Deriving functional safety (ISO 26262) S-parameters for vulnerable road users from national crash data.

Currently, advanced driver assistance systems (ADAS) and automated vehicles (AV) are designed for use in the existing road infrastructure. These partially and fully automated vehicles will be operated in a shared space not only with other vehicles but also with vulnerable road users (VRU). Even though crashes between ADAS equipped vehicles or AV and VRU seem inevitable in such a scenario, functional safety, i.e., the assessment of the quality and safety level of the automation system, plays a crucial role in minimizing the crash frequency and the injury severity. We develop a data-driven approach to injury severity estimation for functional safety, i.e., ISO 26262 S-parameters, for four types of VRU: pedestrians, bicyclists, scooterists, and motorcycle riders. To estimate the S-parameter, the 90th-percentile of the injury severity distribution in the S-scale, a population-based data set (Germany's national data set DESTATIS) is used. Since the description of the injury severity in DESTATIS is not detailed enough for a direct one-to-one mapping to the S-scale, we enhance the level of detail in the population-based data set by using additional information from the German in-depth accident study (GIDAS), an in-depth, size-limited survey of part of the same population. Thus, we are able to transform the 4-level injury scale (uninjured, slightly injures, severely injured, and fatal) of the police reports found in DESTATIS into the three breakpoints of the injury severity scale (ISS) (ISS ≥{4, 9, 16}) which in turn directly translate to the four levels of the S-scale. Furthermore, the ISS ≥9 breakpoint more or less equates to MAIS 3+, the definition of 'severe injury' in nearly all international road safety goals that look beyond fatalities. The derived injury scale transformation can be utilized to translate the injury severities of the police-reported cases to the politically needed MAIS 3+ distribution. Thus, population-based data can be directly used to estimate the proportion of these 'severely injured.' The crashes are analyzed from the perspective of the VRU as well as from the vehicle type involved. We stratified the opposing vehicles by injury mechanism: wrap projection for bonnet type passenger vehicles (BTV), forward projection for box type vehicles like light trucks (LTV), as well as single-vehicle crashes. We cluster the crash data into traffic domains based on the speed limit: shared zone, residential streets, city roads, arterial thoroughfares, rural roads, and autobahn. For each VRU type, injury mechanism, and traffic domain, the S-parameters, i.e., the 90th-percentile of the injury severity measured in S-scale, are calculated with a one-sided 95% confidence level. Exemplary applications of the results are given in the discussion: an evaluation of an AV hitting a crossing pedestrian, an in-lane swerving ADAS system for VRU avoidance, and the rating of the nominal performance of an inflatable helmet for pedestrians.

Behavioural and psychological symptoms in general hospital patients with dementia, distress for nursing staff and complications in care: results of the General Hospital Study.

AIMS: Little is known about how behavioural and psychological symptoms of dementia (BPSD) manifest in the general hospital. The aim was to examine the frequency of BPSD in general hospitals and their associations with nursing staff distress and complications in care. METHODS: Cross-sectional representative study with 1469 patients aged ≥65, including 270 patients with dementia, of 33 randomly selected general hospitals in Germany. BPSD and complications were reported by nurses. RESULTS: Overall frequency of BPSD was higher in patients with dementia (76%) than without (38%). The most frequent symptoms in patients with dementia were nighttime disturbances (38%), depression (29%) and aberrant motor behaviour (28%) and the most distressing symptoms for nursing staff were delusions, aggression and nighttime disturbances. The overall frequency of BPSD increased from 67% in mild dementia, to 76% in moderate dementia and to 88% in severe dementia. The most frequent symptoms in patients without dementia were depression (19%), nighttime disturbances (13%) and irritability (13%). The most distressing symptoms were aggression and delusions, while the same symptoms were consistently rated as less distressing than in patients with dementia. Factor analysis revealed three independent groups of BPSD that explained 45% of the total variance. First, expansive symptoms (aggression, irritability, nighttime disturbances, aberrant motor behaviour and disinhibition) were frequent, distressing for nursing staff and associated with many complications. Second, psychotic symptoms (delusions and hallucinations) were infrequent, distressing and associated with some complications. Third, affective symptoms (apathy, anxiety and depression) were frequent, non-distressing and associated with few complications. The results did not change when cases with delirium were excluded from both groups. CONCLUSIONS: BPSD are common in older hospital patients with dementia and associated with considerable distress in nursing staff, as well as a wide range of special treatments needs and additional behavioural and medical complications. Management strategies are needed to improve the situation for both patients and hospital staff.

[Dementia-friendly hospital wards : Expert recommendations for planning and design]. / Demenzsensible Krankenhausstationen : Expertenempfehlungen zu Planung und Gestaltung.

