机动车驾驶员肇事认定研究进展

通常通过询问当事人、证人、调取现场监控录像等手段,就可以认定肇事的机动车驾驶员。但这些手段无法确定时,就需要通过鉴定来认定肇事的机动车驾驶员。目前,主要是从法医损伤学、计算机仿真模拟机动车碰撞过程并辅助法医学鉴定、对事故现场、车辆、衣着、人体等要素之间的关联性和动态性分析综合认定等角度鉴定肇事的机动车驾驶员。本文综述从以上三种角度鉴定肇事的机动车驾驶员的最新研究进展,并对认定肇事机动车驾驶员进行了展望。     

Value of Re-examining X-ray Films of Outpatients Attending Accident Services

X-ray films of 4,665 patients who had attended an accident service as outpatients were reviewed by the clinicians and reported on by the radiologist the next day.In 20 cases the radiologist did not comment on bony injuries which had been diagnosed and treated by the accident service senior house officer. The radiologist, however, detected bony injuries which had been missed by the accident service senior house officer in 26 cases. In 10 cases injuries which had not been detected at the original examination or by the radiologist were noted when the x-ray films were reviewed. On two occasions the fracture was missed at all three examinations.The daily joint review of x-ray films by accident service officers and the radiologist seemed to increase the clinical and radiological acumen of the staff of the accident service.     

Improving the care of patients with major trauma in the accident and emergency department.

OBJECTIVE--To determine whether improvement in the care of victims of major trauma could be made by using the revised trauma score as a triage tool to help junior accident and emergency doctors rapidly identify seriously injured patients and thereby call a senior accident and emergency specialist to supervise their resuscitation. DESIGN--Comparison of results of audit of management of all seriously injured patients before and after these measures were introduced. SETTING--Accident and emergency department in an urban hospital. PATIENTS--All seriously injured patients (injury severity score greater than 15) admitted to the department six months before and one year after introduction of the measures. RESULTS--Management errors were reduced from 58% (21/36) to 30% (16/54) (p less than 0.01). Correct treatment rather than improvement in diagnosis or investigation accounted for almost all the improvement. CONCLUSIONS--The management of seriously injured patients in the accident and emergency department can be improved by introducing two simple measures: using the revised trauma score as a triage tool to help junior doctors in the accident and emergency department rapidly identify seriously injured patients, and calling a senior accident and emergency specialist to supervise the resuscitation of all seriously injured patients. IMPLICATIONS--Care of patients in accident and emergency departments can be improved considerably at no additional expense by introducing two simple measures.     

Psychological and social evaluation in cases of deliberate self-poisoning seen in an accident department.

The outcome in 115 consecutive patients with mild self-poisoning seen by junior medical staff and discharged from the accident department was compared with that of 98 similar patients admitted to the medical wards. Psychiatrists saw only four patients in the accident department and 25 admissions. In making their assessments the junior medical staff considered psychosocial factors as well as the patients'' physical condition. Most patients recommended for further care, and discharged from the accident department, subsequently received it. Repetition rates were similar in the two groups and there had been no suicides when patients were followed up at one year. It is feasible for junior staff in an accident department to decide whether patients with self-poisoning need admission or may be discharged with or without subsequent referral for psychiatric or social work help.     

The Shift-Work Accident Rate is More Related to the Shift Type than to Shift Rotation

The current study investigated the accident rates across morning, late, and night shifts in rotating shift-workers employed in two different shift rotations at the same steel work factory. A retrospective analysis has been performed of accident data (N = 578) over a 5-year period (2003 through 2007) of 730 male shift-workers employed in either a clockwise (mean age of the workers 38.1 ± SD 9.8 years) or counterclockwise rotation (mean age 38.0 ± SD 10.1 years) with comparable work conditions. The overall accident rate across the 24-h day was not significantly different between clockwise and counterclockwise shift rotation. In both shift-work rotations, morning shifts as opposed to night shifts exhibited a significantly higher accident rate. There was no significant difference between late shifts and morning or night shifts in either shift rotation. The increased accident rate in the morning shift at this steel factory could be related to the early starting time of the shift and to this shift being more labor intensive in both shift rotations. These findings suggest that work-related factors must be considered in addition to shift-work schedules when investigating accident rates in rotating shift-workers.     

