A traffic collision called a motor vehicle collision among other terms, occurs when a vehicle collides with another vehicle, animal, road debris, or other stationary obstruction, such as a tree, pole or building. Traffic collisions result in injury and property damage. A number of factors contribute to the risk of collision, including vehicle design, speed of operation, road design, road environment, driver skill, impairment due to alcohol or drugs, behavior, notably distracted driving and street racing. Worldwide, motor vehicle collisions lead to death and disability as well as financial costs to both society and the individuals involved. In 2013, 54 million people worldwide sustained injuries from traffic collisions; this resulted in 1.4 million deaths in 2013, up from 1.1 million deaths in 1990. About 68,000 of these occurred in children less than five years old. All high-income countries have decreasing death rates, while the majority of low-income countries have increasing death rates due to traffic collisions.
Middle-income countries have the highest rate with 20 deaths per 100,000 inhabitants, accounting for 80% of all road fatalities with 52% of all vehicles. While the death rate in Africa is the highest, the lowest rate is to be found in Europe. Traffic collisions can be classified by general types. Types of collision include head-on, road departure, rear-end, side collisions, rollovers. Many different terms are used to describe vehicle collisions; the World Health Organization uses the term road traffic injury, while the U. S. Census Bureau uses the term motor vehicle accidents, Transport Canada uses the term "motor vehicle traffic collision". Other common terms include auto accident, car accident, car crash, car smash, car wreck, motor vehicle collision, personal injury collision, road accident, road traffic accident, road traffic collision, road traffic incident as well as more unofficial terms including smash-up, pile-up, fender bender; some organizations have begun to avoid the term "accident", instead preferring terms such as "collision", "crash" or "incident".
This is because the term "accident" implies that there is no-one to blame, whereas most traffic collisions are the result of driving under the influence, excessive speed, distractions such as mobile phones or other risky behavior. In the United States, the use of terms other than "accidents" had been criticized for holding back safety improvements, based on the idea that a culture of blame may discourage the involved parties from disclosing the facts, thus frustrate attempts to address the real root causes. Following collisions, long-lasting psychological trauma may occur; these issues may make those. In some cases, the psychological trauma may affect individuals' life can cause difficulty to go to work, attend school, or perform family responsibilities. A number of physical injuries can result from the blunt force trauma caused by a collision, ranging from bruising and contusions to catastrophic physical injury or death. A 1985 study by K. Rumar, using British and American crash reports as data, suggested 57% of crashes were due to driver factors, 27% to combined roadway and driver factors, 6% to combined vehicle and driver factors, 3% to roadway factors, 3% to combined roadway and vehicle factors, 2% to vehicle factors, 1% to combined roadway and vehicle factors.
Reducing the severity of injury in crashes is more important than reducing incidence and ranking incidence by broad categories of causes is misleading regarding severe injury reduction. Vehicle and road modifications are more effective than behavioral change efforts with the exception of certain laws such as required use of seat belts, motorcycle helmets and graduated licensing of teenagers. Human factors in vehicle collisions include anything related to drivers and other road users that may contribute to a collision. Examples include driver behavior and auditory acuity, decision-making ability, reaction speed. A 1985 report based on British and American crash data found driver error and other human factors contribute wholly or to about 93% of crashes. Drivers distracted by mobile devices had nearly four times greater risk of crashing their cars than those who were not. Dialing a phone is the most dangerous distraction, increasing a drivers’ chance of crashing by 12 times, followed by reading or writing, which increased the risk by 10 times.
An RAC survey of British drivers found 78% of drivers thought they were skilled at driving, most thought they were better than other drivers, a result suggesting overconfidence in their abilities. Nearly all drivers, in a crash did not believe themselves to be at fault. One survey of drivers reported that they thought the key elements of good driving were: controlling a car including a good awareness of the car's size and capabilities reading and reacting to road conditions, road signs and the environment alertness and anticipating the behavior of other drivers. Although proficiency in these skills is taught and tested as part of the driving exam, a "good" driver can still be at a high risk of crashing because:...the feeling of being confident in more and more challenging situations is experienced as evidence of driving ability, that'proven' ability reinforces the feelings of confidence. Confidence grows unchecked until something happens -- a near-miss or an accident. An AXA survey concluded Irish drivers are safety-conscious relative to other European drivers.
