What is the incidence of intracranial bleeding in patients with mild traumatic brain injury? A retrospective study in 3088 Canadian CT head rule patients

OBJECTIVE Only limited data exists in terms of the incidence of intracranial bleeding (ICB) in patients with mild traumatic brain injury (MTBI). METHODS We retrospectively identified 3088 patients (mean age 41 range (7-99) years) presenting with isolated MTBI and GCS 14-15 at our Emergency Department who had undergone cranial CT (CCT) between 2002 and 2011. Indication for CCT was according to the "Canadian CT head rules." Patients with ICB were either submitted for neurosurgical treatment or kept under surveillance for at least 24 hours. Pearson's correlation coefficient was used to correlate the incidence of ICB with age, gender, or intake of coumarins, platelet aggregation inhibitors, or heparins. RESULTS 149 patients (4.8%) had ICB on CCT. No patient with ICB died or deteriorated neurologically. The incidence of ICB increased with age and intake of anticoagulants without clinically relevant correlation (R = 0.11; P < 0.001; R = -0.06; P < 0.001). CONCLUSION Our data show an incidence of 4.8% for ICB after MTBI. However, neurological deterioration after MTBI seems to be rare, and the need for neurosurgical intervention is only required in selected cases. The general need for CCT in patients after MTBI is therefore questionable, and clinical surveillance may be sufficient when CCT is not available.

Flow-R, a model for susceptibility mapping of debris flows and other gravitational hazards at a regional scale

The development of susceptibility maps for debris flows is of primary importance due to population pressure in hazardous zones. However, hazard assessment by process-based modelling at a regional scale is difficult due to the complex nature of the phenomenon, the variability of local controlling factors, and the uncertainty in modelling parameters. A regional assessment must consider a simplified approach that is not highly parameter dependant and that can provide zonation with minimum data requirements. A distributed empirical model has thus been developed for regional susceptibility assessments using essentially a digital elevation model (DEM). The model is called Flow-R for Flow path assessment of gravitational hazards at a Regional scale (available free of charge under http://www.flow-r.org) and has been successfully applied to different case studies in various countries with variable data quality. It provides a substantial basis for a preliminary susceptibility assessment at a regional scale. The model was also found relevant to assess other natural hazards such as rockfall, snow avalanches and floods. The model allows for automatic source area delineation, given user criteria, and for the assessment of the propagation extent based on various spreading algorithms and simple frictional laws. We developed a new spreading algorithm, an improved version of Holmgren's direction algorithm, that is less sensitive to small variations of the DEM and that is avoiding over-channelization, and so produces more realistic extents. The choices of the datasets and the algorithms are open to the user, which makes it compliant for various applications and dataset availability. Amongst the possible datasets, the DEM is the only one that is really needed for both the source area delineation and the propagation assessment; its quality is of major importance for the results accuracy. We consider a 10 m DEM resolution as a good compromise between processing time and quality of results. However, valuable results have still been obtained on the basis of lower quality DEMs with 25 m resolution.

Schreibprozesse: medial, didaktisch, intellektuell – Der Kommentar als editionsphilologische Aufgabe

Schon immer hat sich die Gotthelf-Forschung eher mit der kreativen Originalität, seiner schriftstellerischen Impulsivität beschäftigt, und es läge insofern die Versuchung nahe, das psychophysische Profil des Schreibers auch in der Lektüre der Handschrift wieder aufzusuchen. Die nähere Beschäftigung mit Gotthelf zeigt freilich einen Autor, der nicht als ein Originalgenie aus der eigenen Kreativität seine Werke schuf, sondern sein Erzählen in der Auseinandersetzung mit literarischen Vorbildern und Gattungstraditionenen, mit zeittypischen Medienrhetoriken sowie einem christlichen und politischen Engagement verband. Die Aufgabe der Edition besteht nicht zuletzt darin, anhand der Handschriften und Drucke den Schreibprozess als Teil einer diskursiven Tätigkeit in einem konkreten literarischen, medialen und politischen Umfeld darzustellen. Erst die umfassende historische Kommentierung erfüllt die Aufgabe, Texte und Schreiben einer Gegenwart zu vermitteln.

Das Krokodil im Silberauschachen

Erstmals wird mit dem von Gotthelf geführten Neuen Berner-Kalender ein Volkskalender in einer vollständigen kritischen Edition vorgelegt. Zum Vorschein kommen etwa satirische Qualitäten, deren politische Dimension bisher ausgeblendet worden ist.

Jeremias Gotthelf. Historisch-kritische Gesamtausgabe (HKG)

