A prospective longitudinal study assessed 967 consecutive patients who attended an emergency clinic shortly after a motor vehicle accident, again at 3 months, and at 1 year. The prevalence of posttraumatic stress disorder (PTSD) was 23.1% at 3 months and 16.5% at 1 year. Chronic PTSD was related to some objective measures of trauma severity, perceived threat, and dissociation during the accident, to female gender, to previous emotional problems, and to litigation. Maintaining psychological factors, that is, negative interpretation of intrusions, rumination, thought suppression, and anger cognitions, enhanced the accuracy of the prediction. Negative interpretation of intrusions, persistent medical problems, and rumination at 3 months were the most important predictors of PTSD symptoms at 1 year. Rumination, anger cognitions, injury severity, and prior emotional problems identified cases of delayed onset.

Psychological predictors of chronic posttraumatic stress disorder after motor vehicle accidents.

Physical humanârobot interaction and cooperation has become a topic of increasing importance and of major focus in robotics research. An essential requirement of a robot designed for high mobility and direct interaction with human users or uncertain environments is that it must in no case pose a threat to the human. Until recently, quite a few attempts were made to investigate real-world threats via collision tests and use the outcome to considerably improve safety during physical humanârobot interaction. In this paper, we give an overview of our systematic evaluation of safety in humanârobot interaction, covering various aspects of the most significant injury mechanisms. In order to quantify the potential injury risk emanating from such a manipulator, impact tests with the DLR-Lightweight Robot III were carried out using standard automobile crash test facilities at the German Automobile Club (ADAC). Based on these tests, several industrial robots of different weight have been evaluated and the influence of the robot mass and velocity have been investigated. The evaluated non-constrained impacts would only partially capture the nature of humanârobot safety. A possibly constrained environment and its effect on the resulting human injuries are discussed and evaluated from different perspectives. As well as such impact tests and simulations, we have analyzed the problem of the quasi-static constrained impact, which could pose a serious threat to the human even for low-inertia robots under certain circumstances. Finally, possible injuries relevant in robotics are summarized and systematically classified.

/pdf/requirements-for-safe-robots-measurements-analysis-and-new-5cssx3rtac.pdf

Requirements for Safe Robots: Measurements, Analysis and New Insights

Background: The aims of this study were to (1) estimate the prevalence of clinical depression and posttraumatic stress disorder (PTSD) one to two months (Time 1) and five to eight months (Time 2) after musculoskeletal trauma and (2) determine the cross-sectional and longitudinal relationship of psychological variables (depression, PTSD, catastrophic thinking, and pain anxiety) at Time 1 to musculoskeletal disability and pain intensity at Time 1 and Time 2, after accounting for injury characteristics and demographic variables.

Methods: Patients with one or more fractures that had been treated operatively completed measures of depression, PTSD, pain anxiety, catastrophic thinking, musculoskeletal disability (the Short Musculoskeletal Function Assessment [SMFA]), and pain (the Numerical Rating Scale) at rest and during activity at Time 1 (152 patients) and at Time 2 (136 patients). Additional explanatory variables included injury severity, use of opioid pain medication at Time 1, and multiple or single injuries.

Results: The screening criteria for an estimated diagnosis of clinical depression were met by thirty-five of the 152 patients at Time 1, and twenty-nine of the 136 patients at Time 2. Screening criteria for an estimated diagnosis of PTSD were met by forty-three of the 152 patients at Time 1 and twenty-five of the 136 patients at Time 2. Cross-sectional hierarchical linear regression models that included multiple injuries, scores of the Abbreviated Injury Scale, and self-reported opioid use explained between 24% and 29% of the variance in pain and disability, respectively, at Time 1. After the addition of psychological variables, the model explained between 49% and 55% of the variance. Catastrophic thinking (as measured with use of the Pain Catastrophizing Scale) at Time 1 was the sole significant predictor of pain at rest, pain during activity, and disability (as measured with use of the SMFA) at Time 2.

Conclusions: We found that psychological factors that are responsive to cognitive behavioral therapy—catastrophic thinking, in particular—are strongly associated with pain intensity and disability in patients recovering from musculoskeletal trauma.

Level of Evidence: Prognostic Level I. See Instructions for Authors for a complete description of levels of evidence.

Peer Review: This article was reviewed by the Editor-in-Chief and one Deputy Editor, and it underwent blinded review by two or more outside experts. It was also reviewed by an expert in methodology and statistics. The Deputy Editor reviewed each revision of the article, and it underwent a final review by the Editor-in-Chief prior to publication. Final corrections and clarifications occurred during one or more exchanges between the author(s) and copyeditors.

Psychological factors predict disability and pain intensity after skeletal trauma.

The dural sheath surrounding the optic nerve communicates with the subarachnoid space, and distends when intracranial pressure is elevated Magnetic resonance imaging (MRI) is often performed in patients at risk for raised intracranial pressure (ICP) and can be used to measure precisely the diameter of optic nerve and its sheath The objective of this study was to assess the relationship between optic nerve sheath diameter (ONSD), as measured using MRI, and ICP We conducted a retrospective blinded analysis of brain MRI images in a prospective cohort of 38 patients requiring ICP monitoring after severe traumatic brain injury (TBI), and in 36 healthy volunteers ONSD was measured on T2-weighted turbo spin-echo fat-suppressed sequence obtained at 3 Tesla MRI ICP was measured invasively during the MRI scan via a parenchymal sensor in the TBI patients Measurement of ONSD was possible in 95% of cases The ONSD was significantly greater in TBI patients with raised ICP (>20 mmHg; 631 ± 050 mm, 19 measures) than in those with ICP of 20 mmHg or less (529 ± 048 mm, 26 measures; P < 00001) or in healthy volunteers (508 ± 052 mm; P < 00001) There was a significant relationship between ONSD and ICP (r = 071, P < 00001) Enlarged ONSD was a robust predictor of raised ICP (area under the receiver operating characteristic curve = 094), with a best cut-off of 582 mm, corresponding to a negative predictive value of 92%, and to a value of 100% when ONSD was less than 530 mm When brain MRI is indicated, ONSD measurement on images obtained using routine sequences can provide a quantitative estimate of the likelihood of significant intracranial hypertension

/pdf/use-of-t2-weighted-magnetic-resonance-imaging-of-the-optic-1rqsx6yp3y.pdf

Use of T2-weighted magnetic resonance imaging of the optic nerve sheath to detect raised intracranial pressure

Background
A comparison of the amount of and the kinetics of induction of procalcitonin (PCT) with that of C-reactive protein (CRP) during various types of and severities of multiple trauma, and their relation to trauma-related complications, was performed

/pdf/correlation-of-procalcitonin-and-c-reactive-protein-to-2kghktmwu1.pdf

Correlation of procalcitonin and C-reactive protein to inflammation, complications, and outcome during the intensive care unit course of multiple-trauma patients

J. I. Barancak

Papers

Abbreviated Injury Scale