The effect of Chernobyl accident on the development of non malignant diseases

The early medical complications of Chernobyl accident include post radiation disease, which were diagnosed in 134 subjects affected by ionizing radiation. 28 persons died during the first 100 days after the event. The increase occurrence of coronary heart disease, endocrine, haematological, dermatological and other diseases were observed after disaster in the contaminated territories. We also discussed the impact of ionizing radiation from Chernobyl accident on pregnancy and congenital defects occurrence. Changes following the Chernobyl accident, as the inhabitants migration from contaminated regions, political and economic conversions, led to depression, anxiety, and even to "epidemic" of mental diseases. Increased suicide rate, car accidents, alcohol and drug abuse have been observed in this population. Nowadays vegetative neurosis is more often diagnosed in Ukrainian children. Epidemiological studies were conducted on the ionising radiation effect on the health and on the dose of received radiation after Chernobyl accident face numerous problems as the absence of reliable data regarding diseases in the contaminated territories.     

Meaning of Missing Values in Eyewitness Recall and Accident Records

Background

Eyewitness recalls and accident records frequently do not mention the conditions and behaviors of interest to researchers and lead to missing values and to uncertainty about the prevalence of these conditions and behaviors surrounding accidents. Missing values may occur because eyewitnesses report the presence but not the absence of obvious clues/accident features. We examined this possibility.

Methodology/Principal Findings

Participants watched car accident videos and were asked to recall as much information as they could remember about each accident. The results showed that eyewitnesses were far more likely to report the presence of present obvious clues than the absence of absent obvious clues even though they were aware of their absence.

Conclusions

One of the principal mechanisms causing missing values may be eyewitnesses'' tendency to not report the absence of obvious features. We discuss the implications of our findings for both retrospective and prospective analyses of accident records, and illustrate the consequences of adopting inappropriate assumptions about the meaning of missing values using the Avaluator Avalanche Accident Prevention Card.     

Trends in infant leukaemia in West Germany in relation to in utero exposure due to the Chernobyl accident

A temporary increase in the incidence of infant leukaemia in Greece was reported by Petridou et al., which was attributed to in utero exposure to ionising radiation resulting from the Chernobyl accident. We performed a similar analysis based on the data of the German Childhood Cancer Registry in order to check whether the observation could be confirmed by means of independent data. Applying the same definitions as Petridou et al., we also observed an increased incidence of infant leukaemia in a cohort of children born after the Chernobyl accident. More detailed analyses, regarding areas with different contamination levels and dose rate gradients over time after the accident, showed, however, no clear trend with regard to exposure. It would therefore appear less likely that the observed effect was caused by exposure to ionising radiation due to the Chernobyl accident. Received: 30 January 1998 / Accepted in revised form: 23 April 1998     

Patterns of otter Lutra lutra road mortality in a landscape abundant in lakes

In order to reduce otter (Lutra lutra) road mortality and to predict accident sites, we assessed the localities of traffic accidents involving otters in the Uckermark County, Brandenburg, Northeast Germany. Eighty-eight otter accident sites from the years 1990 to 2003—as recorded by the Naturschutzstation Zippelsförde des Landesumweltamtes Brandenburg (Brandenburg State Office for Environment)—were categorised according to traffic and road patterns, otter habitat suitability, as well as presence and type of watercourse crossings. From these numerical data, we compiled a list of characteristics to identify other potentially dangerous sites where otter road traffic accidents are likely to occur using a geographic information system. With a principal component analysis, we categorised three groups of accident sites. Firstly, most otter road accidents were located close to either one or two lakes. Secondly, otters were frequently killed at places where no body of water occurred within a distance of 200 m to the road. Thirdly, and in contrast to other locations, in the Uckermark County, fewest accidents happened where a road crossed a watercourse. Mitigation measures were suggested and discussed for the recorded and potential accident sites.

     

Relation of out of hours activity by general practice and accident and emergency services with deprivation in Nottingham: longitudinal survey.

