This study analyzed data on cycling-related head injury hospital admissions in Canada between 1994 and 2008 to examine the effects of provincial helmet legislation. The results show:
1) The rate of head injuries among young people decreased more in provinces with helmet laws (54.0% reduction) than without (33.1% reduction). Among adults, the rate decreased more with laws (26.0% reduction) than without (no change).
2) However, after accounting for baseline injury rate trends, the study found no independent effect of helmet legislation on reducing head injury admission rates. Rates were already decreasing before laws and the rate of decline was not changed by the laws.
3) While helmets reduce injury
Summarization Techniques in Association Rule Data Mining For Risk Assessment ...IJTET Journal
Abstract— At Early exposure of patients with dignified risk of developing diabetes mellitus is so hyper critical to the bettered prevention and global clinical management of these patients. In an existing system, apriori algorithm is used to find the itemsets for association rules but it is not efficient in finding itemsets and it uses only four association rules for finding the risk of diabetes mellitus so it have low precision. In this paper we are focusing to implement association rule mining to electronic medical records to detect set of danger factors and their equivalent or identical subpopulations that indicates patients at especially steep risk of progressing diabetes. Association rule mining accomplishes a very bulky set of rules for summarizing the EMR with huge dimensionability. We proposed a system in enlargement to combine risk of diabetes for the purpose of finding an suitable summary for this we use ten association rule and using the reorder algorithm for finding the itemsets and rules. For identifying the risk we considered four association rule set summarization techniques and organised a related calculation to support counselling with respect to their applicability merits and demerits and provide solutions to reduce the risk of diabetes. The above four methods having its fair strength but the bus algorithm developed the best acceptable summary.
A 5-Year Retrospective Analysis of Legal Intervention Injuries and Mortality ...Jim Bloyd, DrPH, MPH
There has been a public outcry for the accountability of law enforcement agents who kill and injure citizens. Epidemiological surveillance can underscore the magnitude of morbidity and mortality of citizens at the hands of law enforcement. We used hospital outpatient and inpatient databases to conduct a retrospective analysis of legal interventions in Illinois between 2010 and 2015. We calculated injury and mortality rates based on demographics, spatial distribution, and cause of injury. During the study period, 8,384 patients were treated for injuries caused during contact with law enforcement personnel. Most were male, the mean age was 32.7, and those injured were disproportionately black. Nearly all patients were treated as outpatients, and those who were admitted to the hospital had a mean of length of stay of 6 days. Most patients were discharged home or to an acute or long-term care facility (83.7%). It is unclear if those discharged home or to a different medical facility were arrested, accidentally injured, injured when no crime was committed, or injured when a crime was committed. Surveillance of law enforcement-related injuries and deaths should be implemented, and injuries caused during legal interventions should be recognized as a public health issue rather than a criminal justice issue.
Subámonos a la bici - Resumen del PNB para el ámbito autonómicoConBici
Este es un documento de propuesta realizado por los grupos integrantes de la Mesa Nacional de la Bicicleta entre los meses de marzo a agosto de 2014
Miembros de la Mesa Nacional de la Bicicleta:
Asociación de Ciclistas Profesionales (ACP) Asociación de Marcas y Bicicletas de España (AMBE) Coordinadora en Defensa de la Bicicleta (ConBici) Plataforma Empresarial de la Bicicleta (PEB)
Red de CicloJuristas (RCJ)
Real Federación Española de Ciclismo (RFEC)
Maquetación del resúmen: Carlos Nuñez
Septiembre de 2014
PLAN NACIONAL DE LA BICICLETA COMPLETO:
http://www.slideshare.net/ConBici/directrices-para-una-plan-nacional-de-la-bicicleta
RESUMEN DEL PLAN NACIONAL DE LA BICICLETA:
http://www.slideshare.net/ConBici/subamonos-a-la-bici-resumen-de-las-directrices-de-un-plan-nacional-de-la-biciceta
RESUMEN DEL PLAN NACIONAL DE LA BICICLETA ADAPTADO A LA REALIDAD MUNICIPAL:
http://www.slideshare.net/ConBici/subamonos-a-la-bici-mbito-municipal
Summarization Techniques in Association Rule Data Mining For Risk Assessment ...IJTET Journal
Abstract— At Early exposure of patients with dignified risk of developing diabetes mellitus is so hyper critical to the bettered prevention and global clinical management of these patients. In an existing system, apriori algorithm is used to find the itemsets for association rules but it is not efficient in finding itemsets and it uses only four association rules for finding the risk of diabetes mellitus so it have low precision. In this paper we are focusing to implement association rule mining to electronic medical records to detect set of danger factors and their equivalent or identical subpopulations that indicates patients at especially steep risk of progressing diabetes. Association rule mining accomplishes a very bulky set of rules for summarizing the EMR with huge dimensionability. We proposed a system in enlargement to combine risk of diabetes for the purpose of finding an suitable summary for this we use ten association rule and using the reorder algorithm for finding the itemsets and rules. For identifying the risk we considered four association rule set summarization techniques and organised a related calculation to support counselling with respect to their applicability merits and demerits and provide solutions to reduce the risk of diabetes. The above four methods having its fair strength but the bus algorithm developed the best acceptable summary.
A 5-Year Retrospective Analysis of Legal Intervention Injuries and Mortality ...Jim Bloyd, DrPH, MPH
There has been a public outcry for the accountability of law enforcement agents who kill and injure citizens. Epidemiological surveillance can underscore the magnitude of morbidity and mortality of citizens at the hands of law enforcement. We used hospital outpatient and inpatient databases to conduct a retrospective analysis of legal interventions in Illinois between 2010 and 2015. We calculated injury and mortality rates based on demographics, spatial distribution, and cause of injury. During the study period, 8,384 patients were treated for injuries caused during contact with law enforcement personnel. Most were male, the mean age was 32.7, and those injured were disproportionately black. Nearly all patients were treated as outpatients, and those who were admitted to the hospital had a mean of length of stay of 6 days. Most patients were discharged home or to an acute or long-term care facility (83.7%). It is unclear if those discharged home or to a different medical facility were arrested, accidentally injured, injured when no crime was committed, or injured when a crime was committed. Surveillance of law enforcement-related injuries and deaths should be implemented, and injuries caused during legal interventions should be recognized as a public health issue rather than a criminal justice issue.
Subámonos a la bici - Resumen del PNB para el ámbito autonómicoConBici
Este es un documento de propuesta realizado por los grupos integrantes de la Mesa Nacional de la Bicicleta entre los meses de marzo a agosto de 2014
Miembros de la Mesa Nacional de la Bicicleta:
Asociación de Ciclistas Profesionales (ACP) Asociación de Marcas y Bicicletas de España (AMBE) Coordinadora en Defensa de la Bicicleta (ConBici) Plataforma Empresarial de la Bicicleta (PEB)
Red de CicloJuristas (RCJ)
Real Federación Española de Ciclismo (RFEC)
Maquetación del resúmen: Carlos Nuñez
Septiembre de 2014
PLAN NACIONAL DE LA BICICLETA COMPLETO:
http://www.slideshare.net/ConBici/directrices-para-una-plan-nacional-de-la-bicicleta
RESUMEN DEL PLAN NACIONAL DE LA BICICLETA:
http://www.slideshare.net/ConBici/subamonos-a-la-bici-resumen-de-las-directrices-de-un-plan-nacional-de-la-biciceta
RESUMEN DEL PLAN NACIONAL DE LA BICICLETA ADAPTADO A LA REALIDAD MUNICIPAL:
http://www.slideshare.net/ConBici/subamonos-a-la-bici-mbito-municipal
Only about 1 in 5 cyclists who were injured riding their bicycle report wearing helmets, according to new research. Here’s more from the study, which looked at data from more than 76,000 people who reported a bicycle-related head or neck injury between 2002 and 2012:
•By gender: Some 28% of women reported wearing a helmet, compared to about 20% of men.
•By race: Some 27% of cyclists who were white or Asian/Pacific Islander reported wearing helmets, while only around 8% of Hispanic cyclists reported doing so. Some 6% of black cyclists said they wore a helmet at the time of their injury.
