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Accidents
Kinds of Accidents Terms modified by Accidents Selected AbstractsNear patient blood ketone measurements and their utility in predicting diabetic ketoacidosisDIABETIC MEDICINE, Issue 2 2005S. Harris Abstract Aim To assess the utility of near patient blood ketone measurements in predicting diabetic ketoacidosis (DKA) among a group of hyperglycaemic unwell patients presenting to a hospital emergency department. Methods Near patient blood ,-hydroxybutyrate (,-OHB) testing has recently been introduced as a new tool in our hospital Accident and Emergency department (A&E) for patients with a finger-prick glucose of > 11 mmol/l. We reviewed the records of the first 50 patients to have a ,-OHB measurement to establish if they developed DKA or received treatment with intravenous insulin within 48 h of presentation. We then compared the diagnostic power of ,-OHB measurements with other clinical, physiological and biochemical markers of DKA. Results Nine patients had DKA, eight had a compensated metabolic acidosis secondary to raised serum ketones, and 33 had no evidence of DKA during the following 48 h. The median (range) ,-OHB levels in each group were 6.0 (3.1,6.0) mmol/l, 3.4 (1.2,5.7) mmol/l, and 0.1 (0.0,1.2) mmol/l, respectively. A ,-OHB level of , 3.0 mmol/l had a sensitivity of 100% and specificity of 88% for DKA. All those with ,-OHB level > 3.0 mmol/l required treatment with intravenous insulin. Conclusion Measuring ,-OHB when a hyperglycaemic patient is identified could offer a simple method of identifying at an early stage those patients at highest risk of DKA (,-OHB > 3.0 mmol/l), and redirecting the search for a diagnosis in others (,-OHB < 1.0 mmol/l). [source] The causes and consequences of maxillofacial injuries in elderly peopleGERODONTOLOGY, Issue 1 2002K. Rehman Abstract Objective: The occurrence of trauma in older people is well-documented; however the incidence of maxillofacial trauma is scarcely reported. Therefore, the objective of this study is to determine the causes and consequences of maxillofacial trauma in older people. Design: A five-year (March 95 - March 2000) retrospective study was earned out of all patients over the age of 65 years with facial trauma presenting to Accident and Emergency Department (A&E). The information was collected using the medical notes and discharge summaries. Setting: The Departments of A&E and Maxillofacial Surgery. Subjects: A total of 42 patients' records were examined for study related data. Results: A total of 42 patients were seen during the study period. Thirty-six gave a history of a fall, of which 15 had tripped, 5 had slipped, 3 resulted from a Transient Ischaemic Attack (TIA), 1 as a result of alcohol abuse, in 1 a prosthetic knee gave way and 11 gave no cause for the fall. Of the remaining 6 patients. 5 were assaulted and 1 had a wardrobe fall on top of him. The majority of the falls occurred during the winter months. Maxillofacial injuries were noted in 27 of the 42 patients. Sixteen patients had cheekbone fractures, 8 mandibular fractures, 2 midface and 1 orbital complex fracture. Twenty-five percent of cheekbone fractures and 50% of mandibular fractures were treated surgically. Medical history was noted in 27 patients. Conclusions: This study clearly demonstrates the majority of the facial trauma in the older people can be treated conservatively unless the patients complain of functional problems. [source] Shared patients: multiple health and social care contactHEALTH & SOCIAL CARE IN THE COMMUNITY, Issue 4 2001J. Keene PhD Abstract The paper describes results from the ,Tracking Project', a new method for examining agency overlap, repeat service use and shared clients/patients amongst social and health care agencies in the community. This is the first project in this country to combine total population databases from a range of social, health care and criminal justice agencies to give a multidisciplinary database for one county (n = 97 162 cases), through standardised anonymisation of agency databases, using SOUNDEX, a software programme. A range of 20 community social and health care agencies were shown to have a large overlap with each other in a two-year period, indicating high proportions of shared patients/clients. Accident and Emergency is used as an example of major overlap: 16.2% (n = 39 992) of persons who attended a community agency had attended Accident and Emergency as compared to 8.2% (n = 775 000) of the total population of the county. Of these, 96% who had attended seven or more different community agencies had also attended Accident and Emergency. Further statistical analysis of Accident and Emergency attendance as a characteristic of community agency populations (n = 39 992) revealed that increasing frequency of attendance at Accident and Emergency was very strongly associated with increasing use of other services. That is, the patients that repeatedly attend Accident and Emergency are much more likely to attend more other agencies, indicating the possibility that