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Neurosurgery, or neurological surgery, is the medical specialty concerned with the prevention, surgical treatment, rehabilitation of disorders which affect any portion of the nervous system including the brain, spinal cord, peripheral nerves, extra-cranial cerebrovascular system. In different countries, there are different requirements for an individual to practice neurosurgery, there are varying methods through which they must be educated. In most countries, neurosurgeon training requires a minimum period of seven years after graduating from medical school. In the United States, a neurosurgeon must complete four years of undergraduate education, four years of medical school, seven years of residency. Most, but not all, residency programs have some component of clinical research. Neurosurgeons may pursue additional training in the form of a fellowship, after residency or in some cases, as a senior resident; these fellowships include pediatric neurosurgery, trauma/neurocritical care and stereotactic surgery, surgical neuro-oncology, neurovascular surgery, skull-base surgery, peripheral nerve and spine surgery.
In the U. S. neurosurgery is considered a competitive specialty composed of 0.6% of all practicing physicians. In the United Kingdom, students must gain entry into medical school. MBBS qualification takes four to six years depending on the student's route; the newly qualified physician must complete foundation training lasting two years. Junior doctors apply to enter the neurosurgical pathway. Unlike most other surgical specialties, it has its own independent training pathway which takes around eight years. Neurosurgery remains amongst the most competitive medical specialties in which to obtain entry. Neurosurgery, or the premeditated incision into the head for pain relief, has been around for thousands of years, but notable advancements in neurosurgery have only come within the last hundred years; the Incas appear to have practiced a procedure known as trepanation since the late Stone age. During the Middle Ages in Arabia from 936 to 1013 AD, Al-Zahrawi performed surgical treatments of head injuries, skull fractures, spinal injuries, subdural effusions and headache.
There was not much advancement in neurosurgery until late 19th early 20th century, when electrodes were placed on the brain and superficial tumors were removed. History of electrodes in the brain: In 1878 Richard Canton discovered that electrical signals transmitted through an animal's brain. In 1950 Dr. Jose Delgado invented the first electrode, implanted in an animal's brain, using it to make it run and change direction. In 1972 the cochlear implant, a neurological prosthetic that allowed deaf people to hear was marketed for commercial use. In 1998 researcher Philip Kennedy implanted the first Brain Computer Interface into a human subject. History of tumor removal: In 1879 after locating it via neurological signs alone, Scottish surgeon William Macewen performed the first successful brain tumor removal. On November 25, 1884 after English physician Alexander Hughes Bennett used Macewen's technique to locate it, English surgeon Rickman Godlee performed the first primary brain tumor removal, which differs from Macewen's operation in that Bennett operated on the exposed brain, whereas Macewen operated outside of the "brain proper" via trepanation.
On March 16, 1907 Austrian surgeon Hermann Schloffer became the first to remove a pituitary tumor. The main advancements in neurosurgery came about as a result of crafted tools. Modern neurosurgical tools, or instruments, include chisels, dissectors, elevators, hooks, probes, suction tubes, power tools, robots. Most of these modern tools, like chisels, forcepts, hooks and probes, have been in medical practice for a long time; the main difference of these tools and post advancement in neurosurgery, were the precision in which they were crafted. These tools are crafted with edges. Other tools such as hand held power saws and robots have only been used inside of a neurological operating room; as an example, the University of Utah developed a device for computer-aided design / computer-aided manufacturing which uses an image-guided system to define a cutting tool path for a robotic cranial drill. General neurosurgery involves most neurosurgical conditions including neuro-trauma and other neuro-emergencies such as intracranial hemorrhage.