OBJECTIVES: To investigate the relation between out of hours activity of general practice and accident and emergency services with deprivation and distance from accident and emergency department. DESIGN: Six month longitudinal study. SETTING: Six general practices and the sole accident and emergency department in Nottingham. SUBJECTS: 4745 out of hours contacts generated by 45,182 patients from 23 electoral wards registered with six practices. MAIN OUTCOME MEASURES: Rates of out of hours contacts for general practice and accident and emergency services calculated by electoral ward; Jarman and Townsend deprivation scores and distance from accident and emergency department of electoral wards. RESULTS: Distances of wards from accident and emergency department ranged from 0.8 to 9 km, and Jarman deprivation scores ranged from -23.4 to 51.8. Out of hours contacts varied by ward from 110 to 350 events/1000 patients/year, and 58% of this variation was explained by the Jarman score. General practice and accident and emergency rates were positively correlated (Pearson coefficient 0.50, P = 0.015). Proximity to accident and emergency department was not significantly associated with increased activity when deprivation was included in regression analysis. One practice had substantially higher out of hours activity (B coefficient 124 (95% confidence interval 67 to 181)) even when deprivation was included in regression analysis. CONCLUSIONS: A disproportionate amount of out of hours workload fell on deprived inner city practices. High general practice and high accident and emergency activity occurred in the same areas rather than one service substituting for the other.     

External exposure of the population living in areas of Russia contaminated due to the Chernobyl accident

An updated version of external dose modeling is presented with reference to the population in Russian areas contaminated due to the Chernobyl accident. An earlier version has been modified by applying a study time interval with a starting point immediately after radionuclide deposition (rather than 4 years after the accident as applied earlier) and by introducing an estimate of individual dose distributions. New input data to the model are the nuclide-specific composition of the deposit, additional data about migration of caesium in soil, time dependence of location factors and uncertainty distributions of all input parameters. Model results (i.e. effective dose-rates and accumulated effective doses) from external exposure for the rural and urban populations in contaminated areas of Russia during 100 years after the accident are presented. Radionuclide contributions to the dose during various time intervals after the accident have been estimated. The model has been validated by measurements of absorbed dose-rate in air during the first 30 days after the accident and by TLD measurements of individual external doses among inhabitants of contaminated rural settlements in the year 1993. Both the measurements and model show that the geometric mean of individual external doses is about 10% lower than the arithmetic mean and the upper bound of the 95% confidence range is larger by a factor of about 2.     

Radiobiology and the lessons of Chernobyl

The Chernobyl accident has marked the beginning of a new stage of radiobiology development and revealed scantiness of old concepts. One should (1) search for effective protectors against the long-term influence of low-level radiation and means of removal of radionuclides using criteria that differ principally from those used previously in selecting among nontoxic antioxidants, immunomodulators, and adaptogens; (2) study systematically the synergism of low doses of harmful agents and review the hygienic standardization system with due regard for the risk from their combinations; (3) consider comprehensively, on the basis of the experimental and clinical experience, the problem of "hot" particles and remote consequences of their influence on the respiratory and digestive systems; (4) study independently the problem of chronic stress as a combination of radiation effects and psycho-emotional consequences of the accident and living in the exposed areas; (5) consider it inadmissible to include in the B category the population of the districts influenced by the accident and to use the concept: "35 rads during the lifetime" in standardizing the radiation load; (6) organize a comprehensive analysis of the Chernobyl accident consequences for public health within the contaminated areas as well as for animals and plants using a single approved methodology and programme, the principle of "other equal conditions" being provided.     

Nurse practitioners in accident and emergency departments: what do they do?

