FIMCAR II: Accident Analysis

For the assessment of vehicle safety in frontal collisions compatibility (which consists of self and partner protection) between opponents is crucial. Although compatibility has been analysed worldwide for years, no final assessment approach has been defined to date. Taking into account the European Enhanced Vehicle safety Committee (EEVC) compatibility and frontal impact working group (WG15) and the EC funded FP5 VC-COMPAT project activities, two test approaches have been identified as the most promising candidates for the assessment of compatibility. Both are composed of an off-set and a full overlap test procedure. In addition another procedure (a test with a moving deformable barrier) is getting more attention in today’s research programmes. The overall objective of the FIMCAR project is to complete the development of the candidate test procedures and propose a set of test procedures suitable for regulatory application to assess and control a vehicle’s frontal impact and compatibility crash safety. In addition an associated cost benefit analysis should be performed. The specific objectives of the work reported in this deliverable were: • Determine if previously identified compatibility issues are still relevant in current vehicle fleet o Structural interaction o Frontal force matching o Compartment strength in particular for light cars • Determine nature of injuries and injury mechanisms o Body regions injured o Injury mechanism ▪ Contact with intrusion ▪ Contact ▪ Deceleration / restraint induced The main data sources for this report were the CCIS and Stats 19 databases from Great Britain and the GIDAS database from Germany. The different sampling and reporting schemes for the detailed databases (CCIS & GIDAS) sometimes do not allow for direct comparisons of the results. However the databases are complementary – CCIS captures more severe collisions highlighting structure and injury issues while GIDAS provides detailed data for a broader range of crash severities. The following results represent the critical points for further development of test procedures in FIMCAR

Effect of dexmedetomidine versus lorazepam on outcome in patients with sepsis: an a priori-designed analysis of the MENDS randomized controlled trial

Abstract Introduction Benzodiazepines and α2 adrenoceptor agonists exert opposing effects on innate immunity and mortality in animal models of infection. We hypothesized that sedation with dexmedetomidine (an α2 adrenoceptor agonist), as compared with lorazepam (a benzodiazepine), would provide greater improvements in clinical outcomes among septic patients than among non-septic patients. Methods In this a priori-determined subgroup analysis of septic vs non-septic patients from the MENDS double-blind randomized controlled trial, adult medical/surgical mechanically ventilated patients were randomized to receive dexmedetomidine-based or lorazepam-based sedation for up to 5 days. Delirium and other clinical outcomes were analyzed comparing sedation groups, adjusting for clinically relevant covariates as well as assessing interactions between sedation group and sepsis. Results Of the 103 patients randomized, 63 (31 dexmedetomidine; 32 lorazepam) were admitted with sepsis and 40 (21 dexmedetomidine; 19 lorazepam) without sepsis. Baseline characteristics were similar between treatment groups for both septic and non-septic patients. Compared with septic patients who received lorazepam, the dexmedetomidine septic patients had 3.2 more delirium/coma-free days (DCFD) on average (95% CI for difference, 1.1 to 4.9), 1.5 (-0.1, 2.8) more delirium-free days (DFD) and 6 (0.3, 11.1) more ventilator-free days (VFD). The beneficial effects of dexmedetomidine were more pronounced in septic patients than in non-septic patients for both DCFDs and VFDs (P-value for interaction = 0.09 and 0.02 respectively). Additionally, sedation with dexmedetomidine, compared with lorazepam, reduced the daily risk of delirium [OR, CI 0.3 (0.1, 0.7)] in both septic and non-septic patients (P-value for interaction = 0.94). Risk of dying at 28 days was reduced by 70% [hazard ratio 0.3 (0.1, 0.9)] in dexmedetomidine patients with sepsis as compared to the lorazepam patients; this reduction in death was not seen in non-septic patients (P-value for interaction = 0.11). Conclusions In this subgroup analysis, septic patients receiving dexmedetomidine had more days free of brain dysfunction and mechanical ventilation and were less likely to die than those that received a lorazepam-based sedation regimen. These results were more pronounced in septic patients than in non-septic patients. Prospective clinical studies and further preclinical mechanistic studies are needed to confirm these results. Trial Registration NCT00095251

Natural and cultural heritage in mountain landscapes: towards an integrated valuation

Mountain areas of Europe have been managed by humans for a long time, leading to a prevalence of semi-natural habitats in mountain landscapes today. These landscapes contain both natural and cultural heritage; however, natural and cultural heritage are rarely considered together when valuing landscapes and developing management plans in protected areas. Here we present a case study of seven protected areas in the mountains of Great Britain and Norway. We take a long-term perspective on landscape and land-use change and propose an integrated model of landscape valuation on the basis of combined natural and cultural heritage. Our model plots indicators of natural and cultural heritage along a gradient of land-use intensity, allowing simultaneous assessment and highlighting how valuation depends on what type of heritage is considered. We show that while contemporary land-use changes follow similar trajectories in Norway and Britain, different land-use histories mean that the loss of heritage differs between the regions. The model presented here thus allows for the consolidation of valuation based on both cultural and natural heritage in landscapes.publishedVersio

International, multi-disciplinary, cross-section study of pain knowledge and attitudes in nursing, midwifery and allied health professions students.

Persistent pain is a highly prevalent, global cause of disability. Research suggests that many healthcare professionals are not well equipped to manage pain and that this may be attributable at least in part to undergraduate education. The primary aim of this study was to quantify and compare first and final year nursing, midwifery and allied health professional (NMAHP) students' pain-related knowledge and attitudes. The secondary aim was to explore the factors influencing students' pain-related knowledge and attitudes. This cross-sectional study included 1154 first and final year healthcare students, from 12 universities in five different countries. Participants completed the Revised Neurophysiology of Pain Quiz (RNPQ) knowledge and the Health Care Providers Pain and Impairment Relationship Scale (HC-PAIRS) attitudes. Physiotherapy was the only student group with statistically and clinically improved pain-related knowledge mean difference, 95% CI (3.4, 3.0 to 3.9, p=0.01) and attitudes (-17.2, -19.2 to 15.2, p=0.01) between first and final year. Pain education teaching varied considerably from course to course (0 to 40 hours), with greater levels of pain-related knowledge and attitudes associated with higher volumes of pain-specific teaching. There was little difference in pain knowledge and attitudes between all first and final year NMAHP students other than physiotherapy. This suggests that for most NMAHP disciplines, undergraduate teaching has little or no impact on students' understanding of pain. There is an urgent need to enhance pain education provision at the undergraduate level in NMAHPs

Bostonia: The Boston University Alumni Magazine. Volume 14

Founded in 1900, Bostonia magazine is Boston University's main alumni publication, which covers alumni and student life, as well as university activities, events, and programs