they share more problematic or difficult patients. Research questions arising from these data are discussed and future research methods suggested in order to derive predictors from the database and develop screening instruments to identify multiple agency attenders for targeting or multidisciplinary working. It is suggested that Accident and Emergency attendance might serve as an important predictor of multiple agency attendance. [source] Seasonal variation in emergency referrals to a Surgical Assessment UnitINTERNATIONAL JOURNAL OF CLINICAL PRACTICE, Issue 1 2009S. T. Ward Summary Objectives:, To identify any seasonal variation in the pattern of referrals to the Surgical Assessment Unit (SAU). Methods:, Admission data to the SAU were collected prospectively during two audit periods of 13 weeks each (winter 2004/2005 and summer 2005). The data were analysed comparing numbers of admissions over the two audit periods and variations in the presenting complaint. Results:, There were a significantly greater number of referrals to the SAU in the summer compared with winter (999 vs. 849, p = 0.026). Whilst there were no significant differences in the sex distribution of patients presenting with general surgical symptoms, a significantly greater proportion of male patients presented with urological symptoms. Additionally, a significantly greater proportion of patients presented in the summer with scrotal/testicular symptoms compared with the winter (13.9% vs. 8.5%, p = 0.02). There was no significant difference between the two periods in terms of other diagnoses. In both study periods, the SAU was busy during weekdays compared with weekends. Whilst most patients arrived in the SAU between 9 am and midnight a smaller but not insignificant number arrived outside of these hours. Conclusions:, Summer compared with winter was a busy period for the SAU. This may be important in managing emergency surgical admissions. A significantly greater proportion of patients presented with scrotal/testicular symptoms during the summer, the reasons for which are unclear. The SAU diverts workload away from busy Accident & Emergency departments. [source] Deliberate self-harm (DSH) among older people: a retrospective study in Barnet, North LondonINTERNATIONAL JOURNAL OF GERIATRIC PSYCHIATRY, Issue 2 2005Florian Alexander Ruths Abstract Background Rates of suicide remain high among older people and those who deliberately self harm are believed to be at an increased risk of killing themselves in the future. If older people who deliberately harm themselves are to be helped by developments in services we need to understand what currently happens to them in terms of service provision and outcome. Methods A retrospective paper and electronic case note survey was carried out on all older people living in the London Borough of Barnet who presented to Accident & Emergency Departments with DSH over a two-year period. Ensuing actions and events were then tracked. Results Forty-three older people with DSH were identified. 18/43 (42%) had previous contact with local psychiatric services. The main method of DSH was overdose of medication (36/43 or 84%). Compared to the general population there were more women and widows. There were similar levels of physical ill-health. Thirty-seven of 43 (86%) received documented psychiatric input outside of hospital following the DSH. The mean follow-up period was 789.0 days (SD 419.8) and during this time 8/43 (19%) had a further documented episode of DSH, and 18/43 (40%) died from natural causes. Conclusions This study confirms the need for improved documentation of DSH and its coding; this needs to be reviewed at local and national level. The vast majority of older people who attempt suicide do have subsequent contact with psychiatric services. There is a strong likelihood of repeat DSH and a higher risk of death by natural causes, emphasising the need to conceptualise DSH as a risk factor relevant to all medical specialities. Copyright © 2005 John Wiley & Sons, Ltd. [source] Accident not intention: Llyn Cerrig Bach, Isle of Anglesey, Wales,site of an Iron Age shipwreckINTERNATIONAL JOURNAL OF NAUTICAL ARCHAEOLOGY, Issue 1 2002Owain T. P. Roberts The assemblage recovered fortuitously from Llyn Cerrig Bach in 1942 has been assumed without evidence to be the result of a Late Iron Age casting of votive offerings into that lake. The circumstances of its recovery and a consideration of the natural forces that have worked great changes to the coastline of south-west Anglesey suggest an alternative origin for the assemblage, that of its being the remains of cargo from a trading vessel lost about 50 BC. [source] Accident and emergency staff opinion on the effects of family presence during adult resuscitation: critical literature reviewJOURNAL OF ADVANCED NURSING, Issue 4 2008Wendy Walker Abstract Title.,Accident and emergency staff opinion on the effects of family presence during adult resuscitation: critical literature review. Aim., This paper is a report of a critical literature review to identify the positive and negative