OBJECTIVE--To determine the distribution and scope of nurse practitioner schemes in accident and emergency departments in England and Wales; to describe the caseloads of doctors and nurse practitioners on two representative days; and to estimate the number of patients managed by nurse practitioners in the year to 31 March 1991. DESIGN--A postal survey of accident and emergency departments and a content analysis of case notes of new patients attending a representative sample of accident and emergency departments on two days. SETTING--All accident and emergency departments in England and Wales. PARTICIPANTS--Survey: 560 nurses in charge of accident and emergency departments. Census: case notes of 5814 patients in 37 accident and emergency departments. MAIN OUTCOME MEASURES--Survey: number of accident and emergency departments with nurse practitioner schemes. Census: demographic and clinical characteristics of new patients attending and whether nurse practitioner or doctor made diagnoses and ordered investigations, treatments, referrals, discharges. RESULTS--513 replies (92%) from 465 surveyed functioning accident and emergency departments and 48 departments recently closed. 27 (6%) departments used designated nurse practitioners and 159 (34%) "unofficial" nurse practitioners. Only 530 (9%) of the 5814 patients in the census were managed entirely or mainly by nurse practitioners, with higher proportions in ophthalmic departments (nearly 30%) and minor casualty departments (over 40%) than in major departments (3%). Most patients managed by nurse practitioners (86%) had minor trauma. In the year ending 31 March 1991 an estimated 390,000 (95% confidence interval 260,000 to 520,000) patients out of a total of 12.5 million (3.1%, 2.1% to 4.1%) were clinically managed by a nurse practitioner. CONCLUSIONS--Designated nurse practitioner schemes are rare. The volume and range of nurse practitioner work in major general accident and emergency departments is small compared with those in specialised and minor accident and emergency departments.     

Results of cytogenetic studies of the consequences of the Chernobyl accident

The selected results of the cytogenetic studies of the Chernobyl accident consequences were summarised. The chromosomal aberrations were used as a method of biodosimetry for a dose assessment for victims during the initial period after the Chernobyl accident. A good correlation between doses calculated based on chromosomal aberrations (dicentrics) and severity of acute radiation syndrome observed in clinic was found. The biodosimetry based on conventional cytogenetic technique (dicentrics) has been unsuccessful for various groups (rehabilitation workers, evacuees, inhabitants of contaminated areas) sampled long time after the Chernobyl accident. The possible reasons of the failure are analysed. The original results of multiaberration cell yield observed in different cohorts of the Chernobyl victims are presented. The problems related to the phenomena are discussed.     

Hereditary minisatellite mutations among the offspring of Estonian Chernobyl cleanup workers

A single accidental event such as the fallout released from the Chernobyl reactor in 1986 can expose millions of people to non-natural environmental radiation. Ionizing radiation increases the frequency of germline mutations in experimental studies, but the genetic effects of radiation in humans remain largely undefined. To evaluate the hereditary effects of low radiation doses, we compared the minisatellite mutation rates of 155 children born to Estonian Chernobyl cleanup workers after the accident with those of their siblings born prior to it. All together, 94 de novo paternal minisatellite mutations were found at eight tested loci (52 and 42 mutants among children born after and before the accident, respectively). The minisatellite mutation rate was nonsignificantly increased among children born after the accident (0.042 compared to 0.036, OR 1.33, 95% CI 0.80-2.20). Furthermore, there was some indication of an increased mutation rate among offspring born after the accident to workers who had received doses of 20 cSv or above compared with their siblings born before the accident (OR 3.0, 95% CI 0.97-9.30). The mutation rate was not associated with the father's age (OR 1.04, 95% CI 0.94-1.15) or the sex of the child (OR 0.95, 95% CI 0.50-1.79). Our results are consistent with both no effect of radiation on minisatellite mutations and a slight increase at dose levels exceeding 20 cSv.     

The molecular and cellular consequences of the chernobyl accident

In this paper the results of research at 5–10 and 24 years after the Chernobyl accident are summarized. These results include the investigation of genomic instability, formation of the adaptive response, genome damage, and oxidative status. The studies were performed on cells in culture, mice, children and adults who lived in the contaminated areas, and liquidators of the consequences of the Chernobyl accident. Inhibition of cell proliferative activity, late cell death, and the increase in micronucleus and giant cell frequency were observed after the exposure of cells in culture in the accident zone followed by their culturing in laboratory conditions. In the progeny of the exposed cells, the effect of enhanced radiosensitivity was detected. Thus, it can be assumed that exposure of parental cells in culture in the area of the accident induced genomic instability that resulted in the development of various abnormalities in progeny cells. At the organism level, the Chernobyl zone exposure of mice caused an increase in radiosensitivity; as well, a decrease in the endotheliocyte density in the cerebral cortex and other brain tissues was observed. In the blood lymphocytes of children stimulated by PHA, a more than two times increase in micronucleus cell frequency was detected. A reduced number of individuals with significant adaptive response was found in both the juvenile and adult groups. In all investigated populations, an increased number of individuals with enhanced radiosensitivity were observed in response to low-dose radiation exposure. At 24 years after the accident liquidators were subjected to examinations, which revealed an increased frequency of cells with micronuclei and chromosome-type aberrations in blood lymphocytes, an elevated level of DNA double strand breaks, and a reduced level of reactive oxygen species compared to those of the control group. This means that the genomic instability that was accumulated by the residents of the contaminated regions and liquidators as a result of the accident leads to damage of the genetic apparatus, an increase in radiosensitivity, and hypoxia as late consequences that all are risk factors and increase the probability of the development of tumor and non-tumor diseases. The development of the above-mentioned pathological processes may occur in the distant future.