•By age: Adults aged 40 and younger were most likely to have been wearing a helmet, while children and teens under the age of 17 were the least likely.
Identification of road traffic fatal crashes leading factors using principal ...eSAT Journals
Abstract
Traffic crash fatalities create primary safety concern beyond the traffic congestion and delay. Therefore, the purpose of this study
is to identify the principal components/factors associated with road traffic crash in the U.S. through retrospective reviewing based
on more than two million records of fatal crashes and 38 years (1975-2012) of National Highway Traffic Safety Administration
official’s Fatal Accident Reporting System (FARS) database. This study portrays an integrated geographic information system
and SAS application in order to find the major factors forcing traffic crashes. The resulting geospatial analysis and principal
components analysis yielded critical significant factors causing fatal traffic crashes. The outcomes of this research could be used
in transportation safety policy making and planning significantly.
Key Words: Accident Analysis Prevention, Clustering, Crash Hot Spot, Geographic Information Systems, Principal
Components Analysis, and Traffic Crash
Clinico-Demographic Profile of Traumatic Spinal Injury in a Tertiary HospitalLemuelJohnTonogan
As of today, there has been a limited number of studies about the demographic profile of traumatic spinal injuries in our locality and our country. The objective of this study is to determine the clinico-demographic profile of patients with traumatic spinal injury admitted in our institution for the past 10 years. A chart review of 73 patients who satisfied the inclusion criteria with traumatic spinal injuries were reviewed. Traumatic spinal injury in the locality mostly affects ages 46-60 years with a mean age of 53.5. Males were most commonly affected, married and unemployed secondary to fall and motor vehicular accidents. The cervical spine is the most commonly affected area, resulting to an incomplete paraplegia with ASIA D score in most cases. These patients were mostly managed conservatively and improved upon discharge. Strict implementation of traffic rules and fall prevention should be emphasized by the government and the locality, and also increase the awareness of patients at risk for traumatic spinal injuries and its debilitating consequences.
Experience Mazda Zoom Zoom Lifestyle and Culture by Visiting and joining the Official Mazda Community at http://www.MazdaCommunity.org for additional insight into the Zoom Zoom Lifestyle and special offers for Mazda Community Members. If you live in Arizona, check out CardinaleWay Mazda's eCommerce website at http://www.Cardinale-Way-Mazda.com
DOSIMETRY ANALYSIS OF 3D CRT AND IMRT TECHNIQUES ON SMALL AND LARGE BREAST C...AM Publications
The aim of the study was to compare dosimetric parameters of planning target volume (PTV) and organs at risk (lungs) between 3D-conformal radiation therapy (3D CRT) and intensity-modulated radiation therapy (IMRT) in breast cancer, also to find correlation between volume and these parameters. A total of 60 patients with left/right breast cancer received radiotherapy, 30 by 3D CRT and 30 by IMRT, with a dose of 50 Gy in 25 sessions. Plans were compared according to dose-volume histogram (DVH) analysis in terms of PTV homogeneity (HI) and conformity (CI) indices as well as lungs dose, also integral dose (ID). IMRT had the higher CI than 3D CRT, and the lower HI than 3D CRT. But IMRT had the higher ID than 3D CRT. So, IMRT had the better HI and CI than 3D CRT in breast cancer treatment. In other hand, there are negatif correlation between volume and CI in 3D CRT. But no signifficant correlation in IMRT. And there are no correlations between volume and HI in both techniques. Also there are signifficant positif correlation between volume and ID in both techniques.
Evaluation of SVM performance in the detection of lung cancer in marked CT s...nooriasukmaningtyas
This paper concerns the development/analysis of the IQ-OTH/NCCD lung cancer dataset. This CT-scan dataset includes more than 1100 images of diagnosed healthy and tumorous chest scans collected in two Iraqi hospitals. A computer system is proposed for detecting lung cancer in the dataset by using image-processing/computer-vision techniques. This includes three preprocessing stages: image enhancement, image segmentation, and feature extraction techniques. Then, support vector machine (SVM) is used at the final stage as a classification technique for identifying the cases on the slides as one of three classes: normal, benign, or malignant. Different SVM kernels and feature extraction techniques are evaluated. The best accuracy achieved by applying this procedure on the new dataset was 89.8876%.
Our current approach to root causeanalysis is it contributi.docxgerardkortney
Our current approach to root cause
analysis: is it contributing to our
failure to improve patient safety?
Kathryn M Kellogg,1 Zach Hettinger,1 Manish Shah,2 Robert L Wears,3
Craig R Sellers,4 Melissa Squires,5 Rollin J Fairbanks1
ABSTRACT
Background Despite over a decade of efforts to
reduce the adverse event rate in healthcare, the
rate has remained relatively unchanged. Root
cause analysis (RCA) is a process used by
hospitals in an attempt to reduce adverse event
rates; however, the outputs of this process have
not been well studied in healthcare. This study
aimed to examine the types of solutions
proposed in RCAs over an 8-year period at a
major academic medical institution.
Methods All state-reportable adverse events
were gathered, and those for which an RCA was
performed were analysed. A consensus rating
process was used to determine a severity rating
for each case. A qualitative approach was used
to categorise the types of solutions proposed by
the RCA team in each case and descriptive
statistics were calculated.
Results 302 RCAs were reviewed. The most
common event types involved a procedure
complication, followed by cardiopulmonary
arrest, neurological deficit and retained foreign
body. In 106 RCAs, solutions were proposed.
A large proportion (38.7%) of RCAs with
solutions proposed involved a patient death. Of
the 731 proposed solutions, the most common
solution types were training (20%), process
change (19.6%) and policy reinforcement
(15.2%). We found that multiple event types
were repeated in the study period, despite
repeated RCAs.
Conclusions This study found that the most
commonly proposed solutions were weaker
actions, which were less likely to decrease event
recurrence. These findings support recent
attempts to improve the RCA process and to
develop guidance for the creation of effective
and sustainable solutions to be used by RCA
teams.
INTRODUCTION
The problem of morbidity and mortality
from adverse events in healthcare has
undergone over 15 years of intense scru-
tiny, funding, regulation and research
worldwide. Despite dramatically intensi-
fied efforts to increase the safety of the
healthcare system, reports have suggested
that safety has not improved. The adverse
event rate has remained essentially the
same, suggesting that our current solu-
tions to the problem are not working.1–10
This lack of progress persists despite the
devotion of a tremendous amount of
financial and human resources at the
local, state and national levels in an effort
to reduce errors and patient harm.11
One common, resource-intensive, prac-
tice is the root cause analysis (RCA)
process, which is used by most hospitals
in the USA.12–15 The RCA process has
been mandated in response to sentinel
events by the Joint Commission since
1997.16 Although the RCA process has
been presumed to induce change, its
effectiveness has been questioned and
there is not robust literature to support
its efficacy.17 18 In healthcare, there are
reports of difficul.
Remote Rehabilitation: A Solution to Overloaded & Scarce Health Care Systems_...CrimsonpublishersTTEH
Remote Rehabilitation: A Solution to Overloaded & Scarce Health Care Systems by Karla Muñoz Esquivel in Trends in Telemedicine & E-health
The population across Northern Europe is aging. Coupled with socio-economic challenges, health care systems are at risk of overloading and incurring unsustainable high costs. Rehabilitation services are used disproportionately by older people. One solution pertinent to rural areas is to change the model of rehabilitation to incorporate new technologies. This has the potential to free resources and reduce costs. However, implementation is challenging. In the Northern Periphery and Artic Programme (NPA), the Smart sensor Devices for rehabilitation and Connected health (SENDoc) project.
For more Open access journals in Crimson Publishers Please click on: https://crimsonpublishers.com/
For more articles in Open access journal of Innovation in urgical Open Access Journal
Please click on: https://crimsonpublishers.com/tteh/index.php
Does road safety have any lessons for workplace health and safety.docxelinoraudley582231
Does road safety have any lessons for workplace health and safety?
Authors:
Bailey, Trevor J.; Woolley, Jeremy E.; Raftery, Simon J.