Most level 1 hospitals have this kind of practice. Specialized branches have developed to cater to difficult conditions; these specialized branches co-exist with general neurosurgery in more sophisticated hospitals. To practice advanced specialization within neurosurgery, additional higher fellowship training of one to two years is expected from the neurosurgeon; some of these divisions of neurosurgery are: Vascular neurosurgery includes clipping of aneurysms and performing carotid endarterectomy. Stereotactic neurosurgery, functional neurosurgery, epilepsy surgery (the latter includes partial or total corpus callosotomy – severing part or all of the corpus callosum to stop or lessen seizure spread and activity, the surgical removal of functional, physiological and/or anatomical pieces or divisions of the brain, called epileptic foci, that are operable and th
Medical diagnosis is the process of determining which disease or condition explains a person's symptoms and signs. It is most referred to as diagnosis with the medical context being implicit; the information required for diagnosis is collected from a history and physical examination of the person seeking medical care. One or more diagnostic procedures, such as diagnostic tests, are done during the process. Sometimes posthumous diagnosis is considered a kind of medical diagnosis. Diagnosis is challenging, because many signs and symptoms are nonspecific. For example, redness of the skin, by itself, is a sign of many disorders and thus does not tell the healthcare professional what is wrong, thus differential diagnosis, in which several possible explanations are compared and contrasted, must be performed. This involves the correlation of various pieces of information followed by the recognition and differentiation of patterns; the process is made easy by a sign or symptom, pathognomonic. Diagnosis is a major component of the procedure of a doctor's visit.
From the point of view of statistics, the diagnostic procedure involves classification tests. The first recorded examples of medical diagnosis are found in the writings of Imhotep in ancient Egypt. A Babylonian medical textbook, the Diagnostic Handbook written by Esagil-kin-apli, introduced the use of empiricism and rationality in the diagnosis of an illness or disease. Traditional Chinese Medicine, as described in the Yellow Emperor's Inner Canon or Huangdi Neijing, specified four diagnostic methods: inspection, auscultation-olfaction and palpation. Hippocrates was known to make diagnoses by smelling their sweat. A diagnosis, in the sense of diagnostic procedure, can be regarded as an attempt at classification of an individual's condition into separate and distinct categories that allow medical decisions about treatment and prognosis to be made. Subsequently, a diagnostic opinion is described in terms of a disease or other condition, but in the case of a wrong diagnosis, the individual's actual disease or condition is not the same as the individual's diagnosis.
A diagnostic procedure may be performed by various health care professionals such as a physician, physical therapist, healthcare scientist, dentist, nurse practitioner, or physician assistant. This article uses diagnostician as any of these person categories. A diagnostic procedure does not involve elucidation of the etiology of the diseases or conditions of interest, that is, what caused the disease or condition; such elucidation can be useful to optimize treatment, further specify the prognosis or prevent recurrence of the disease or condition in the future. The initial task is to detect a medical indication to perform a diagnostic procedure. Indications include: Detection of any deviation from what is known to be normal, such as can be described in terms of, for example, physiology, pathology and human homeostasis. Knowledge of what is normal and measuring of the patient's current condition against those norms can assist in determining the patient's particular departure from homeostasis and the degree of departure, which in turn can assist in quantifying the indication for further diagnostic processing.
A complaint expressed by a patient. The fact that a patient has sought a diagnostician can itself be an indication to perform a diagnostic procedure. For example, in a doctor's visit, the physician may start performing a diagnostic procedure by watching the gait of the patient from the waiting room to the doctor's office before she or he has started to present any complaints. During an ongoing diagnostic procedure, there can be an indication to perform another, diagnostic procedure for another concomitant, disease or condition; this may occur as a result of an incidental finding of a sign unrelated to the parameter of interest, such as can occur in comprehensive tests such as radiological studies like magnetic resonance imaging or blood test panels that include blood tests that are not relevant for the ongoing diagnosis. General components which are present in a diagnostic procedure in most of the various available methods include: Complementing the given information with further data gathering, which may include questions of the medical history, physical examination and various diagnostic tests.