effects of family presence during adult resuscitation, as perceived by accident and emergency healthcare staff based in primary (out-of-hospital) and secondary (in-hospital) environments of care. Background., The controversial practice of family presence during resuscitation of adults has stimulated debate over the past two decades, giving rise to a growing body of literature and the development of clinical guidelines for practice. Methods., A search was carried out for the period 1987,2007 using the Science Direct, CINAHL, Medline, EMBASE, psychINFO and BNI databases and the search terms resuscitation, witnessed resuscitation, family presence, relatives' presence, attitudes and opinions and accident and emergency. Results., Eighteen studies were included in the critical review, primarily comprising retrospective survey research. The majority of studies were descriptive in design. A standardized approach to the appraisal process was achieved through the utilization of guidelines for critiquing self-reports. The findings revealed that accident and emergency healthcare staff perceive both positive and negative effects as a consequence of family presence during adult resuscitation and their opinions suggest that there are more risks than benefit. Conclusion., Further research is essential if family presence during resuscitation of adults is to be better defined and understood. Qualitative methods of enquiry are recommended as a way of gaining a deeper insight into and understanding of this practice. [source] Reactions to a Motor-Vehicle Accident in Relation to Mitigating Circumstances and the Gender and Moral Worth of the Driver,JOURNAL OF APPLIED SOCIAL PSYCHOLOGY, Issue 1 2000NORMAN T. FEATHER Male and female students (N= 153) at the Flinders University of South Australia read scenarios describing a motor-vehicle accident that varied mitigating circumstances (driving on a slippery road vs. driving at high speed), gender of driver, and the moral worth of the driver (very dependable and trustworthy vs. not dependable and a bit untrustworthy). Results showed that mitigation affected judgments about the driver's responsibility, seriousness of the offense, driver's deservingness of penalty imposed, harshness of penalty, positive affect about the penalty, and sympathy for the driver, consistent with a social cognitive process model (Feather, 1996c, 1998). Moral worth affected judgments about the driver's moral character, harshness of penalty, and liking and sympathy for the driver. Participants attributed higher moral character to the female driver and also reported more liking for the female driver. There was some limited evidence for an in-group gender bias. [source] Incidence and Predictors of Periprocedural Cerebrovascular Accident in Patients Undergoing Catheter Ablation of Atrial FibrillationJOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 12 2009DANIEL SCHERR M.D. Background: Cerebrovascular accident (CVA) is a serious complication of catheter ablation of atrial fibrillation (AF). The incidence and clinical predictors of periprocedural CVA in patients undergoing AF ablation are not fully understood. Methods: This study included 721 cases (age 57 ± 11 years; 23% female; 345 persistent AF) in 579 consecutive patients referred for AF ablation. Periprocedural CVA was defined as onset of a new neurologic deficit that occurred anytime between the start of the procedure and 30 days after the AF ablation, and was confirmed by a neurologist. Cranial imaging with CT and/or MRI was performed in each case. Patients were anticoagulated with warfarin for at least 4 weeks pre- and immediately postprocedure and were bridged with enoxaparin. Transesophageal echocardiography was performed within 24 hours prior to ablation in all cases. Results: Periprocedural CVA occurred in 10 of 721 cases (1.4%). The risk of periprocedural CVA did not vary significantly during the course of the study. Among these 10 patients (age 62 ± 11 years; 1 female; 5 persistent AF), 6 manifested neurological deficits within 24 hours, 3 after 24,48 hours, and 1 patient had a CVA 6 days following AF ablation despite a therapeutic INR level. All CVAs were ischemic. Five patients had residual deficits after 30 days. Four of 43 patients (9.3%) with a prior history of CVA had periprocedural CVA. Periprocedural CVA occurred in 0.3%, 1.0%, and 4.7% of patients with CHADS2 scores of 0, 1, and , 2 (P < 0.001). In 2 separate multivariate analyses, a CHADS2 score , 2 (OR 7.1, P = 0.02) and history of CVA (OR 9.5, P < 0.01) remained independent predictors of periprocedural CVA. Conclusions: Despite periprocedural anticoagulation and transesophageal echocardiography, we found a 1.4% incidence of periprocedural CVA in AF ablation patients. A CHADS2 score , 2 and a history of CVA are independent predictors of CVA after AF ablation. The CVA risk is low in patients with CHADS2 score of 0. [source] Aggression towards health care staff in a UK general hospital: variation among professions and departmentsJOURNAL OF CLINICAL NURSING, Issue 1 2004Sue Winstanley