Affiliation:
Centre for Automotive Safety Research (CASR), University of Adelaide, South Australia
Source:
Journal of the Australasian College of Road Safety (J AUSTRALAS COLL ROAD SAF), May2015; 26(2): 26-33. (8p)
Publication Type:
Journal Article
Language:
English
Journal Subset:
Australia & New Zealand; Public Health
Special Interest:
Public Health
ISSN:
1832-9497
Entry Date:
20150923
Revision Date:
20150923
Accession Number:
109743319
Database:
CINAHL Complete
by Trevor J Bailey1, Jeremy E Woolley1 and Simon J Raftery1 1Centre for Automotive Safety Research (CASR) University of Adelaide, South Australia [email protected]
Abstract Work health and safety (WHS) and road safety are distinctive perspectives of public health but they share much in common. Both have evolved from a former focus on individual responsibility to embracing systemwide, integrated approaches. Both now talk of incidents rather than accidents. Both are now characterised by proactive rather than reactive responses and their broad countermeasure approaches share many similarities. However, there are various aspects of WHS policy and practice that could be examined in relation to the road safety experience, particularly how compliance and deterrence approaches work best in WHS; the use of rewards and incentives; better attention to young worker safety; improved collection, analysis and usage of WHS data; and optimal use of WHS auditing and inspection programs. The aim of such examinations should be to gauge
if current WHS policies and practices are appropriately balanced in light of the road safety experience. Keywords Enforcement, Occupational health and safety, Regulation, Road safety, Work health and safety Introduction Both work health and safety (WHS) and road safety, along with such fields as epidemiology, environmental health, community safety and health economics, are distinct yet interlinked organised efforts by society under the collective term ‘public health’. An early, but now almost universally accepted definition of health is “…a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity” [1, pg100]. This definition
Journal of the Australasian College of Road Safety – Volume 26 No.2, 2015
27
is applicable to both WHS and road safety. For example, safety-oriented culture and systems that promote wellness are currently advocated in both WHS and road safety strategies over and above simply focussing on reducing incidents that can result in injury and death [2, 3]. Besides such commonalities, there are some strong contrasts between the two; so much so that in the last five years there have been emergent views that WHS has much to teach road safety. In 2009, a trio of eminent road safety professionals asserted that WHS had some important lessons for work-related road safety, if not.
Study on Physicians Request for Computed Tomography Examinations for Patients...IRJESJOURNAL
Background and objectives: There is a lot controversy about the use of Computed tomography (CT) for patients with minor head injury. We aimed to determine the practice of guiding rules for the safety of radiation and increasing awareness of physicians about risks of ionizing radiation and find out the reasons of emergency doctors for sending head injury patients to CT scan exams. Materials and Methods: A descriptive questionnaire in the Emergency Department (ED) based study was performed to assess physicians' knowledge of radiation doses received from radiological treatments and knowledge about Clinic Decision Support rules (CDS). The questionnaire consisted of 26 questions distributed to physicians working in the emergency department in six hospitals in East Java. Finally, the data collected have been analyzed by some tests using SPSS version 15 and Smart PLS. Results: In this study 44 participants had taken part. The percentage of general knowledge and awareness that shows the response of people who work in the emergency departments was total 44 respondents, by percent 6.8% of the respondents had passably knowledge, awareness and 84.1% they were having a good knowledge and awareness and 9.1% the respondents had very good knowledge and awareness. That means almost of respondents have good knowledge and awareness. To find out if an indicator is forming a construct (latent variables) testing the convergent validity of the measurement model with a reflexive indicator assessed based on the correlation between the item score to construct scores were calculated with the help of software Smart PLS. Size reflexive considered valid if the individual has a correlation (loading) to construct (latent variables) to be measured ≥ 0.5 or the value of t-statistics should ≥1.96 (test two tailed) at a significance level of α = 0.05. If one of the indicators has a leading value <0.5,><1.96, then the indicator should be discarded (dropped) because it indicates that the indicators are not good enough to measure the construct in right. The positive influence between general knowledge and awareness against to knowledge about radiation doses can be interpreted that the better general knowledge and awareness, then it will be followed by an increase in their knowledge about radiation doses. And vice versa, the worse general knowledge and awareness, then this will decrease their knowledge about radiation doses too. Conclusion: The present study has illustrated that the level of awareness and knowledge physicians who deal with ionizing radiation in CT scan units are adequate overall. There is a good influence between the diligence in applying the principles of guidance and rules stipulated by the nuclear energy in Indonesia by physicians to adjust the use of CT in the emergency department, the majority of participants who have a good awareness & knowledge, there are some of them do not have enough knowledge.
Peticiones de LorcaBiciudad al Alcalde de Lorca (Murcia)ConBici
La Asociación LorcaBiicudad hace numerosas propuestas para mejorar la ciudad, solicitando una reducción genérica de la velocidad máxima en todas las calles para aumentar la seguridad de los ciclistas y, por consiguiente, de los peatones.
Only about 1 in 5 cyclists who were injured riding their bicycle report wearing helmets, according to new research. Here’s more from the study, which looked at data from more than 76,000 people who reported a bicycle-related head or neck injury between 2002 and 2012:
•By gender: Some 28% of women reported wearing a helmet, compared to about 20% of men.
•By race: Some 27% of cyclists who were white or Asian/Pacific Islander reported wearing helmets, while only around 8% of Hispanic cyclists reported doing so. Some 6% of black cyclists said they wore a helmet at the time of their injury.
•By age: Adults aged 40 and younger were most likely to have been wearing a helmet, while children and teens under the age of 17 were the least likely.
Identification of road traffic fatal crashes leading factors using principal ...eSAT Journals
Abstract
Traffic crash fatalities create primary safety concern beyond the traffic congestion and delay. Therefore, the purpose of this study
is to identify the principal components/factors associated with road traffic crash in the U.S. through retrospective reviewing based
on more than two million records of fatal crashes and 38 years (1975-2012) of National Highway Traffic Safety Administration
official’s Fatal Accident Reporting System (FARS) database. This study portrays an integrated geographic information system
and SAS application in order to find the major factors forcing traffic crashes. The resulting geospatial analysis and principal
components analysis yielded critical significant factors causing fatal traffic crashes. The outcomes of this research could be used
in transportation safety policy making and planning significantly.
Key Words: Accident Analysis Prevention, Clustering, Crash Hot Spot, Geographic Information Systems, Principal
Components Analysis, and Traffic Crash
Clinico-Demographic Profile of Traumatic Spinal Injury in a Tertiary HospitalLemuelJohnTonogan
As of today, there has been a limited number of studies about the demographic profile of traumatic spinal injuries in our locality and our country. The objective of this study is to determine the clinico-demographic profile of patients with traumatic spinal injury admitted in our institution for the past 10 years. A chart review of 73 patients who satisfied the inclusion criteria with traumatic spinal injuries were reviewed. Traumatic spinal injury in the locality mostly affects ages 46-60 years with a mean age of 53.5. Males were most commonly affected, married and unemployed secondary to fall and motor vehicular accidents. The cervical spine is the most commonly affected area, resulting to an incomplete paraplegia with ASIA D score in most cases. These patients were mostly managed conservatively and improved upon discharge. Strict implementation of traffic rules and fall prevention should be emphasized by the government and the locality, and also increase the awareness of patients at risk for traumatic spinal injuries and its debilitating consequences.
Experience Mazda Zoom Zoom Lifestyle and Culture by Visiting and joining the Official Mazda Community at http://www.MazdaCommunity.org for additional insight into the Zoom Zoom Lifestyle and special offers for Mazda Community Members. If you live in Arizona, check out CardinaleWay Mazda's eCommerce website at http://www.Cardinale-Way-Mazda.com
DOSIMETRY ANALYSIS OF 3D CRT AND IMRT TECHNIQUES ON SMALL AND LARGE BREAST C...AM Publications
The aim of the study was to compare dosimetric parameters of planning target volume (PTV) and organs at risk (lungs) between 3D-conformal radiation therapy (3D CRT) and intensity-modulated radiation therapy (IMRT) in breast cancer, also to find correlation between volume and these parameters. A total of 60 patients with left/right breast cancer received radiotherapy, 30 by 3D CRT and 30 by IMRT, with a dose of 50 Gy in 25 sessions. Plans were compared according to dose-volume histogram (DVH) analysis in terms of PTV homogeneity (HI) and conformity (CI) indices as well as lungs dose, also integral dose (ID). IMRT had the higher CI than 3D CRT, and the lower HI than 3D CRT. But IMRT had the higher ID than 3D CRT. So, IMRT had the better HI and CI than 3D CRT in breast cancer treatment. In other hand, there are negatif correlation between volume and CI in 3D CRT. But no signifficant correlation in IMRT. And there are no correlations between volume and HI in both techniques. Also there are signifficant positif correlation between volume and ID in both techniques.