BACKGROUND: Hospitals face great challenges in the necessity of providing care for the rising number of elderly patients with dementia. The adaptation of the spatial environment represents an important component to improve the care situation of patients with dementia. For more than 30 years research results from long-term care have provided evidence on the therapeutic effect of numerous architectural features on people with dementia. Due to specific medical and organizational requirements in hospitals, the transferability of these findings is, however, limited. MATERIAL AND METHODS: An interdisciplinary workshop with experts from the fields of medicine, nursing, gerontology, self-help and architecture was conducted in July 2015. Based on existing research findings and experiences from pilot projects, the spatial requirements for dementia-friendly hospital wards were collated, suggested solutions were discussed from different perspectives and finally design recommendations were derived. RESULTS: The article gives a first comprehensive overview of architectural measures that are required for the design of dementia-friendly hospital wards. The recommendations provided range from architectural criteria, such as the size and spatial structure of hospital wards, to interior design elements, including orientation and navigation aids and the use of light and colors. Furthermore, information about the planning process are given.

Operator space theory: a natural framework for bell inequalities.

In this Letter we show that the field of operator space theory provides a general and powerful mathematical framework for arbitrary Bell inequalities, in particular, regarding the scaling of their violation within quantum mechanics. We illustrate the power of this connection by showing that bipartite quantum states with local, Hilbert space dimension n can violate a Bell inequality by a factor of order sqrt[n]/(log{2}n) when observables with n possible outcomes are used. Applications to resistance to noise, Hilbert space dimension estimates, and communication complexity are given.

[The Abbreviated Injury Scale (AIS). Options and problems in application]. / Die Abbreviated Injury Scale (AIS). Potenzial und Probleme bei der Anwendung.

The new AIS (Abbreviated Injury Scale) was released with an update by the AAAM (Association for the Advancement of Automotive Medicine) in 2008. It is a universal scoring system in the field of trauma applicable in clinic and research. In engineering it is used as a classification system for vehicle safety. The AIS can therefore be considered as an international, interdisciplinary and universal code of injury severity. This review focuses on a historical overview, potential applications and new coding options in the current version and also outlines the associated problems.

Post-mortem evaluation of 415 pacemakers: in situ measurements and bench tests.

AIM: The hypothesis was that there is more undetected dysfunction of implanted pacemaker systems than that detected and corrected. This prompted a research project (sponsored by the German Research Foundation) to detect pacemaker abnormalities and evaluate their complications for patients, thus, proving or disproving the hypothesis. METHODS AND RESULTS: Four hundred and fifteen pacemakers of deceased patients were analyzed assessing their functionality by in situ measurements and bench tests including five measurements and one telemetric interrogation. Results were divided into four categories and statistically evaluated. Life-threatening abnormalities were found in 3.8%, potentially life-threatening in 3.7%, probably symptomatic, divided into atrial and ventricular problems, 13.3% and 2.8%, respectively, and premature exhaustion in 1.2%. Three of 179 bipolar ventricular leads and 2 of 131 bipolar atrial leads had insulation defects corresponding to 1.7% and 1.5%, respectively. The bipolar complication rate was 2.8 times higher than unipolar. CONCLUSION: The pacemaker patients investigated, living 4 years with their pacemaker on average, had a post-mortem evaluated complication rate of the category "life-threatening" of 3.8%. This result corresponds to an annual complication rate of 0.94% compared with a rate of only 0.39% in an earlier investigation.

Cutaneous current marks due to a stun gun injury.

Histological changes of the skin following electrical injury with a stun gun have rarely been described. We report the case of a 61-year-old man who died after having been tortured with a stun gun during a robbery. At autopsy two reddish, dot-like lesions where found on the chest and histological examination revealed electric current-related changes. Only a few reports concerning micromorphological cutaneous changes following stun gun injury have been reported; therefore further investigations concerning the frequency and type of histological findings due to stun gun injuries will be necessary in order to provide sufficient characteristic data for a conclusive interpretation.

Antiandrogenic pesticides disrupt sexual characteristics in the adult male guppy Poecilia reticulata.

Environmental contaminants have been identified as endocrine disruptors through their antiandrogenic activity. Thus, as androgen receptor antagonists, the fungicide vinclozolin and the principal DDT metabolite p,p'-DDE have been demonstrated to induce demasculinization in rats. Whether this is also the case in fish remains to be demonstrated. For a period of 30 days, groups of adult male guppies were exposed to vinclozolin, p,p'-DDE, or the therapeutic antiandrogen flutamide (used as positive control) applied to the fodder at concentrations between 0.1 and 100 microg/g fodder. Subsequently, sexual characteristics of relevance to the male reproductive capacity were measured and compared with untreated control fish. All three chemicals caused profound alterations at increasing levels of biological organization, even in these fully matured males. At the cellular level, the three compounds induced a significant reduction in the number of ejaculated sperm cells. At the organ level, the sexually attractive orange-yellow coloration was reduced in area and discolored, and treated fish also had smaller testes. Further, at the organismal level, computer-aided behavior analyses demonstrated a severe disruption in male courtship behavior. We conclude that this demasculinization is consistent with an antiandrogenic action of vinclozolin and p,p'-DDE and is likely to compromise reproductive capability in this fish.