BSc Background., Aggression towards health care staff is an increasing problem and although many studies have examined psychiatric settings, few have considered general hospitals and in particular, variation among professions and locations. In addition, studies often fail to include all forms of aggression such as threatening behaviour and verbal aggression. Methods., This study extends existing research by evaluating physical assault, threatening behaviour and verbal aggression from patients/visitors towards general hospital staff in the context of different professions and departments. Results and conclusions., The survey of staff showed that aggression is widespread. Within the preceding year, 27% of the respondents were assaulted, 23% experienced threatening behaviour from patients and 15.5% experienced threatening behaviour from visitors. Over 68% reported verbal aggression, 25.7% experiencing it more regularly than monthly. By departments, over 42% of the medical department staff, 36% of the surgical staff and over 30% of the Accident and Emergency staff were assaulted. By profession, staff nurses and enrolled nurses reported the most assaults (43.4%) and doctors, the fewest (13.8%). Other nursing grades and health care professions all reported levels of physical assault in excess of 20%. Correspondingly high levels of threatening behaviour and verbal aggression were also reported although the patterns of victimization differed according to the various professions and departments. Independently, significant levels of assault, threatening behaviour and verbal aggression were reported. When aggregated they demonstrate the higher levels of victimization that general hospital staff experienced on a regular basis. Relevance to clinical practice., Institutional averages actually obscure the much higher levels of aggression experienced by the particular professions in particular departments. This study helps to localize the problem and identify those at most risk, but more research is needed into the aetiology of the aggression and of vulnerability factors associated with victimization. [source] Stakeholder perspectives on new ways of delivering unscheduled health care: the role of ownership and organizational identityJOURNAL OF EVALUATION IN CLINICAL PRACTICE, Issue 2 2007Gill Haddow MA PhD Abstract Rationale, aims and objectives, To explore stakeholder perspectives of the implementation of a new, national integrated nurse-led telephone advice and consultation service [National Health Service 24 (NHS 24)], comparing the views of stakeholders from different health care organizations. Methods, Semi-structured interviews with 26 stakeholders including partner organizations located in primary and secondary unscheduled care settings [general practitioner (GP) out-of-hours cooperative; accident and emergency department; national ambulance service, members of NHS 24 and national policy makers. Attendance at key meetings, documentary review and email implementation diaries provided a contextual history of events with which interview data could be compared. Results, The contextual history of events highlighted a fast-paced implementation process, with little time for reflection. Key areas of partner concern were increasing workload, the clinical safety of nurse triage and the lack of communication across the organizations. Concerns were most apparent within the GP out-of-hours cooperative, leading to calls for the dissolution of the partnership. Accident and emergency and ambulance service responses were more conciliatory, suggesting that such problems were to be expected within the developmental phase of a new organization. Further exploration of these responses highlighted the sense of ownership within the GP cooperative, with GPs having both financial and philosophical ownership of the cooperative. This was not apparent within the other two partner organizations, in particular the ambulance service, which operated on a regional model very similar to that of NHS 24. Conclusions, As the delivery of unscheduled primary health care crosses professional boundaries and locations, different organizations and professional groups must develop new ways of partnership working, developing trust and confidence in each other. The results of this study highlight, for the first time, the key importance of understanding the professional ownership and identity of individual organizations, in order to facilitate the most effective mechanisms to enable that partnership working. [source] Perineal-Vaginal Injuries in Children: Accident or Abuse?JOURNAL OF FORENSIC SCIENCES, Issue 4 2010Claudia Liuzzi M.D. Abstract:, A large number of conditions have been mistaken for abuse. Differentiating accidental injuries from inflicted injuries is important in the management of injured children. In this work, the authors describe two cases of accidental perineal-vaginal injury in children. In case 1, a 4-year-old girl suffered a vaginal tear caused by violent stretching during play; in case 2, a 3-year-old girl had minor lacerations of labia minora