Evaluation of SVM performance in the detection of lung cancer in marked CT s...nooriasukmaningtyas
This paper concerns the development/analysis of the IQ-OTH/NCCD lung cancer dataset. This CT-scan dataset includes more than 1100 images of diagnosed healthy and tumorous chest scans collected in two Iraqi hospitals. A computer system is proposed for detecting lung cancer in the dataset by using image-processing/computer-vision techniques. This includes three preprocessing stages: image enhancement, image segmentation, and feature extraction techniques. Then, support vector machine (SVM) is used at the final stage as a classification technique for identifying the cases on the slides as one of three classes: normal, benign, or malignant. Different SVM kernels and feature extraction techniques are evaluated. The best accuracy achieved by applying this procedure on the new dataset was 89.8876%.
Our current approach to root causeanalysis is it contributi.docxgerardkortney
Our current approach to root cause
analysis: is it contributing to our
failure to improve patient safety?
Kathryn M Kellogg,1 Zach Hettinger,1 Manish Shah,2 Robert L Wears,3
Craig R Sellers,4 Melissa Squires,5 Rollin J Fairbanks1
ABSTRACT
Background Despite over a decade of efforts to
reduce the adverse event rate in healthcare, the
rate has remained relatively unchanged. Root
cause analysis (RCA) is a process used by
hospitals in an attempt to reduce adverse event
rates; however, the outputs of this process have
not been well studied in healthcare. This study
aimed to examine the types of solutions
proposed in RCAs over an 8-year period at a
major academic medical institution.
Methods All state-reportable adverse events
were gathered, and those for which an RCA was
performed were analysed. A consensus rating
process was used to determine a severity rating
for each case. A qualitative approach was used
to categorise the types of solutions proposed by
the RCA team in each case and descriptive
statistics were calculated.
Results 302 RCAs were reviewed. The most
common event types involved a procedure
complication, followed by cardiopulmonary
arrest, neurological deficit and retained foreign
body. In 106 RCAs, solutions were proposed.
A large proportion (38.7%) of RCAs with
solutions proposed involved a patient death. Of
the 731 proposed solutions, the most common
solution types were training (20%), process
change (19.6%) and policy reinforcement
(15.2%). We found that multiple event types
were repeated in the study period, despite
repeated RCAs.
Conclusions This study found that the most
commonly proposed solutions were weaker
actions, which were less likely to decrease event
recurrence. These findings support recent
attempts to improve the RCA process and to
develop guidance for the creation of effective
and sustainable solutions to be used by RCA
teams.
INTRODUCTION
The problem of morbidity and mortality
from adverse events in healthcare has
undergone over 15 years of intense scru-
tiny, funding, regulation and research
worldwide. Despite dramatically intensi-
fied efforts to increase the safety of the
healthcare system, reports have suggested
that safety has not improved. The adverse
event rate has remained essentially the
same, suggesting that our current solu-
tions to the problem are not working.1–10
This lack of progress persists despite the
devotion of a tremendous amount of
financial and human resources at the
local, state and national levels in an effort
to reduce errors and patient harm.11
One common, resource-intensive, prac-
tice is the root cause analysis (RCA)
process, which is used by most hospitals
in the USA.12–15 The RCA process has
been mandated in response to sentinel
events by the Joint Commission since
1997.16 Although the RCA process has
been presumed to induce change, its
effectiveness has been questioned and
there is not robust literature to support
its efficacy.17 18 In healthcare, there are
reports of difficul.
Remote Rehabilitation: A Solution to Overloaded & Scarce Health Care Systems_...CrimsonpublishersTTEH
Remote Rehabilitation: A Solution to Overloaded & Scarce Health Care Systems by Karla Muñoz Esquivel in Trends in Telemedicine & E-health
The population across Northern Europe is aging. Coupled with socio-economic challenges, health care systems are at risk of overloading and incurring unsustainable high costs. Rehabilitation services are used disproportionately by older people. One solution pertinent to rural areas is to change the model of rehabilitation to incorporate new technologies. This has the potential to free resources and reduce costs. However, implementation is challenging. In the Northern Periphery and Artic Programme (NPA), the Smart sensor Devices for rehabilitation and Connected health (SENDoc) project.
For more Open access journals in Crimson Publishers Please click on: https://crimsonpublishers.com/
For more articles in Open access journal of Innovation in urgical Open Access Journal
Please click on: https://crimsonpublishers.com/tteh/index.php
Does road safety have any lessons for workplace health and safety.docxelinoraudley582231
Does road safety have any lessons for workplace health and safety?
Authors:
Bailey, Trevor J.; Woolley, Jeremy E.; Raftery, Simon J.
Affiliation:
Centre for Automotive Safety Research (CASR), University of Adelaide, South Australia
Source:
Journal of the Australasian College of Road Safety (J AUSTRALAS COLL ROAD SAF), May2015; 26(2): 26-33. (8p)
Publication Type:
Journal Article
Language:
English
Journal Subset:
Australia & New Zealand; Public Health
Special Interest:
Public Health
ISSN:
1832-9497
Entry Date:
20150923
Revision Date:
20150923
Accession Number:
109743319
Database:
CINAHL Complete
by Trevor J Bailey1, Jeremy E Woolley1 and Simon J Raftery1 1Centre for Automotive Safety Research (CASR) University of Adelaide, South Australia [email protected]
Abstract Work health and safety (WHS) and road safety are distinctive perspectives of public health but they share much in common. Both have evolved from a former focus on individual responsibility to embracing systemwide, integrated approaches. Both now talk of incidents rather than accidents. Both are now characterised by proactive rather than reactive responses and their broad countermeasure approaches share many similarities. However, there are various aspects of WHS policy and practice that could be examined in relation to the road safety experience, particularly how compliance and deterrence approaches work best in WHS; the use of rewards and incentives; better attention to young worker safety; improved collection, analysis and usage of WHS data; and optimal use of WHS auditing and inspection programs. The aim of such examinations should be to gauge
if current WHS policies and practices are appropriately balanced in light of the road safety experience. Keywords Enforcement, Occupational health and safety, Regulation, Road safety, Work health and safety Introduction Both work health and safety (WHS) and road safety, along with such fields as epidemiology, environmental health, community safety and health economics, are distinct yet interlinked organised efforts by society under the collective term ‘public health’. An early, but now almost universally accepted definition of health is “…a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity” [1, pg100]. This definition
Journal of the Australasian College of Road Safety – Volume 26 No.2, 2015
27
is applicable to both WHS and road safety. For example, safety-oriented culture and systems that promote wellness are currently advocated in both WHS and road safety strategies over and above simply focussing on reducing incidents that can result in injury and death [2, 3]. Besides such commonalities, there are some strong contrasts between the two; so much so that in the last five years there have been emergent views that WHS has much to teach road safety. In 2009, a trio of eminent road safety professionals asserted that WHS had some important lessons for work-related road safety, if not.