Death after excessive propofol abuse.

Abuse of the anaesthetic agent propofol (2,6-diisopropylphenol) is rare, but we report a case of a 26-year-old male nurse in which the autopsy showed unspecific signs of intoxication and criminological evidence pointed towards propofol abuse and/or overdose. Intravenously administered propofol is a fast and short-acting narcotic agent, therefore it seemed questionable whether the deceased would have been able to self-administer a lethal overdose before losing consciousness. The blood and brain concentrations corresponded to those found 1-2 min after bolus administration of a narcotic standard dose of 2.5 mg propofol/kg body weight. Extremely high propofol concentrations were found in the urine indicating excessive abuse before death. However, due to the short half-life of propofol, the cumulative effects of repeated injections should not be relevant for toxicity, since this would result in a blood level increase of only 1-2 micrograms/ml. Furthermore, the detection and quantitation of propofol in three different hair segments indicated chronic propofol abuse by the deceased. The results of the investigation suggest that death was not caused by a propofol overdose but by respiratory depression resulting from overly rapid injection.

Zygmunt Bauman's poisoned gift of morality.

Bauman's attempt to develop a sociological theory of morality turning around fundamental premises of Durkheim's approach fails in the last analysis, since in Bauman's view the 'moral party of two' does not constitute a social situation. It is argued that the necessary condition to think sociologically about morality is the concept of reciprocity and thus one can arrive at a view of morality in postmodernity consistent with Bauman's earlier theory of practice. If Bauman's idea about responsibilty as the core of morality is transformed to the idea of an appeal of history to compassion and is supplemented with the idea of reciprocity as an emerging norm it is possible to outline a sociological theory of moral practice according to postmodern conditions.

Suicide by insulin injection in combination with beta-blocker application.

A 68-year-old non-diabetic physician with a known psychiatric history was found dead in his home. The death scene investigation revealed three used insulin syringes on the coffee table next to the body. The autopsy and the consecutive chemical-toxicological investigation revealed that the deceased committed suicide by injecting an overdose of insulin in combination with a high therapeutic oral bolus application of a beta-blocker (Metoprolol). A surprising morphological finding was a terminal pulmonary thromboembolism in the right pulmonary artery.

Recent developments in cornea transplantation (1997-1999).

Between 1997 and 1999 a steady increase in cornea donations was achieved, but the number of transplantations remained stable because many grafts did not pass quality control. Intermediate organ culture of entire bulbi was examined as a possible solution to reduce post-mortem times and increase suitability for transplantation.

A food-grade cloning system for industrial strains of Lactococcus lactis.

We have previously reported the construction of a food-grade cloning vector for Lactococcus using the ochre suppressor, supB, as the selective marker. This vector, pFG1, causes only a slight growth inhibition in the laboratory strain MG1363 but is unstable in the industrial strains tested. As supB suppresses both amber and ochre stop codons, which are present in 82% of all known lactococcal genes, this undesirable finding may result from the accumulation of elongated mistranslated polypeptides. Here, we report the development of a new food-grade cloning vector, pFG200, which is suitable for overexpressing a variety of genes in industrial strains of Lactococcus lactis. The vector uses an amber suppressor, supD, as selectable marker and consists entirely of Lactococcus DNA, with the exception of a small polylinker region. Using suppressible pyrimidine auxotrophs, selection and maintenance are efficient in any pyrimidine-free medium including milk. Importantly, the presence of this vector in a variety of industrial strains has no significant effect on the growth rate or the rate of acidification in milk, making this an ideal system for food-grade modification of industrially relevant L. lactis strains. The usefulness of this system is demonstrated by overexpressing the pepN gene in a number of industrial backgrounds.

[The effect of propofol on vomiting after strabismus surgery in children]. / Einfluss von Propofol auf das Erbrechen nach Strabismusoperationen bei Kindern.