and majora. The intervention of a multi-specialist team including a forensic pathologist and forensic psychiatrist was the key factor in being able to exclude abuse by third parties in the described cases.. This leads to the appropriate recommendations to be adopted in the forensic medicine setting. [source] The Death of Countess Agusta in Portofino (Northern Italy) and the Soil from Two Mismatched SlippersJOURNAL OF FORENSIC SCIENCES, Issue 2 2009Gianni Lombardi Ph.D. Abstract:, Accident, suicide, or homicide might have caused the death of Countess Agusta who fell from the 80-m tall cliff of her villa. Two mismatched slippers were recovered along the cliff. Use was made of microscope, X-ray diffractometry, scanning electron microscopy, and microprobe techniques to compare 40 mg of soil collected from the slipper soles with samples from the villa garden. Structural details of the slipper soles were consistent with the lady wearing them during the fall. Analysis of the soil residues confirmed that they originated from the garden only. The features of a few, minute glass chips adhering to the slipper soles reasonably matched those of other fragments that were found on a small ledge on the cliff beyond the garden parapet. Based on this and other evidence, the case was closed with a verdict of accidental fall. [source] Recovering the Reptile Community after the Mine-Tailing Accident of Aznalcóllar (Southwestern Spain)RESTORATION ECOLOGY, Issue 5 2009Rocío Márquez-Ferrando Abstract Ecosystem restoration requires that habitat requirements of all species be considered. Among animal communities in Mediterranean ecosystems, reptiles, as ectothermic vertebrates, need refuges for avoidance of extreme environmental temperatures, concealment from predators, and oviposition sites. In 1998, a massive amount of tailings broke out of the holding pond of the Aznalcóllar mine (southwestern Spain) and polluted the Guadiamar river valley. After the accident, a soil- and vegetation restoration program began, and the Guadiamar Green Corridor was created to connect two huge natural areas, Doñana National Park and the Sierra Morena. Within this corridor, the reptile community remained dramatically impoverished, probably because of elimination of all natural refuges during the soil restoration program. To test this hypothesis, we set an array of artificial refuges (logs) in a large experimental plot. During the 5 years of the experiment (2002,2006), the area managed with artificial refuges exhibited a better and faster recovery of the reptile community in species richness and individual abundance than did the control area with no artificial refuges. Moreover, reptile colonization of the Guadiamar Green Corridor was transverse rather than lineal,that is, it did not act as a corridor for reptiles, at least in the first stages of colonization. This suggests that landscape restoration programs should not neglect refuge availability, a limiting resource for reptile species. [source] Respiratory problems in Accident and Emergency , the role of helium,oxygen mixturesANAESTHESIA, Issue 5 2009P. Bathke No abstract is available for this article. [source] Determinants of hospital costs associated with traumatic brain injury in England and Wales,ANAESTHESIA, Issue 5 2008S. Morris Summary Using data from the Trauma Audit Research Network, we investigated the costs of acute care in patients , 18 years of age hospitalised for traumatic brain injury between January 2000 and December 2005 in England and Wales. Traumatic brain injury patients were defined and stratified using the Abbreviated Injury Scale. A total of 6484 traumatic brain injury patients were identified; 22.3% had an Abbreviated Injury Scale score of three, 38.0% of four and 39.7% of five. Median age (IQR) was 42 years (28,59) and 76.7% were men. Primary cause of injury was motor vehicle collisions (42.4%) followed by falls (38.0%). In total 23.7% of the patients died before discharge. Hospitalisation costs averaged £15 462 (SD £16 844). Costs varied significantly by age, Glasgow Coma Score, Injury Severity Score, coexisting injuries of the thorax, spine and lower limb, hospital mortality, availability of neurosurgical services, and specialty of attendants seen in the Accident and Emergency department. [source] Feasibility study of multicentre comparison of NHS hospital pharmacy computer dataBRITISH JOURNAL OF CLINICAL PHARMACOLOGY, Issue 1 2000Pauline Debra Walker Aims This study aims to determine the feasibility of collecting, collating and analysing drug expenditure data from a sample of acute hospitals in England. Methods The hospital pharmacy computer system was used to report on drug expenditure from 16 hospitals throughout England for a 2 year period. These data were analysed as a whole and hospital episode statistics were correlated to hospital drug costs. Results Hospital outpatient costs were found to be approximately one third of hospital inpatient costs. Cardiovascular drugs accounted for the greatest increase in expenditure for both inpatients and outpatients (25%). The