A diagnostic test is any kind of medical test performed to aid in the diagnosis or detection of disease. Diagnostic tests can be used to provide prognostic information on people with established disease. Processing of the answers, findings or other results. Consultations with other providers and specialists in the field may be sought. There are a number of methods or techniques that can be used in a diagnostic procedure, including performing a differential diagnosis or following medical algorithms. In reality, a diagnostic procedure may involve components of multiple methods; the method of differential diagnosis is based on finding as many candidate diseases or conditions as possible that can cause the signs or symptoms, followed by a process of elimination or at least of rendering the entries more or less probable by further medical tests and other processing until, aiming to reach the point where only one candidate disease or condit
The torso or trunk is an anatomical term for the central part or core of many animal bodies from which extend the neck and limbs. The torso includes: the thoracic segment of the trunk, the abdominal segment of the trunk, the perineum. Most critical organs are housed within the torso. In the upper chest, the heart and lungs are protected by the rib cage, the abdomen contains most of the organs responsible for digestion: the stomach, which breaks down digested food via gastric acid; the pelvic region houses both the male and female reproductive organs. The torso harbours many of the main groups of muscles in the body, including the: pectoral muscles abdominal muscles lateral muscle epaxial muscles The organs and other contents of the torso are supplied by nerves, which originate as nerve roots from the thoracic and lumbar parts of the spinal cord; some organs receive a nerve supply from the vagus nerve. The sensation to the skin is provided by: Lateral cutaneous branches of torso|Lateral cutaneous branches Dorsal cutaneous branches Belly cast Waist Belvedere Torso
Botulinum toxin is a neurotoxic protein produced by the bacterium Clostridium botulinum and related species. It prevents the release of the neurotransmitter acetylcholine from axon endings at the neuromuscular junction and thus causes flaccid paralysis. Infection with the bacterium causes the disease botulism; the toxin is used commercially in medicine and research. Botulinum is the most acutely lethal toxin known, with an estimated human median lethal dose of 1.3–2.1 ng/kg intravenously or intramuscularly and 10–13 ng/kg when inhaled. There are eight types of botulinum toxin, named type A–H. Types A and B are capable of causing disease in humans, are used commercially and medically. Types C–G are less common. Type H is considered the deadliest substance in the world – an injection of only 2 ng can cause death to an adult. Botulinum toxin types A and B are used in medicine to treat various muscle spasms and diseases characterized by overactive muscle. Commercial forms are marketed among others. Botulinum toxin is used to treat a number of problems.
Botulinum toxin is used to treat a number of disorders characterized by overactive muscle movement, including post-stroke spasticity, post-spinal cord injury spasticity, spasms of the head and neck, vagina, limbs and vocal cords. Botulinum toxin is used to relax clenching of muscles, including those of the oesophagus, lower urinary tract and bladder, or clenching of the anus which can exacerbate anal fissure, it may be used for improper eye alignment. Botulinum toxin appears to be effective for refractory overactive bladder. Strabismus is caused by imbalances in the actions of muscles that rotate the eyes, can sometimes be relieved by weakening a muscle that pulls too or pulls against one, weakened by disease or trauma. Muscles weakened by toxin injection recover from paralysis after several months, so it might seem that injection would need to be repeated. However, muscles adapt to the lengths at which they are chronically held, so that if a paralyzed muscle is stretched by its antagonist, it grows longer, while the antagonist shortens, yielding a permanent effect.
If there is good binocular vision, the brain mechanism of motor fusion, which aligns the eyes on a target visible to both, can stabilize the corrected alignment. In January 2014, botulinum toxin was approved by UK's Medicines and Healthcare Products Regulatory Agency for treatment of restricted ankle motion due to lower limb spasticity associated with stroke in adults. On July 29, 2016, Food and Drug Administration, of the United States of America approved abobotulinumtoxinA for injection for the treatment of lower limb spasticity in pediatric patients two years of age and older. AbobotulinumtoxinA is the first and only FDA-approved botulinum toxin for the treatment of pediatric lower limb spasticity. In the United States of America, the FDA approves the text of the labels of prescription medicines; the FDA approves. However, those approved by the FDA to prescribe these drugs may prescribe them for any condition they wish, called off-label use. Botulinum toxins have been used off-label for several pediatric conditions, including infantile esotropia.