Strabismus surgery in children is associated with a high incidence of postoperative nausea and vomiting (PONV). METHODS. Ninety ASA class I and II children aged 6 to 16 years and scheduled for strabismus surgery were randomly assigned to one of the following groups: Group 1 (n=30):thiopentone 4-6 mg/kg i.v., halothane 0.8-1.5%, N2O--O2 2:1, no opioids, droperidol 75 micrograms/kg i.v.; Group 2 (n=30):propofol 2-3 mg/kg i.v., propofol 6-9 mg/kg.h, alfentanil 30 micrgrams/kg.h, N2O-O2 2:1, no antiemetics; Group 3 (n=30):similar to group 2, but ventilation with air and O2 2:1. All patients were mechanically ventilated during anaesthesia and gastric contents were aspirated. Recovery scores were calculated for 2 h, emetic scores for 24 h postoperatively.

[Multiple sclerosis. Clinical topodiagnosis in comparison with cerebral MRI findings]. / Multiple Sklerose. Klinische Topodiagnostik im Vergleich mit zerebralen MRT-Befunden.

Clinicotopographic correlations were performed in a larger group of patients with multiple sclerosis (n = 121). In the assessment of two raters working independently from one another, 73% of all clinical brainstem findings (n = 74) could be traced back to demyelination plaques in the supposed localization as visualized by MRI. The clinical topodiagnostic was especially in accordance with MRI findings concerning internuclear ophthalmoplegia (85%) and abducens palsy (79%). Cerebellar dysfunctions (n = 60) correlated with morphological findings in 87%. More than half of all patients with cerebellar and brainstem symptoms exhibited a periventricular demyelination around the 4th ventricle which was associated with the clinical topodiagnostic. Unequivocal MRI correlations could be hardly found for clinical findings of low topodiagnostical value (symptoms of the long motor and sensory pathways). The clinical status as expressed by Kurtzke's EDSS reflects the extent of cerebral demyelination as seen by MRI only in a larger patient group.

Adaptation to extrauterine existence: cardiac and respiratory rates during the first 72 hours.

In 29 asymptomatic underweight newborns, 10 true preterms and 19 small-forgestational age (SGA), recordings of respiratory and cardiac rates were performed during the first 72 hours of life. The results may be summarized as follows: 1. Respiratory rates (RR) are slightly elevated during the first day of life. 2. The respiratory-to-cardiac ratio (RR/CR) is very constant throughout the first three days. 3. Low-Apgar infants initially have an elevated RR. 4. True preterm infants have higher cardiac rates (CR) than SGA infants. Not all of the phenomena observed can be totally explained on the basis of existing knowledge.

Metabolic rate and O2 consumption in newborns during different states of vigilance.

In 135 asymptomatic newborn infants, 1--53 days of age, body weight 1,820--4,120 g, indirect calometry was performed. According to the state of wakefulness the infants showed during the testing procedure, they were divided into four groups of vigilance (V1--V4). Metabolic rate and oxygen consumption showed similar results between groups V1, V2 and V3 (deep sleep; REM sleep; wakefulness with no muscular activity). V4 infants (with muscular activity) had a higher metabolic rate and O2 consumption. Correlation between metabolic rate and body surface area is similar in V2 and V3 but shows a steeper slope in the V1 group. It is speculated that central regulatory mechanisms may account for this difference.

Acid-base parameters and alveolar-arterial oxygen tension gradients in healthy neonatal and postneonatal infants.

In a randomly selected group of asymptomatic neonatal and postneonatal infants, acid-base parameters and oxygen tension measurements in arterial blood (radial artery) were carried out during air and oxygen breathing. Acid-base results showed a mild, partially compensated metabolic acidosis, indicating adequate pulmonary function. Arterial oxygen tension was in the normal range for this age group. Calculated alveolar oxygen tension levels demonstrated alveolar-arterial gradients of about 30 mm Hg during air breathing and 320 mm Hg during O2 breathing. Volumes of R-L shunts calculated from these gradients, were in the order of magnitude commonly found at this age, i.e., about 20% of right cardiac output. No differences were discernible between infants of appropriate weight for gestational age and small-for-date infants.

Transcutaneous determination of arterial oxygen tension.

Arterial oxygen tension measurements were performed simultaneously using two different techniques: (1) the conventional method of analyzing a blood sample obtained from the radial artery by means of a Clark electrode and (2) a new method of transcutaneous oxygen tension recording using a newly developed surface electrode containing a built-in heating device to ensure optimal cutaneous perfusion at the site of measurement. Two groups of newborn infants were used as subjects: (1) 70 clinically healthy babies who were tested during normoxia and hyperoxia (breathing 80% to 100% oxygen) and (2) 20 sick preterm and term infants receiving inspired oxygen concentrations of between 21% and 100% during the measurement. Our results indicate a satisfactory accuracy for the transcutaneous oxygen tension measurements in normoxia and hyperoxia (percentage coefficient of variation, 15.9% and 24.1%, respectively). In hypoxia agreement between the two methods varies depending on the degree of circulatory derangement. Overall correlation coefficients were greater than 0.85 in each group.