most expensive therapeutic area of drug use across all sites was anti-infectives. The average daily number of occupied beds explained 55% of the variation in inpatient expenditure and the number of outpatient (including Accident and Emergency) attendances explained 60% of the outpatient drug expenditure. Conclusions This project has confirmed the feasibility of collecting, collating and analysing hospital drug expenditure and identified some interesting patterns and trends in hospital drug use. Hospital activity is reflected in hospital drug costs. [source] Seasonal occurrence of impetigo: a retrospective 8-year review (1996,2003)CLINICAL & EXPERIMENTAL DERMATOLOGY, Issue 5 2005A. Loffeld Summary Impetigo, a common skin infection, has shown seasonal variation in African, Australian and Indian studies. We investigated seasonal variation of impetigo in a UK paediatric population. A total of 1552 children with impetigo were seen in the Accident and Emergency (A&E) department between 1996 and 2003. The number of impetigo cases was always higher in late summer than in winter, and furthermore, increased year on year. These changes could not be accounted for by variation in total patient numbers seen in A&E, and suggest a correlation between impetigo frequency and climatic temperature. Possible reasons for these findings include exposed skin due to loose clothing in the summer leading to more skin-to-skin contact and minor trauma. [source] Risk of Cerebrovascular Accident After a First Diagnosis of Atrial FibrillationCLINICAL CARDIOLOGY, Issue 11 2008Dhanya Kalathil MRCP (UK) No abstract is available for this article. [source] Clopidogrel versus low-dose aspirin as risk factors for epistaxisCLINICAL OTOLARYNGOLOGY, Issue 3 2009J.W. Rainsbury Objectives:, To quantify the relative risk of epistaxis for patients taking low-dose aspirin or clopidogrel compared to patients taking neither drug. Design:, Case-control study. Setting:, Primary care. Participants:, 10,241 patients from three GP practices in the West Midlands. Main outcome measures:, Epistaxis resulting in presentation to the GP, attendance at Accident & Emergency, or referral to ENT outpatients. Results:, There was a significant difference in the proportion of patients with epistaxis across the three groups (,2 = 84.1; 2 degrees of freedom; P < 0.000001). Relative risk of epistaxis was increased in both the aspirin (RR = 9.04; 95% CI = 5.13,15.96) and clopidogrel (RR = 6.40; 95% CI = 2.33,17.56) groups compared to the no drug group. There was no increased risk of epistaxis with aspirin compared to clopidogrel (RR = 1.4; 95% CI = 0.6,3.4). Conclusion:, There is an increased risk of troublesome epistaxis in patients taking aspirin or clopidogrel. There is no significant difference in risk of epistaxis between the two drug groups. [source] The epidemiology and chronobiology of epistaxis: an investigation of Scottish hospital admissions 1995,2004CLINICAL OTOLARYNGOLOGY, Issue 5 2007T.W.M. Walker Objectives:, This study aimed at investigating aspects of the epidemiology and chronobiology of emergency admissions with epistaxis in Scotland between 1995 and 2004. In particular, we sought to examine the epidemiology of hospital admission with epistaxis and effects of factors such as day of week, time of year and lunar cycle. Design:, A statistical analysis, in terms of descriptive statistics, logistical regression and linear regression, was carried out on data obtained from the Scottish Morbidity Records related to emergency Ear, Nose and Throat (ENT) admissions. Setting and participants:, All emergency inpatient admissions for Scottish residents to ENT wards in Scottish NHS hospitals during the 10-year period, between 1st January 1995 and December 31st 2004 were studied. This study only looked at admissions and thus excludes Accident and Emergency attendances caused by epistaxis. Main outcome measures:, Age, gender, year, month and day of the week of admission were considered, as was relationship to the moon phase. Results:, During the study period, the mean daily admission rate with epistaxis was six. Epistaxis accounted for 33% of all ENT emergency admissions. The average age of non-epistaxis ENT emergency admission was 31 years. For epistaxis emergency admissions the median age was 70 years. There were fewer admissions in the summer months [August RR: 0.59 (95% CI: 0.54,0.65) P < 0.001]. There were more admissions at the weekends and on non-weekend public holidays [RR: ,0.115 (95% CI ,0.160,0.071) P < 0.001]. There was a trend towards a reduction in admission rates from the year 2001. Despite the fluctuations with season and weekday, there was no relationship with phase of the moon [RR: 0.98 (95% CI: 0.88,1.09) for day of the full moon compared with non-full moon weekday]. Conclusions:, This study underlines the importance of epistaxis as the single most frequent emergency diagnosis in ENT. The frequency and patterns of admission show pronounced fluctuations. The observed increase in winter admissions confirms earlier work and may have implications for health