     

Radiation-induced late effects in two affected individuals of the Lilo radiation accident

Radiation exposure leads to a risk for long-term deterministic and stochastic late effects. Two individuals exposed to protracted photon radiation in the radiological accident at the Lilo Military site in Georgia in 1997 received follow-up treatment and resection of several chronic radiation ulcers in the Bundeswehr Hospital Ulm, Germany, in 2003. Multi-parameter analysis revealed that spermatogenetic arrest and serum hormone levels in both patients had recovered compared to the status in 1997. However, we observed a persistence of altered T-cell ratios, increased ICAM1 and beta1-integrin expression, and aberrant bone marrow cells and lymphocytes with significantly increased translocations 6 years after the accident. This investigation thus identified altered end points still detectable years after the accident that suggest persistent genomic damage as well as epigenetic effects in these individuals, which may be associated with an elevated risk for the development of further late effects. Our observations further suggest the development of a chronic radiation syndrome and indicate follow-up parameters in radiation victims.     

The problem of induced genome instability as the basis of the increased morbidity in children exposed to low-intensity radiation at low doses

The main results of the complex examination of the genome instability are presented in children constantly living on territories contaminated with radionuclides as a result of the accident at the CNPP (Novozybkov district, Bryansk region, 16-18 Ci/km2, 137Cs) and in children exposed to low-intensity radiation at different stages of ontogenetic development: children exposed to postnatal irradiation in 1986 (born before the accident), children exposed to intrauterine irradiation during the accident in 1986, children of irradiated parents born after the accident in 1987-1992 and in 1994-2000. In all examined groups of irradiated children increased frequencies of certain radiation-induced chromosome aberrations were observed as well as a reduced activity of unscheduled synthesis of genomic DNA in lymphocytes and peculiarities in individual heterozygosity of genes encoding structural and enzymatic proteins of blood. An increased radiosensitivity of lymphocyte genomes to testing in vitro irradiation and peculiarities in the dynamics of the frequencies of chromosome aberrations and sister chromatid exchanges in 3 cell generations were revealed in children from the contaminated areas. The data obtained suggest a systemic character of dysgenomic effects, the reality of induction of genome instability in the growing organism of children exposed to low-intensity radiation at low doses the expression of which is determined by individual genotypic features of the organism. Biological significance of the phenomenon of the post-radiation genome instability, its relation to the state of health and the pathogenetic role in the development of somatic pathology are postulated.     

15 years after the accident at the Chernobyl Nuclear Power Plant

Health effects as a result of the accident at the Chernobyl nuclear power plant occurred in 1986 are considered in the paper. Wrong prognosis of the health effects with respect to mortality and morbidity among the population exposed to low radiation doses is shown. Proven increase in thyroid cancer cases among people who were children aged from 0 to 18 at the time of the accident is shown. Linear relationship between thyroid cancer cases and dose to thyroid ranged from 0.2 to 4.0 Gy is considered. An additional absolute risk of thyroid cancer in children varies in the range 1.9-2.6 cases per 10(4) person-year Gy. During the fifteen years following the accident no cases of acute and chronic radiation sickness have been revealed because the population living in contaminated areas received low radiation doses. Also, exposures to low radiation doses did not result in excess of malignant tumors among population. In some cases the outcomes of acute radiation sickness were as follows: radiation damages to the skin, cancer cataracts, development of oncopathology.