Study on Physicians Request for Computed Tomography Examinations for Patients...IRJESJOURNAL
Background and objectives: There is a lot controversy about the use of Computed tomography (CT) for patients with minor head injury. We aimed to determine the practice of guiding rules for the safety of radiation and increasing awareness of physicians about risks of ionizing radiation and find out the reasons of emergency doctors for sending head injury patients to CT scan exams. Materials and Methods: A descriptive questionnaire in the Emergency Department (ED) based study was performed to assess physicians' knowledge of radiation doses received from radiological treatments and knowledge about Clinic Decision Support rules (CDS). The questionnaire consisted of 26 questions distributed to physicians working in the emergency department in six hospitals in East Java. Finally, the data collected have been analyzed by some tests using SPSS version 15 and Smart PLS. Results: In this study 44 participants had taken part. The percentage of general knowledge and awareness that shows the response of people who work in the emergency departments was total 44 respondents, by percent 6.8% of the respondents had passably knowledge, awareness and 84.1% they were having a good knowledge and awareness and 9.1% the respondents had very good knowledge and awareness. That means almost of respondents have good knowledge and awareness. To find out if an indicator is forming a construct (latent variables) testing the convergent validity of the measurement model with a reflexive indicator assessed based on the correlation between the item score to construct scores were calculated with the help of software Smart PLS. Size reflexive considered valid if the individual has a correlation (loading) to construct (latent variables) to be measured ≥ 0.5 or the value of t-statistics should ≥1.96 (test two tailed) at a significance level of α = 0.05. If one of the indicators has a leading value <0.5,><1.96, then the indicator should be discarded (dropped) because it indicates that the indicators are not good enough to measure the construct in right. The positive influence between general knowledge and awareness against to knowledge about radiation doses can be interpreted that the better general knowledge and awareness, then it will be followed by an increase in their knowledge about radiation doses. And vice versa, the worse general knowledge and awareness, then this will decrease their knowledge about radiation doses too. Conclusion: The present study has illustrated that the level of awareness and knowledge physicians who deal with ionizing radiation in CT scan units are adequate overall. There is a good influence between the diligence in applying the principles of guidance and rules stipulated by the nuclear energy in Indonesia by physicians to adjust the use of CT in the emergency department, the majority of participants who have a good awareness & knowledge, there are some of them do not have enough knowledge.
Peticiones de LorcaBiciudad al Alcalde de Lorca (Murcia)ConBici
La Asociación LorcaBiicudad hace numerosas propuestas para mejorar la ciudad, solicitando una reducción genérica de la velocidad máxima en todas las calles para aumentar la seguridad de los ciclistas y, por consiguiente, de los peatones.
Subámonos a la bici - PNB: Ámbito municipalConBici
Este es un documento de propuesta realizado por los grupos integrantes de la Mesa Nacional de la Bicicleta entre los meses de marzo a agosto de 2014
Miembros de la Mesa Nacional de la Bicicleta:
Asociación de Ciclistas Profesionales (ACP) Asociación de Marcas y Bicicletas de España (AMBE) Coordinadora en Defensa de la Bicicleta (ConBici) Plataforma Empresarial de la Bicicleta (PEB)
Red de CicloJuristas (RCJ)
Real Federación Española de Ciclismo (RFEC)
Maquetación del resúmen: Carlos Nuñez
Septiembre de 2014
PLAN NACIONAL DE LA BICICLETA COMPLETO (53 pág.):
http://www.slideshare.net/ConBici/directrices-para-una-plan-nacional-de-la-bicicleta
RESUMEN DEL PLAN NACIONAL DE LA BICICLETA (8 pág.):
http://www.slideshare.net/ConBici/subamonos-a-la-bici-resumen-de-las-directrices-de-un-plan-nacional-de-la-biciceta
Subámonos a la bici. Resumen de un PNB para EspañaConBici
Subámonos a la bici. Resumen de las Directrices de un Plan Nacional de la Bicicleta.
Este es un documento de propuesta realizado por los grupos integrantes de la Mesa Nacional de la Bicicleta entre los meses de marzo a agosto de 2014
Miembros de la Mesa Nacional de la Bicicleta:
Asociación de Ciclistas Profesionales (ACP) Asociación de Marcas y Bicicletas de España (AMBE) Coordinadora en Defensa de la Bicicleta (ConBici) Plataforma Empresarial de la Bicicleta (PEB)
Red de CicloJuristas (RCJ)
Real Federación Española de Ciclismo (RFEC)
Maquetación del resúmen: Carlos Nuñez
Septiembre de 2014
PLAN NACIONAL DE LA BICICLETA COMPLETO:
http://www.slideshare.net/ConBici/directrices-para-una-plan-nacional-de-la-bicicleta
Directrices para una Plan Nacional de la BicicletaConBici
Es este documento la Mesa Nacional de la Bicicleta (MNB) propone un plan de acción para la promoción de la bicicleta en toda España, entre los meses de marzo a agosto de 2014
Miembros de la Mesa Nacional de la Bicicleta:
Asociación de Ciclistas Profesionales (ACP)
Asociación de Marcas y Bicicletas de España (AMBE) Coordinadora en Defensa de la Bicicleta (ConBici)
Red de CicloJuristas (RCJ)
Real Federación Española de Ciclismo (RFEC)
Maquetación, portada y coordinación de la redacción:
Juan Merallo Grande
Septiembre de 2014
PROPOSICIÓN NO DE LEY
El Congreso de los Diputados insta al Gobierno a la adopción de las siguientes medidas en relación con el apoyo a la bicicleta como alternativa de movilidad sostenible :
1-Incluir en el Decreto correspondiente a 2014 la bicicleta eléctrica de pedaleo asistido mediante una batería, considerándola como uno más de los vehículos eléctricos que podrán beneficiarse de la concesión de subvenciones directas destinadas a su adquisición
2-Rebajar el IVA que se aplica en la venta de bicicletas convencionales y eléctricas de pedaleo asistido, pasando del 21% actual a un IVA reducido del 10 % para fomentar un medio de transporte no contaminante que produce importantes retornos y ahorros también evaluables económicamente.
3. Presentar en el plazo de tres meses un Plan Nacional de la Bicicleta de carácter estratégico, como existe en otros Estados Europeos, para promover su uso en las ciudades así como una cultura del transporte sostenible.
4. Constituir el Consejo Estatal de la Bicicleta como entidad de participación plural que acoja a los diferentes Ministerios implicados, entidades, asociaciones, empresas y colectivos del sector que permita el diálogo sobre el Plan y las nuevas normativas y realice funciones de impulso, coordinación y seguimiento de las acciones a poner en marcha.
El uso del casco en la bici: una visión general basada en pruebas concluyentes
El siguiente informe expone las razones, respaldadas por pruebas concluyentes, para que el uso del casco no sea obligatorio por ley ni sea objeto de campañas promocionales.
Basavarajeeyam is a Sreshta Sangraha grantha (Compiled book ), written by Neelkanta kotturu Basavaraja Virachita. It contains 25 Prakaranas, First 24 Chapters related to Rogas& 25th to Rasadravyas.
ABDOMINAL TRAUMA in pediatrics part one.drhasanrajab
Abdominal trauma in pediatrics refers to injuries or damage to the abdominal organs in children. It can occur due to various causes such as falls, motor vehicle accidents, sports-related injuries, and physical abuse. Children are more vulnerable to abdominal trauma due to their unique anatomical and physiological characteristics. Signs and symptoms include abdominal pain, tenderness, distension, vomiting, and signs of shock. Diagnosis involves physical examination, imaging studies, and laboratory tests. Management depends on the severity and may involve conservative treatment or surgical intervention. Prevention is crucial in reducing the incidence of abdominal trauma in children.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Integrating Ayurveda into Parkinson’s Management: A Holistic ApproachAyurveda ForAll
Explore the benefits of combining Ayurveda with conventional Parkinson's treatments. Learn how a holistic approach can manage symptoms, enhance well-being, and balance body energies. Discover the steps to safely integrate Ayurvedic practices into your Parkinson’s care plan, including expert guidance on diet, herbal remedies, and lifestyle modifications.
DISSERTATION on NEW DRUG DISCOVERY AND DEVELOPMENT STAGES OF DRUG DISCOVERYNEHA GUPTA
The process of drug discovery and development is a complex and multi-step endeavor aimed at bringing new pharmaceutical drugs to market. It begins with identifying and validating a biological target, such as a protein, gene, or RNA, that is associated with a disease. This step involves understanding the target's role in the disease and confirming that modulating it can have therapeutic effects. The next stage, hit identification, employs high-throughput screening (HTS) and other methods to find compounds that interact with the target. Computational techniques may also be used to identify potential hits from large compound libraries.