resource allocation. Relationships between weekends/public holidays and increased admissions with epistaxis may correspond with social patterns of alcohol use (a known aetiological factor). The lunar cycle does not have an effect on the frequency of epistaxis admissions. [source] Investigating Driver Injury Severity in Traffic Accidents Using Fuzzy ARTMAPCOMPUTER-AIDED CIVIL AND INFRASTRUCTURE ENGINEERING, Issue 6 2002Hassan T. Abdelwahab This paper applies fuzzy adaptive resonance theory MAP (fuzzy ARTMAP) neural networks to analyze and predict injury severity for drivers involved in traffic accidents. The paper presents a modified version of fuzzy ARTMAP in which the training patterns are ordered using the K,means algorithm before being presented to the neural network. The paper presents three applications of fuzzy ARTMAP for analyzing driver injury severity for drivers involved in accidents on highways, signalized intersections, and toll plazas. The analysis is based on central Florida's traffic accident database. Results showed that the ordered fuzzy ARTMAP proved to reduce the network size and improved the performance. To facilitate the application of fuzzy ARTMAP, a series of simulation experiments to extract knowledge from the models were suggested. Results of the fuzzy ARTMAP neural network showed that female drivers experience higher severity levels than male drivers. Vehicle speed at the time of an accident increases the likelihood of high injury severity. Wearing a seat belt decreases the chance of having severe injuries. Drivers in passenger cars are more likely to experience a higher injury severity level than those in vans or pickup trucks. Point of impact, area type, driving under the influence, and driver age were also among the factors that influence the severity level. [source] Road traffic accidents and the elderlyGERIATRICS & GERONTOLOGY INTERNATIONAL, Issue 3 2009Suzan Abou-Raya Aim: To identify and evaluate the causes and characteristics of road traffic accidents (RTA) and to analyze injury patterns in elderly road traffic victims in order to apply appropriate measures for the prevention of RTA in the elderly. Methods: Two hundred and fifty-eight elderly road traffic victims admitted to the Emergency and Traumatology Departments of our institution were enrolled. Complete data about the circumstances surrounding the accident, mechanism of injury, specific injury, comorbid conditions and drug history were recorded. All subjects underwent a physical and mental function examination. Results: The majority of road traffic victims were pedestrians. Most elderly pedestrian accidents were due to falls. Accidents by elderly car drivers occurred frequently at intersections. Craniocerebral and extremity injuries formed the majority of the injuries in pedestrian and cyclist victims whereas chest injuries were commoner in car accident victims. Medical problems and medication usage was common among RTA victims. Conclusion: The fragility of elderly car occupants and pedestrians should be taken into consideration and strategies aimed at the road-user safety including periodic medical screening, improvement of road structure and facilities, and the improved design of motor vehicles should be implemented. [source] Genetic Aberrations in Chernobyl-Related Thyroid Cancers: Implications for Possible Future Nuclear Accidents or Nuclear AttacksIUBMB LIFE, Issue 12 2003Gennady Ermak Abstract Cases of thyroid cancer among children in Belarus represent a unique model system in which the cause of the cancer is known - radiation. Although other sources of radiation-induced cancers are diminishing (survivors of Hiroshima and Nagasaki, and individuals exposed to diagnostic or therapeutic radiation) fears of radiation exposure from accidents and terrorism are increasing. Our analysis of current data reveals that Chernobyl-related cancer cases might have a specific pattern of genetic aberrations. These data strongly confirm the hypothesis that radiation-induced cancers might arise as a result of specific gene aberrations that are distinct from those in sporadic cancers, suggesting that methods of prevention and treatment of radiation-induced cancers might require a different approach. Understanding of the molecular mechanisms of Chernobyl-related papillary thyroid carcinomas will help to identify mechanisms by which radiation causes aberrations and oncogenic cell transformation. Thus, in turn, it will be important in the development of new treatments or technologies to minimize the effects of radiation damage from nuclear accidents or nuclear attacks. IUBMB Life, 55: 637-641, 2003 [source] Sophia Lee and the Genre SérieuxJOURNAL FOR EIGHTEENTH-CENTURY STUDIES, Issue 1 2010PETER HYNES Abstract This article measures the influence of Denis Diderot's theory of the genre sérieux on English drama of the later eighteenth century, using Sophia Lee's The Chapter of Accidents as its principal test case. It concludes that, while Lee borrowed extensively for plot devices and character types, she did not adopt many of the innovations