.9%) and traumatic brain injury (TBI) was detected in 28 patients (10%). Eight (8) of the 27 patients with mild traumatic brain injuries (GCS 13-15), (29.6%) exhibited intracranial haemorrhage. All patients with intracranial haemorrhage were older than 48 years and needed in-hospital treatment. Patients with intracranial haemorrhage were significantly older and had higher haemoglobin levels than the control group with TBI but without intracranial bleeding (p<0.05 for both).In univariate analysis, we found that intracranial haemorrhage in patients with TBI was associated with direct trauma in general and with age (both p<0.05), but not with the mechanism of the fall, its location (shower or bathtub) or the gender of the patient. Multivariate logistic regression analysis identified only age as a risk factor for cerebral bleeding (p<0.05; OR 1.09 (CI 1.01;1.171)). CONCLUSION In patients with ED admissions associated with the bathtub or shower direct trauma and age are risk factors for intracranial haemorrhage. Additional effort in prevention should be considered, especially in the elderly.

Bilateral Accidents with Intrinsically Interdependent Costs of Precaution

The standard economic model of bilateral precaution postulates an interdependency between the care taken by injurers and victims that operates through the effects of each on the expected accident loss. This paper considers situations in which each party's precaution affects not only expected accident loss, but also directly affects the other party's cost of taking precaution. Generalizing the economic model of tort law in this way allows for a more complete analysis of when standard tort rules can and cannot induce optimal precaution. When this additional externality is introduced into a model of unilateral harm (where all accident losses are borne by the victim), none of the standard tort liability rules induces socially optimal behavior by both parties. Moreover, under a contributory negligence rule, the only equilibrium is in mixed strategies; this gives rise to the possibility of litigation in equilibrium. A 'tort-like' liability rule that induces socially optimal behavior by both parties is then characterized; this involves a payment by victims to non-negligent injurers whenever an accident occurs. The model is then extended to consider the case of bilateral harm (where both parties suffer accident losses). It is shown that, as long as both parties can sue to recover their accident losses, all negligence-based tort rules lead to socially optimal behavior by both parties.

Dietrich de Freiberg, Oeuvres choisies, vol. I : Substances, quidités et accidents, textes latins traduits et annotés par Catherine König-Pralong, avec la collaboration de Ruedi Imbach, Introduction de Kurt Flasch, Paris, Vrin, 2008 (Bibliothèque des textes philosophiques), 222 p. ; ISBN 978-2-71116-1983-2

Fil: Ocampo, Fernanda.

Discriminant analysis of the specialty of elite cyclist

The different demands of competition coupled with the morphological and physiological characteristics of cyclists have led to the appearance of cycling specialities. The aims of this study were to determine the differences in the anthropometric and physiological features in road cyclists with different specialities, and to develop a multivariate model to classify these specialities and predict which speciality may be appropriate to a given cyclist. Twenty male, elite amateur cyclists were classified by their trainers as either flat terrain riders, hill climbers, or all-terrain riders. Anthropometric and cardiorespiratory studies were then undertaken. The results were analysed by MANOVA and two discriminant tests. Most differences between the speciality groups were of an anthropometric nature. The only cardiorespiratory variable that differed significantly (p < 0.05) was maximum oxygen consumption with respect to body weight (VO2max/kg). The first discriminant test classified 100% of the cyclists within their true speciality; the second, which took into account only anthropometric variables, correctly classified 75%. The first discriminant model allows the likely speciality of still non-elite cyclists to be predicted from a small number of variables, and may therefore help in their specific training.