Mit der Historisch-kritischen Gesamtausgabe HKG der Werke und Briefe Jeremias Gotthelfs wird eine der grössten Lücken in der Aufarbeitung der deutschsprachigen Literatur des 19. Jahrhunderts geschlossen. In der Ausgabe der Sämtlichen Werke (1911 bis 1977) wurden die Korrespondenzen, die Predigten und die Publizistik nur unvollständig und ungenügend berücksichtigt. Gerade aber die Publizistik und die Predigten verhelfen zu neuen Einsichten in sein erzählerisches Werk. In diesen Texten zeigen sich bereits vor dem Bauern-Spiegel (1837) der impulsive satirische Zeitkritiker, der Analytiker menschlicher Schwächen aus republikanisch-rebellischem Geist und der Mahner zu verantwortlichem Handeln aus christlichen Glaubensgrundsätzen. Die erstmalig vollständige kommentierte Edition dieser Schriften, mit der die HKG eröffnet wird, ermöglicht es, Gotthelfs erzählerisches Werk als Auseinandersetzung mit der Schweizer Geschichte der kritischen, turbulenten Jahre vom liberalen Umsturz 1831 bis zu den ersten Jahren nach der Gründung des Schweizerischen Bundesstaates 1848 zu lesen. Die Kommentare machen sichtbar, in welchem Masse Gotthelfs Werke an den zeitgenössischen Diskursen über Volksbildung und Staatsbürgererziehung, zur sozialen Frage und zu pädagogischen Problemen sowie zum technischen und ökonomischen Fortschritt teilhaben. Die HKG erfüllt den Wunsch nach einer sämtliche Textzeugen berücksichtigenden und zuverlässigen Ausgabe der Werke Gotthelfs. Die wichtigste Erzählsammlung mit programmatischem Anspruch Bilder und Sagen aus der Schweiz (1843-1846) wird erstmals wieder als Zyklus ediert. Ebenso werden auch die vollständigen Hefte des Neuen Berner-Kalenders (1840-1845) als ganzes Kalenderheft mit ausführlichem Kommentar präsentiert. Die Kommentare erkunden die Verflechtungen zwischen Tagespublizistik, Predigttätigkeit, Kalenderarbeit und dem Erzählwerk.

Towards a consensus on a hearing preservation classification system

The comprehensive Hearing Preservation classification system presented in this paper is suitable for use for all cochlear implant users with measurable pre-operative residual hearing. If adopted as a universal reporting standard, as it was designed to be, it should prove highly beneficial by enabling future studies to quickly and easily compare the results of previous studies and meta-analyze their data. Objectives: To develop a comprehensive Hearing Preservation classification system suitable for use for all cochlear implant users with measurable pre-operative residual hearing. Methods: The HEARRING group discussed and reviewed a number of different propositions of a HP classification systems and reviewed critical appraisals to develop a qualitative system in accordance with the prerequisites. Results: The Hearing Preservation Classification System proposed herein fulfills the following necessary criteria: 1) classification is independent from users' initial hearing, 2) it is appropriate for all cochlear implant users with measurable pre-operative residual hearing, 3) it covers the whole range of pure tone average from 0 to 120 dB; 4) it is easy to use and easy to understand.

Detection of Clostridium perfringens type C in pig herds following disease outbreak and subsequent vaccination

Immunisation of sows using Clostridium perfringens type C toxoid vaccines is recommended to prevent necrotising enteritis (NE) on pig breeding farms. Absence of disease, however, oftentimes leads to the false assumption of pathogens being eradicated. The prevalence of C perfringens type C was determined by PCR in faecal samples of piglets and sows in three Swiss pig breeding farms two to four years after implementation of a vaccination programme following disease outbreaks. C perfringens type C could still be detected several years after an outbreak despite absence of NE. In-herd prevalence of the pathogens varied significantly between the farms and was also lower compared with a farm which experienced a recent outbreak. In conclusion, C perfringens type C can be detected on once-affected farms, even in the absence of NE for several years.

Does normalized signal intensity of cervical discs on T2 weighted MRI images change in whiplash patients?

PURPOSE We tested the hypothesis that whiplash trauma leads to changes of the signal intensity of cervical discs in T2-weighted images. METHODS AND MATERIALS 50 whiplash patients (18-65 years) were examined within 48h after motor vehicle accident, and again after 3 and 6 months and compared to 50 age- and sex-matched controls. Signal intensity in ROI's of the discs at the levels C2/3 to C7/T1 and the adjacent vertebral bodies were measured on sagittal T2 weighted MR images and normalized using the average of ROI's in fat tissue. The contrast between discs and both adjacent vertebrae was calculated and disc degeneration was graded by the Pfirrmann-grading system. RESULTS Whiplash trauma did not have a significant effect on the normalized signals from discs and vertebrae, on the contrast between discs and adjacent vertebrae, or on the Pfirrmann grading. However, the contrast between discs and adjacent vertebrae and the Pfirrmann grading showed a strong correlation. In healthy volunteers, the contrast between discs and adjacent vertebrae and Pfirrmann grading increased with age and was dependent on the disc level. CONCLUSION We could not find any trauma related changes of cervical disc signal intensities. Normalized signals of discs and Pfirrmann grading changed with age and varied between disc levels with the used MR sequence.

Normative MR Cervical Spinal Canal Dimensions

Purpose To provide normal values of the cervical spinal canal and spinal cord dimensions in several planes with respect to spinal level, age, sex, and body height. Materials and Methods This study was approved by the institutional review board; all individuals provided signed informed consent. In a prospective multicenter study, two blinded raters independently examined cervical spine magnetic resonance (MR) images of 140 healthy volunteers who were white. The midsagittal diameters and areas of spinal canal and spinal cord, respectively, were measured at the midvertebral levels of C1, C3, and C6. A multivariate general linear model described the influence of sex, body height, age, and spinal level on the measured values. Results There were differences for sex, spinal level, interaction between sex and level, and body height, while age had significant yet limited influence. Normative ranges for the sagittal diameters and areas of spinal canal and spinal cord were defined at C1, C3, and C6 levels for men and women. In addition to a calculation of normative ranges for a specific sex, spinal level, age, and body height data, data for three different height subgroups at 45 years of age were extracted. These results show a range of the spinal canal dimensions at C1 (from 10.7 to 19.7 mm), C3 (from 9.4 to 17.2 mm), and C6 (from 9.2 to 16.8 mm) levels. Conclusion : The dimensions of the cervical spinal canal and cord in healthy individuals are associated with spinal level, sex, age, and height. © RSNA, 2013 Online supplemental material is available for this article.