that in Diderot's view constituted the heart of his programme of reform. A number of reasons for this neglect are suggested, foremost among them the practical demands of English stage production in the 1780s. [source] KENYA: Corruption Causes AccidentsAFRICA RESEARCH BULLETIN: ECONOMIC, FINANCIAL AND TECHNICAL SERIES, Issue 1 2009Article first published online: 9 MAR 200 No abstract is available for this article. [source] Screening for Hazardous Drinking Using the Michigan Alcohol Screening Test,Geriatric Version (MAST-G) in Elderly Persons With Acute Cerebrovascular AccidentsALCOHOLISM, Issue 9 2009Doug Johnson-Greene Background:, Effective and valid screening methods are needed to identify hazardous drinking in elderly persons with new onset acute medical illness. The goal of the current study was to examine the effectiveness of the Michigan Alcohol Screening Test,Geriatric Version (MAST-G) in identifying hazardous drinking among elderly patients with acute cerebrovascular accidents (CVA) and to compare the effectiveness of 2 shorter versions of the MAST-G with the full instrument. Methods:, The study sample included 100 men and women who averaged 12 days posthemorrhagic or ischemic CVA admitted to a rehabilitation unit and who were at least 50 years of age and free of substance use other than alcohol. This cross-sectional validation study compared the 24-item full MAST-G, the 10-item Short MAST-G (SMAST-G), and a 2-item regression analysis derived Mini MAST-G (MMAST-G) to the reference standard of hazardous drinking during the past 3 months. Alcohol use was collected using the Timeline Followback (TLFB). Recent and lifetime alcohol-related consequences were collected using the Short Inventory of Problems (SIP). Results:, Nearly one-third (28%) of the study sample met the World Health Organization (WHO) criteria for hazardous drinking. Moderately strong associations were found for the MAST-G, SMAST-G, and MMAST-G with alcohol quantity and frequency and recent and lifetime alcohol consequences. All 3 MAST-G versions could differentiate hazardous from nonhazardous drinkers and had nearly identical area under the curve characteristics. Comparable sensitivity was found across the 3 MAST-G measures. The optimal screening threshold for hazardous drinking was 5 for the MAST-G, 2 for the SMAST-G, and 1 for the MMAST-G. Conclusions:, The 10-item SMAST-G and 2-item MMAST-G are brief screening tests that show comparable effectiveness in detecting hazardous drinking in elderly patients with acute CVA compared with the full 24-item MAST-G. Implications for research and clinical practice are discussed. [source] Number of Accidents or Number of Claims?JOURNAL OF RISK AND INSURANCE, Issue 4 2009An Approach with Zero-Inflated Poisson Models for Panel Data The,hunger for bonus,is a well-known phenomenon in insurance, meaning that the insured does not report all of his accidents to save bonus on his next year's premium. In this article, we assume that the number of accidents is based on a Poisson distribution but that the number of claims is generated by censorship of this Poisson distribution. Then, we present new models for panel count data based on the zero-inflated Poisson distribution. From the claims distributions, we propose an approximation of the accident distribution, which can provide insight into the behavior of insureds. A numerical illustration based on the reported claims of a Spanish insurance company is included to support this discussion. [source] Accidents, often the result of an ,uncontrolled business process',a study in the (Dutch) chemical industryQUALITY AND RELIABILITY ENGINEERING INTERNATIONAL, Issue 3 2003P. J. M. Sonnemans Abstract Often companies in the (petro-) chemical industry claim that all possible countermeasures against potential accidents have been taken and therefore accidents are unforeseeable. In this paper we question this statement by analysing the pre-warning signals (precursors) preceding a number of industrial accidents. 17 accidents that occurred in the (petro-) chemical industry have been investigated by exploring FACTS, an accident database containing information about industrial accidents worldwide. This paper will demonstrate that the existence of precursor information could have been used to foresee and even prevent these accidents if a proper control action had been initiated. The accidents are analysed further, according to a control model, which was adapted from that of C. Argyris. It demonstrates the ineffectiveness of several elements of business process control loops and that the so-called ,double-loop learning' cycle is more important than the ,single-loop learning' cycle if one considers safety improvement. Copyright © 2003 John Wiley & Sons, Ltd. [source] Disasters, Accidents, and Crises in American History: A Reference Guide to the Nation's Most Catastrophic EventsTHE JOURNAL OF POPULAR CULTURE, Issue 6 2008Clifford PutneyArticle first published online: 12 NOV 200 No abstract is available for this article. [source] | |||||||||||||||||||||||||||||||||||||||||||||||||