Following hit identification, the hits are optimized to improve their efficacy, selectivity, and pharmacokinetic properties, resulting in lead compounds. These leads undergo further refinement to enhance their potency, reduce toxicity, and improve drug-like characteristics, creating drug candidates suitable for preclinical testing. In the preclinical development phase, drug candidates are tested in vitro (in cell cultures) and in vivo (in animal models) to evaluate their safety, efficacy, pharmacokinetics, and pharmacodynamics. Toxicology studies are conducted to assess potential risks.
Before clinical trials can begin, an Investigational New Drug (IND) application must be submitted to regulatory authorities. This application includes data from preclinical studies and plans for clinical trials. Clinical development involves human trials in three phases: Phase I tests the drug's safety and dosage in a small group of healthy volunteers, Phase II assesses the drug's efficacy and side effects in a larger group of patients with the target disease, and Phase III confirms the drug's efficacy and monitors adverse reactions in a large population, often compared to existing treatments.
After successful clinical trials, a New Drug Application (NDA) is submitted to regulatory authorities for approval, including all data from preclinical and clinical studies, as well as proposed labeling and manufacturing information. Regulatory authorities then review the NDA to ensure the drug is safe, effective, and of high quality, potentially requiring additional studies. Finally, after a drug is approved and marketed, it undergoes post-marketing surveillance, which includes continuous monitoring for long-term safety and effectiveness, pharmacovigilance, and reporting of any adverse effects.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
Top 10 Best Ayurvedic Kidney Stone Syrups in India
Estudio Jessica Dennis Canada
1. BMJ 2013;346:f2674 doi: 10.1136/bmj.f2674 (Published 14 May 2013)
Page 1 of 10
Research
RESEARCH
Helmet legislation and admissions to hospital for
cycling related head injuries in Canadian provinces
and territories: interrupted time series analysis
OPEN ACCESS
1
2
Jessica Dennis PhD candidate , Tim Ramsay assistant professor , Alexis F Turgeon assistant
3
4
professor , Ryan Zarychanski assistant professor
Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, ON, M5T 3M7, Canada; 2Ottawa
Hospital Research Institute, Ottawa, ON, Canada; 3Division of Critical Care Medicine, Department of Anesthesiology, Population
Health—Practice-changing Research Unit (Trauma-Emergency-Critical Care Medicine), Université Laval, QC, Canada; 4Departments of Internal
Medicine and of Community Health Sciences, University of Manitoba, Winnipeg, MB, Canada
1
Abstract
Objective To investigate the association between helmet legislation and
admissions to hospital for cycling related head injuries among young
people and adults in Canada.
Design Interrupted time series analysis using data from the National
Trauma Registry Minimum Data Set.
Setting Canadian provinces and territories; between 1994 and 2003,
six of 10 provinces implemented helmet legislation.
Participants All admissions (n=66 716) to acute care hospitals in Canada
owing to cycling related injury between 1994 and 2008.
Main outcome measure Rate of admissions to hospital for cycling
related head injuries before and after the implementation of provincial
helmet legislation.
Results Between 1994 and 2008, 66 716 hospital admissions were for
cycling related injuries in Canada. Between 1994 and 2003, the rate of
head injuries among young people decreased by 54.0% (95% confidence
interval 48.2% to 59.8%) in provinces with helmet legislation compared
with 33.1% (23.3% to 42.9%) in provinces and territories without
legislation. Among adults, the rate of head injuries decreased by 26.0%
(16.0% to 36.3%) in provinces with legislation but remained constant in
provinces and territories without legislation. After taking baseline trends
into consideration, however, we were unable to detect an independent
effect of legislation on the rate of hospital admissions for cycling related
head injuries.
Conclusions Reductions in the rates of admissions to hospital for cycling
related head injuries were greater in provinces with helmet legislation,
but injury rates were already decreasing before the implementation of
legislation and the rate of decline was not appreciably altered on
introduction of legislation. While helmets reduce the risk of head injuries
and we encourage their use, in the Canadian context of existing safety
campaigns, improvements to the cycling infrastructure, and the passive
uptake of helmets, the incremental contribution of provincial helmet
legislation to reduce hospital admissions for head injuries seems to have
been minimal.
Introduction
Bicyclists are vulnerable road users. Compared with car
occupants, bicyclists are more than twice as likely to be fatally
injured per person trip and up to 10 times more likely to be
injured per kilometre travelled.1 2 Moreover, as with many
transportation related injuries, cycling injuries are often to the
head; such injuries account for approximately 30% of admissions
to hospital for cycling related injuries3-6 and over 75% of cycling
fatalities.7 8 A proportion of these injuries can be prevented by
the use of helmets,9-12 and legislation mandating helmet use for
all cyclists, or for cyclists under a given age (for example, 18
years), has been implemented in six of 10 Canadian provinces
and countries such as Australia, New Zealand, and parts of the
United States. Such laws, however, are contentious and the
focus of active public debate.13 14
Fuelling the debate is the uncertain effectiveness of legislation
to reduce head injuries. Several studies have attempted to answer
this fundamental question but have been limited by sample size
Correspondence to: J Dennis jessica.dennis@mail.utoronto.ca
Extra material supplied by the author (see http://www.bmj.com/content/346/bmj.f2674?tab=related#webextra)
ICD-9 and ICD-10 codes used to identify admissions to hospital for cycling related injuries
Captions for supplementary figures 1-3
Rate ratio estimation from segmented regression analysis
Supplementary figures 1-3
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2. BMJ 2013;346:f2674 doi: 10.1136/bmj.f2674 (Published 14 May 2013)
Page 2 of 10
RESEARCH
or methodological quality.15-20 Controlled before and after studies
do suggest a protective effect of legislation targeting young
bicyclists,21-24 but only one of these studies, which examined
cycling related deaths, accounted for baseline trends in cycling
injury rates.22 Moreover, no controlled before and after study
has investigated the association between helmet legislation and
head injuries in adult cyclists. We therefore examined changes
in the rate of cycling related head injuries associated with helmet
legislation in young people and adults while accounting for
baseline trends in the rate of cycling injuries.
Methods
We used a controlled, interrupted time series design—a series
of observations taken at regular, evenly spaced intervals, before
and after the implementation of an intervention, in both
intervention and control groups. This design accounts for
baseline trends and is among the strongest of quasi-experimental
approaches for evaluating the effect of an intervention.25
Data sources and variable definitions
We analysed annual counts of admissions to hospital for cycling
related injuries obtained from the National Trauma Registry
Minimum Data Set, managed by the Canadian Institute for
Health Information. The registry contains personal and
diagnostic information on all admissions to acute care hospitals
in Canada due to injury from 1994 onwards. The cause and
nature of each patient’s injuries are coded according to the
international classification of diseases (ICD-9, ICD-9-CM, and
ICD-10-CA), and up to 25 injuries are coded per patient. We
included admissions to hospital due to a cycling injury that
occurred in the 15 years between 1 April 1994 and 31 March
2008 (see supplementary table 1 for cycling injury codes) and
we summed counts by fiscal year—for example, fiscal year
1994 runs from 1 April 1994 to 31 March 1995. The national
trauma registry does not include information on helmet use.
We defined head injured cyclists as those with an injury to the
brain, skull, scalp, or face (see supplementary table 2 for head
injury codes). We also included the total number of admissions
to hospital for cycling related injuries (that is, admissions due
to a cycling injury to any body region, including the head) in
our analysis to control for trends in admissions to hospital for
cycling related head injuries that were attributable to factors
other than helmet legislation.
Canada includes 10 provinces and three territories. Between
1994 and 2003, helmet laws were introduced in six provinces,
and these provinces comprised the intervention group (table
1⇓). Although adults are not specifically targeted by legislation
in two of these provinces, a strong modifying effect of
legislation aimed at young people on helmet use in adults in
these provinces has been previously observed26 and so we
grouped these provinces with the other intervention provinces.