Khalaf Bushara and David Park were the first to demonstrate a nonmuscular use of BTX-A while treating patients with hemifacial spasm in England in 1993, showing that botulinum toxin injections inhibit sweating, so are useful in treating hyperhidrosis. BTX-A has since been approved for the treatment of severe primary axillary hyperhidrosis, which cannot be managed by topical agents. In 2010, the FDA approved intramuscular botulinum toxin injections for prophylactic treatment of chronic migraine headache. In cosmetic applications, botulinum toxin is considered safe and effective for reduction of facial wrinkles in the uppermost third of the face. Injection of botulinum toxin into the muscles under facial wrinkles causes relaxation of those muscles, resulting in the smoothing of the overlying skin. Smoothing of wrinkles is visible three days after treatment and is maximally visible two weeks following injection; the treated muscles regain function, return to their former appearance three to four months after treatment.
Muscles can be treated to maintain the smoothed appearance. Botulinum toxin is used to treat disorders of hyperactive nerves including excessive sweating, neuropathic pain, some allergy symptoms. In addition to these uses, botulinum toxin is being evaluated for use in treating chronic pain. While botulinum toxin is considered safe in a clinical setting, there can be serious side effects from its use. Most botulinum toxin can be injected into the wrong muscle group or spread from the injection site, causing paralysis of unintended muscles. Side effects from cosmetic use result from unintended paralysis of facial muscles; these include partial facial paralysis, muscle weakness, trouble swallowing. Side effects are not limited to direct paralysis however, can include headaches, flu-like symptoms, allergic reactions. Just as cosmetic treatments only last a number of months, paralysis side-effects can have the same durations. At least in some cases, these effects are reported to dissipate in the weeks after treatment.
Bruising at the site of injection is not a side effect of the toxin but rather of the mode of administration, is reported as preventable if the clinician applies pressure to the injection site.
Hand strength measurements are of interest to study pathology of the hand that involves loss of muscle strength. Examples of these pathologies are carpal tunnel syndrome, nerve injury, tendon injuries of the hand, neuromuscular disorders. Hand strength testing is used for clinical decision-making and outcome evaluation in evidence-based medicine, it is used to diagnose diseases, to evaluate and compare treatments, to document progression of muscle strength, to provide feedback during the rehabilitation process. In addition, strength testing is used in areas such as sports medicine and ergonomics. In general, hand strength measurements can be divided into dynamometry. In clinical practice, hand muscles are most evaluated using manual muscle strength testing using the Medical Research Council Scale. In this scale, muscle strength is graded on a scale from 0 to 5. For evaluating the strength of the intrinsic hand muscles, a small modification to the standard MRC grading has been made so that grade 3 indicates ‘full active range of motion’ as compared to ‘movement against gravity’: Grade 5: full active range of motion & Normal muscle resistance Grade 4: full active range of motion & Reduced muscle resistance Grade 3: full active range of motion & No muscle resistance Grade 2: Reduced active range of motion & No muscle resistance Grade 1: No active range of motion & Palpable muscle contraction only Grade 0: No active range of motion & No palpable muscle contraction Manual muscle testing, has a number of limitations.
One limitation is that the MRC scale is an ordinal scale with disproportional distances between grades. Another limitation of the MRC scale is. With the 6-point ordinal MRC scale, it is difficult to identify small but clinically relevant changes in muscle strength. To create more quantitative assessments of hand muscle strength, dynamometers have been developed; these dynamometer measurements are more sensitive to change compared to manual muscle testing and render outcome on a continuous scale. In clinical evaluation and research studies on patients with hand problems, muscle strength measurements are based on grip strength and pinch strength dynamometry; the most used grip and pinch dynamometers are the Jamar dynamometers and similar devices by other manufacturers. In several patients groups, these measurements have a good validity. In addition, grip- and pinch strength are functionally relevant to measure the combined action of a large number of intrinsic and extrinsic hand muscles as well as the combined action of a number of different joints.
