Comparison of the serious injury pattern of adult bicyclists, between South-West Netherlands and the State of Victoria, Australia 2001-2009

Background: Head injury is the leading cause of death and long term disability from bicycle injuries and may be prevented by helmet wearing. We compared the pattern of injury in major trauma victims resulting from bicyclist injury admitted to hospitals in the State of Victoria, Australia and South-West Netherlands, with respective high and low prevalence of helmet use among bicyclists. Methods: A cohort of bicycle injured patients with serious injury (defined as Injury Severity Score > 15) in South-West Netherlands, was compared to a cohort of serious injured bicyclists in the State of Victoria, Australia. Additionally, the cohorts of patients with serious injury admitted to a Dutch level 1 trauma centre in Rotterdam, the Netherlands and an Australian level 1 trauma centre in Melbourne, Australia were compared. Both cohorts included patients admitted between July 2001 and June 2009. Primary outcome was in-hospital mortality and secondary outcome was prevalence of severe injury per body region. Outcome was compared using univariate analysis and mortality outcomes were also calculated using multivariable logistic regression models. Results: A total of 219 cases in South-West Netherlands and 500 cases in Victoria were analyzed. Further analyses comparing the major trauma centres in each region, showed the percentage of bicycle-related death was higher in the Dutch population than in the Australian (n = 45 (24%) vs n = 13(7%); P < 0.001). After adjusting for age, mechanism of injury, GCS and head injury severity in both hospitals, there was no significant difference in mortality (adjusted odds ratio 1.4; 95% confidence interval = 0.6, 3.5). Patients in Netherlands trauma centre suffered from more serious head injuries (Abbreviated Injury Scale ≥ 3) than patients in the Australian trauma centre (n = 165 (88.2%) vs n = 121 (62.4%); P < 0.001). The other body regions demonstrated significant differences i

Effects of decoherence and errors on Bell-inequality violation

We study optimal conditions for violation of the Clauser-Horne-Shimony-Holt form of the Bell inequality in the presence of decoherence and measurement errors. We obtain all detector configurations providing the maximal Bell inequality violation for a general (pure or mixed) state. We consider local decoherence which includes energy relaxation at the zero temperature and arbitrary dephasing. Conditions for the maximal Bell-inequality violation in the presence of decoherence are analyzed both analytically and numerically for the general case and for a number of important special cases. Combined effects of measurement errors and decoherence are also discussed.Comment: 18 pages, 5 figure

Trauma resuscitation errors and computer-assisted decision support

Hypothesis This project tested the hypothesis that computer-aided decision support during the first 30 minutes of trauma resuscitation reduces management errors. Design Ours was a prospective, open, randomized, controlled interventional study that evaluated the effect of real-time, computer-prompted, evidence-based decision and action algorithms on error occurrence during initial resuscitation between January 24, 2006, and February 25, 2008. Setting A level I adult trauma center. Patients Severely injured adults. Main Outcome Measures The primary outcome variable was the error rate per patient treated as demonstrated by deviation from trauma care algorithms. Computer-assisted video audit was used to assess adherence to the algorithms. Results A total of 1171 patients were recruited into 3 groups: 300 into a baseline control group, 436 into a concurrent control group, and 435 into the study group. There was a reduction in error rate per patient from the baseline control group to the study group (2.53 to 2.13, P = .004) and from the control group to the study group (2.30 to 2.13, P = .04). The difference in error rate per patient from the baseline control group to the concurrent control group was not statistically different (2.53 to 2.30, P = .21). A critical decision was required every 72 seconds, and error-free resuscitations were increased from 16.0% to 21.8% (P = .049) during the first 30 minutes of resuscitation. Morbidity from shock management (P = .03), blood use (P < .001), and aspiration pneumonia (P = .046) were decreased. Conclusions Computer-aided, real-time decision support resulted in improved protocol compliance and reduced errors and morbidity