The four provinces and three territories that did not implement
helmet legislation comprised the control group. We considered
the year in which provincial legislation was enacted to be the
time point at which the intervention occurred; all years thereafter
were considered post-intervention. In Ontario and New
Brunswick, where legislation was enacted after the Canadian
cycling season (after September), we considered the intervention
to have occurred in the subsequent year. We defined young
people as those aged less than 18 years.
Statistical analyses
We used two methods to assess the association between helmet
legislation and cycling related head injuries. Firstly, we
calculated the annual rates of admissions to hospital for cycling
related head injuries per 100 000 person years in all provinces
and in the territories. Population counts for the denominator
were obtained from CANSIM (Canadian Socioeconomic
Information Management System).27 Sparse injury counts among
young people in the territories and in smaller provinces
necessitated the estimation of crude rates for young people,
whereas among adults we estimated age adjusted rates using
three age strata (18-24 years, 25-44 years, and ≥45 years) and
the 2006 Canadian population as the standard population. We
then estimated the percentage change in rates in the legislation
group between 1994 and 2003 (the time over which legislation
was implemented in these provinces), and we compared this
change with the percentage change in the rates in the control
group over this same period. We followed these same steps in
the analysis of total admissions to hospital for cycling related
injuries.
Secondly, using an over-dispersed Poisson segmented regression
analysis, we modeled the annual rates of admissions to hospital
for cycling related head injuries per total admissions to hospital
for cycling related injuries—that is, using a different
denominator than in the first analysis. Segmented regression is
a statistical method used specifically for assessing the response
to an intervention while controlling for baseline trends in
interrupted time series studies (for more information see
supplementary appendix 1).25 28 We included all available data
from 1994 to 2008, specified separate models for young people
and adults in each intervention province (12 models in total),
and included interaction terms in each model to model the rate
in the control group (see supplementary appendix 1 for model
formulation).
Results of the segmented regression analysis were expressed in
two ways. Firstly, we expressed the effect of legislation one
year after its implementation within each intervention province
as a rate ratio and its 95% confidence interval, with rate ratios
<1 suggesting that the rate of head injuries one year after
implementation of the legislation was less than if legislation
had not been implemented—that is, that legislation was
effective. Although we assessed the effect of legislation at only
one time point (one year after its implementation), all time points
contributed to model parameterisation and estimation of rate
ratios. Thus, we averaged out seasonal or other variation in the
injury rate in the year after the introduction of the legislation.
The second way in which results of the segmented regression
analysis were expressed was through the statistical significance
of the interaction terms that compared the post-legislation
changes in the rate of head injuries in the intervention province
with those in the control group. All tests of statistical
significance reflect a two sided α of 0.05. Since error terms of
consecutive observations may be correlated in a time series, we
visually inspected plots of model residuals against time to ensure
that no pattern suggesting autocorrelation was evident. We
estimated the summary estimates of the effect of helmet
legislation among young people and adults by combining
individual rate ratios in a random effects model. All analyses
were conducted with SAS 9.2.
Results
Between 1994 and 2008 we identified 66 716 admissions to
hospital for cycling related injuries across the Canadian
provinces and territories (table 2⇓). Head injuries accounted for
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3. BMJ 2013;346:f2674 doi: 10.1136/bmj.f2674 (Published 14 May 2013)
Page 3 of 10
RESEARCH
29.6% of these, and over two thirds of head injured cyclists had
a brain injury. Overall, 19% of head injured cyclists had a face
injury without a concomitant scalp, skull, or brain injury.
Cyclists aged less than 18 years comprised 44.7% (n=29 844)
of admissions to hospital for injuries and 52.6% (n=10 369) of
admissions for head injuries, despite comprising approximately
20% of the Canadian population. The majority of injuries
occurred in males (75.0%, n=50 004). Approximately 1% of
admissions for head injuries were fatal compared with 0.4% of
all admissions for injuries.
The rate of hospital admissions for cycling related head injuries
in Canada among young people decreased from 17.0 to 4.9 per
100 000 person years between 1994 and 2008 (fig 1⇓). In
provinces that implemented helmet legislation, the rate decreased
steeply between 1994 and 2003, the time over which legislation
was implemented, from 15.9 to 7.3 per 100 000 person years,
corresponding to a 54.0% (95% confidence interval 48.2% to
59.8%) reduction. In provinces and territories that did not
implement helmet legislation, the rate of admissions for cycling
related head injuries also decreased between 1994 and 2003,
but to a lesser degree. The reduction in provinces without
legislation was 33.2% (23.3% to 43.0%), corresponding to a
decrease from 19.1 to 12.9 per 100 000 person years. Among
adults, the rate of admissions for cycling related head injuries
was low in all provinces and across all study years. Between
1994 and 2003, the rate of head injuries in adults in provinces
with helmet legislation decreased by 26.2% (16.0% to 36.3%),
a reduction from 3.0 to 2.2 per 100 000 person years, compared
with a negligible increase in rates in provinces and territories
with no legislation, from 2.7 to 2.8 per 100 000 person years.
The rate of total hospital admissions for cycling related injuries
also decreased across Canada among young people but not
among adults between 1994 and 2008 (see supplementary figure
1). Between 1994 and 2003, the rate among young people
decreased to a similar extent in provinces both with legislation
(28.0%, 95% confidence interval 22.8% to 33.2%) and without
legislation (22.3%, 15.0% to 29.6%), suggesting fewer young
cyclists, improvements to cycling safety, or a change in hospital
admission policies. Among adults the rate of total hospital
admissions for cycling related injuries increased between 1994
and 2003, but this increase, from 10.0 to 10.5 per 100 000 person
years in provinces that implemented helmet legislation, and
from 9.7 to 10.0 per 100 000 person years in provinces and
territories with no such legislation, was not statistically
significant in either group.
Using segmented regression analysis, we did not detect a
statistically significant effect of helmet legislation on the rate
of hospital admissions for cycling related head injuries per total
admissions for cycling related injuries among young people in
the year after legislation was implemented (fig 2⇓). The age
group of cyclists targeted by legislation (<18 years versus all
ages) was not associated with meaningful changes in rate ratios
for head injuries (fig 2). The rate ratio was statistically
significant (indicating a protective effect of legislation) in only
one province, New Brunswick, where legislation applies to all
cyclists (fig 2). None of the interaction terms were statistically
significant, indicating no difference in the post-legislation rate
of head injuries in provinces with legislation compared with
those without legislation. Among adults, a statistically
significant protective effect of helmet legislation was detected
in one province, British Columbia, where legislation applies to
all cyclists (fig 3⇓). None of the interaction terms were
significant. Results did not change appreciably when face
injuries were excluded from the definition of head injuries (see
supplementary figures 2 and 3).
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Discussion
Since 1994 in Canada the rate of bicycling injuries, including
those to the head, has decreased among young people. In six
provinces where helmet legislation was implemented, we
observed a steep decline in the rate of hospital admissions for
young people with cycling related head injuries (54% reduction)
compared with provinces and territories without legislation
(33% reduction). In adults over this same period we observed
a 26% reduction in the rate of admissions for head injuries in
provinces that implemented helmet legislation, compared with
no reduction in provinces without legislation. While these results
superficially suggest an important effect of legislation, after
taking baseline trends into consideration we were unable to
show an independent effect of helmet legislation on the rate of
head injuries per hospital admission for a cycling related injury
one year after the implementation of legislation, either overall
or according to the age group of cyclists targeted by the
legislation.
Three previous studies have investigated the effects of helmet
legislation on bicycle related head injuries using a before and
after design and a concurrent comparison group.21 23 29 All
focused on paediatric populations. In a Canadian study that
analysed data from the National Trauma Registry Minimum
Data Set (years 1994 to 1997), the same data source used in our
study, the authors concluded that helmet legislation was
associated with a significant reduction in the rate of cycling
related head injuries among Canadians aged 5-19 years.21 Using
the same data source but with an extended period of follow-up,
over which time two additional provinces implemented
legislation, we replicated the results of this previous study in
our initial analysis that did not adjust for baseline trends. In our
time series analysis, we none the less could not confirm that the
reduction in the rate of head injuries was an independent effect
of helmet legislation above and beyond the concomitant
declining trend in the rate of head injuries observed throughout
Canada.