By comparing outcome with normative data, the amount of muscle strength loss can be determined. For more specific dynamometry of the intrinsic muscles, intrinsic hand dynamometers have been developed; the advantage of these dynamometers is that they to do not measure a large number of muscles in combined action, but can measure single actions such as thumb opposition of index finger abduction. One such dynamometer is the Rotterdam Intrinsic Hand Myometer. Reliability and validity of this dynamometer is comparable to grip- and pinch dynamometers. Myoton: Publications
The brain is an organ that serves as the center of the nervous system in all vertebrate and most invertebrate animals. The brain is located in the head close to the sensory organs for senses such as vision; the brain is the most complex organ in a vertebrate's body. In a human, the cerebral cortex contains 14–16 billion neurons, the estimated number of neurons in the cerebellum is 55–70 billion; each neuron is connected by synapses to several thousand other neurons. These neurons communicate with one another by means of long protoplasmic fibers called axons, which carry trains of signal pulses called action potentials to distant parts of the brain or body targeting specific recipient cells. Physiologically, the function of the brain is to exert centralized control over the other organs of the body; the brain acts on the rest of the body both by generating patterns of muscle activity and by driving the secretion of chemicals called hormones. This centralized control allows coordinated responses to changes in the environment.
Some basic types of responsiveness such as reflexes can be mediated by the spinal cord or peripheral ganglia, but sophisticated purposeful control of behavior based on complex sensory input requires the information integrating capabilities of a centralized brain. The operations of individual brain cells are now understood in considerable detail but the way they cooperate in ensembles of millions is yet to be solved. Recent models in modern neuroscience treat the brain as a biological computer different in mechanism from an electronic computer, but similar in the sense that it acquires information from the surrounding world, stores it, processes it in a variety of ways; this article compares the properties of brains across the entire range of animal species, with the greatest attention to vertebrates. It deals with the human brain insofar; the ways in which the human brain differs from other brains are covered in the human brain article. Several topics that might be covered here are instead covered there because much more can be said about them in a human context.
The most important is brain disease and the effects of brain damage, that are covered in the human brain article. The shape and size of the brain varies between species, identifying common features is difficult. There are a number of principles of brain architecture that apply across a wide range of species; some aspects of brain structure are common to the entire range of animal species. The simplest way to gain information about brain anatomy is by visual inspection, but many more sophisticated techniques have been developed. Brain tissue in its natural state is too soft to work with, but it can be hardened by immersion in alcohol or other fixatives, sliced apart for examination of the interior. Visually, the interior of the brain consists of areas of so-called grey matter, with a dark color, separated by areas of white matter, with a lighter color. Further information can be gained by staining slices of brain tissue with a variety of chemicals that bring out areas where specific types of molecules are present in high concentrations.
It is possible to examine the microstructure of brain tissue using a microscope, to trace the pattern of connections from one brain area to another. The brains of all species are composed of two broad classes of cells: neurons and glial cells. Glial cells come in several types, perform a number of critical functions, including structural support, metabolic support and guidance of development. Neurons, are considered the most important cells in the brain; the property that makes neurons unique is their ability to send signals to specific target cells over long distances. They send these signals by means of an axon, a thin protoplasmic fiber that extends from the cell body and projects with numerous branches, to other areas, sometimes nearby, sometimes in distant parts of the brain or body; the length of an axon can be extraordinary: for example, if a pyramidal cell of the cerebral cortex were magnified so that its cell body became the size of a human body, its axon magnified, would become a cable a few centimeters in diameter, extending more than a kilometer.
These axons transmit signals in the form of electrochemical pulses called action potentials, which last less than a thousandth of a second and travel along the axon at speeds of 1–100 meters per second. Some neurons emit action potentials at rates of 10–100 per second in irregular patterns. Axons transmit signals to other neurons by means of specialized junctions called synapses. A single axon may make as many as several thousand synaptic connections with other cells; when an action potential, traveling along an axon, arrives at a synapse, it causes a chemical called a neurotransmitter to be released. The neurotransmitter binds to receptor molecules in the membrane of the target cell. Synapses are the key functional elements of the brain; the essential function of the brain is cell-to-cell communication, synapses are the points at which communication occurs. The human brain has been estimated to contain 100 trillion synapses; the functions of these synapses are diverse: some are excitatory.