Whiplash and Concussion: Similar Acute Changes in Middle-Latency SEPs

Objective: Middle-latency somatosensory evoked potentials (SEPs) following median nerve stimulation can provide a sensitive measure of cortical function. We sought to determine whether the mechanical forces of whiplash injury or concussion alter normal processing of middle-latency SEPs. Methods: In a cross-sectional pilot study 20 subjects with whiplash were investigated (50% between 0.5-2 months and 50% between 6-41 months post injury) and compared to 83 healthy subjects using a standard middle-latency SEP procedure. In a subsequent prospective study subjects with either acute whiplash (n=13) or Grade 3 concussion (n=16) were investigated within 48 hours and again three months post injury. Results: In the pilot study the middle-latency SEP component N60 was significantly increased in the ten subjects investigated within two months after whiplash. In contrast, the ten subjects examined more than six months after injury showed normal latencies. In the prospective study N60 latencies were increased after whiplash and concussion when tested within 48 hours of injury. At three months, latencies were improved though still significantly different from controls post whiplash and concussion. Conclusion: Both whiplash injury and concussion alter processing of the middle-latency SEP component N60 in the acute post traumatic period. The acute changes appear to normalize between three-six months post injury. The SEP similarities suggest that the overlapping clinical symptomatology post whiplash and concussion may reflect a similar underlying mechanism of rotational mild traumatic brain injur

Transition from van-der-Waals to H Bonds dominated Interaction in n-Propanol physisorbed on Graphite

Multilayer sorption isotherms of 1-propanol on graphite have been measured by means of high-resolution ellipsometry within the liquid regime of the adsorbed film for temperatures ranging from 180 to 260 K. In the first three monolayers the molecules are oriented parallel to the substrate and the growth is roughly consistent with the Frenkel-Halsey-Hill-model (FHH) that is obeyed in van-der-Waals systems on strong substrates. The condensation of the fourth and higher layers is delayed with respect to the FHH-model. The fourth layer is actually a bilayer. Furthermore there is indication of a wetting transition. The results are interpreted in terms of hydrogen-bridge bonding within and between the layers.Comment: 4 pages, 3 figure

Risikoteilung und Rückversicherung

Die vorliegende Arbeit illustriert das Prinzip der Risikoteilung anhand typischer Beispiele von Versicherungsverträgen zwischen Versicherungsnehmer und Versicherungsunternehmen oder zwischen Erstversicherer und Rückversicherer, und sie skizziert einige der mit der Risikoteilung verbundenen mathematischen Probleme.The present paper illustrates the principle of risk sharing by way of prominent examples of insurance contracts between the policyholder and the insurance company, as well as between the primary insurer and the reinsurer, and it addresses some of the mathematical problems related to risk sharing

Risikoteilung und Rückversicherung

Die vorliegende Arbeit illustriert das Prinzip der Risikoteilung anhand typischer Beispiele von Versicherungsverträgen zwischen Versicherungsnehmer und Versicherungsunternehmen oder zwischen Erstversicherer und Rückversicherer, und sie skizziert einige der mit der Risikoteilung verbundenen mathematischen Probleme.The present paper illustrates the principle of risk sharing by way of prominent examples of insurance contracts between the policyholder and the insurance company, as well as between the primary insurer and the reinsurer, and it addresses some of the mathematical problems related to risk sharing

Quality of life data from EQ-5D for evidence-based health service practice in dialysis care

Hemodialysis (HD) and peritoneal dialysis (PD) are therapeutic options for patients with end-stage-renal-disease (ESRD), if transplantation is not available. Mortality rates for HD and PD are similar, while PD is generally the less costly alternative. Percentage of HD and PD shows considerable variability between high income countries (for PD from 5-7% in Germany and Switzerland up to 19- 24% in the UK and Scandinavia). Patient reported outcomes, such as quality of life (QOL), can provide complementary evidence for planning of patient oriented dialysis services. Profile instruments (e.g. SF36, KDQOL) show no consistent QOL differences between HD and PD. However, single index preference-based QOL measures (such as EQ5D), may add new information and are useful for later health economic evaluations. We aimed to collect current evidence for QOL of ESRD patients as measured with EQ-5D

Impact evaluation of Swiss Medical Board reports on routine care in Switzerland : a case study of PSA screening and treatment for rupture of anterior cruciate ligament

Questions under Study: Evidence-based recommendations play an important role in medical decision-making, but barriers to adherence are common. In Switzerland, the Swiss Medical Board (SMB) publishes evidence reports that conclude with recommendations. We assessed the impact of two SMB reports on service provision (2009: Recommendation of conservative treatment as first option for rupture of the anterior cruciate ligament of the knee; 2011: Recommendation against PSA screening for prostate cancer). Methods: We performed an observational study and assessed quantitative data over time via interrupted times series analyses. The primary outcome was the quarterly number of performed prostate-specific antigen (PSA) tests and the annual rates of surgical ACL repair in patients with ACL rupture. Data were adjusted for time trends and relevant confounders. Results: We analysed PSA tests in 662,874 outpatients from 2005-2013 and treatment data in 101,737 patients with knee injury from 1990-2011. For the number of PSA tests, the secular trend before the intervention showed a continuous but diminishing increase over time. A statistically significant reduction in tests was estimated immediately after the intervention, but a later return to the trend before the intervention cannot be ruled out. The rate of surgical ACL repair had already declined after the late 1990s to about 55% in 2009. No relevant additional change emerged in this secular trend after the intervention. Conclusions: Despite some evidence of a possible change, we did not find a sustained and significant impact of SMB recommendations in our case study. Further monitoring is needed to confirm or refute these findings