Helmets reduce the risk of injuries to the brain by up to 88%,
the head by up to 85%, and the face by up to 65%.10-12 Laws that
mandate the use of helmets increase the chance that cyclists will
wear a helmet, especially when they apply to all cyclists.26 30
Given this evidence, why is it difficult to detect a decrease in
hospital admissions for cycling related head injuries after the
implementation of helmet legislation? Concurrent interventions
that improve cycling safety combined with municipality specific
helmet legislation are two possible explanations. The Canadian
Cycling Association’s CAN-BIKE programme to promote
cycling safety, for example, has been taught in Canada since
1985,31 and local educational programmes, media campaigns,
and subsidised or free helmet distribution programmes are also
known to have occurred in Canada around the time legislation
was implemented (table 1).32-37 Similarly, changes to cycling
infrastructure over the study period (for example, traffic calming,
and designated bicycle lanes and routes)38-41 could have
confounded associations with helmet legislation. In provinces
and territories without legislation, several municipalities
implemented helmet legislation between 1994 and 2003.42 43
Notably, seven municipalities in Newfoundland and Labrador,
including St John’s, the province’s largest municipality,
implemented bylaws that may have contributed to the steep
decrease in cycling rated head injury rates we observed in this
province.44
A third possible explanation for our results is that the
effectiveness of helmets is greater for mild and moderate head
injuries than for the severe head injuries captured by hospital
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4. BMJ 2013;346:f2674 doi: 10.1136/bmj.f2674 (Published 14 May 2013)
Page 4 of 10
RESEARCH
admission data. Diagnostic and prognostic improvements over
time that allowed for the treatment of patients with mild and
moderate head injuries in emergency rooms, as opposed to in
inpatient hospital wards, could have further impeded our ability
to detect an effect of helmet legislation, if one exists.45 46
injuries, however, were decreasing before the implementation
of provincial helmet legislation and did not seem to change in
response to legislation. While helmets reduce head injuries and
their use should be encouraged, this study suggests that, in the
Canadian context of provincial and municipal safety campaigns,
improvements to the cycling infrastructure, and the passive
uptake of helmets, the incremental contribution of provincial
helmet legislation to reduce the number of hospital admissions
for head injuries is uncertain to some extent, but seems to have
been minimal.
Strengths and limitations of this study
We thank the peer reviewers and Sarah Namer for their thoughtful
comments that improved the quality of our manuscript.
While minimal enforcement may compromise the effectiveness
of helmet legislation, fear of the police and of fines motivates
helmet use,47 and despite nominal fines and few issued tickets,
helmet use rose dramatically in provinces immediately after the
enactment of legislation (table 1).30
The National Trauma Registry Minimum Data Set captures
information on all hospital admissions for cycling related injuries
in Canada. Cyclists who die from their injuries before reaching
a hospital are not included. Additional data on emergency room
visits would have been beneficial, both to make inferences on
the association between helmet legislation and milder head
injuries and to refine counts of head injuries in small provinces
and in the territories. None the less, before 2002 no province or
territory systematically reported data on visits to emergency
rooms to a national database. The National Trauma Registry
Minimum Data Set also makes no distinction between cyclists
injured on-road and off-road (for example, while jumping on
BMX bikes or mountain biking), yet provincial helmet laws
apply only to on-road cyclists. Helmets are standard in off-road
cycling, with usage more than 80% in the 1990s and nearly
100% in recent studies.48-50 This increase, coupled with
improvements to helmet design, may have contributed to a
reduction in bicycle related head injuries in provinces where
off-road cycling is common (British Columbia, Alberta,
Quebec).
Data on exposure to cycling are desirable, yet were unavailable
for Canada at the time helmet legislation was implemented.
Recent data from the Canadian Community Health Survey
indicate that bicycle use varies across provinces,26 reflecting
differences in climate and cycling infrastructure. Variation in
cycling possibly contributes to differences in cycling injury
rates between provinces. Within a province, however, the
introduction of helmet legislation does not discourage bicycle
use and thus permits assessment of helmet legislation on cycling
related head injuries.26 51
One further limitation of our study is the small number of time
points, especially preintervention, which may have reduced the
power of the segmented regression analysis.25 28 52 In small
provinces, few observations at each time point resulted in wide
confidence intervals.
Strengths of our study include the number of provinces,
territories, and years analysed, combined with our use of
descriptive statistics and statistical methods for interrupted time
series data that explicitly considered baseline trends. This is the
first study to use a controlled before and after design to assess
the association between helmet legislation and cycling related
head injuries in adults, as well as the first controlled study to
incorporate background trends in rates of injury. Results from
our study are timely and relevant, following ongoing debates
in the lay and medical press as to the merit of bicycle helmet
laws.53-56
Conclusion
From 1994 to 2008, we observed a substantial and consistent
decrease in the rate of hospital admissions for cycling related
head injuries across Canada. Reductions were greatest in
provinces with helmet legislation. Rates of admissions for head
No commercial reuse: See rights and reprints http://www.bmj.com/permissions
Contributors: JD, TR, and RZ conceived and designed the study. JD
analysed the data and all authors contributed to its interpretation. JD
drafted the manuscript and all authors participated in the revision process
and have approved this submission for publication. JD and RZ had full
access to all of the data in the study and can take responsibility for the
integrity of the data and the accuracy of the data analysis.
Funding: JD is a Canadian Institute of Health Research Vanier graduate
scholar, AFT is a recipient of a research career award from the Fonds
de la Recherche du Québec-Santé, and RZ is a recipient of a
RCT-mentorship award from the Canadian Institute of Health Research.
None of the funders influenced the conduct of this research.
Competing interests: All authors have completed the ICMJE uniform
disclosure form at www.icmje.org/coi_disclosure.pdf (available on
request from the corresponding author) and declare: no support from
any organisation for the submitted work; no financial relationships with
any organisations that might have an interest in the submitted work in
the previous three years; no other relationships or activities that could
appear to have influenced the submitted work.
Ethical approval: Not required.
Data sharing: Cycling injury counts by province and year are available
from the corresponding author at jessica.dennis@mail.utoronto.ca.
1
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5. BMJ 2013;346:f2674 doi: 10.1136/bmj.f2674 (Published 14 May 2013)
Page 5 of 10
RESEARCH
What is already known on this topic
Cyclists are vulnerable road users; head injuries among cyclists account for 75% of cycling related fatalities
Debate exists about whether or not helmet legislation is an effective strategy to reduce serious head injuries among child and adult
cyclists
What this study adds
When baseline trends in cycling related injury rates were considered, the overall rates of head injuries were not appreciably altered by
helmet legislation
In the context of provincial and municipal safety campaigns, improvements to the cycling infrastructure, and the passive uptake of
helmets, the incremental benefit of provincial helmet legislation to reduce admissions to hospital for head injuries is substantially uncertain
19
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Accepted: 15 April 2013
Cite this as: BMJ 2013;346:f2674
This is an Open Access article distributed in accordance with the Creative Commons
Attribution Non Commercial (CC BY-NC 3.0) license, which permits others to distribute,
remix, adapt, build upon this work non-commercially, and license their derivative works
on different terms, provided the original work is properly cited and the use is
non-commercial. See: http://creativecommons.org/licenses/by-nc/3.0/.
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6. BMJ 2013;346:f2674 doi: 10.1136/bmj.f2674 (Published 14 May 2013)
Page 6 of 10
RESEARCH
Tables
Table 1| Bicycle helmet legislation in Canadian provinces and territories
Province or territory
Date
implemented
Helmet use
Penalty ($C)
Enforcement
Cointerventions
Prelegislation
Post-legislation
2009 (%)*
Legislation applies to
all cyclists:
New Brunswick
December
1995
21
No information
available
No information available
No information
available
No information
available
51
British Columbia
September
1996
100
No information
available
Province wide safe cycling
promotion programme
(education, media, helmet
rebate) launched in 199536
47% in 199536
72% in 199936
59
Nova Scotia
July 1997
25 for first
offence, 50 for
second, 100 for
third or
subsequent
offences
60 tickets issued in Extensive media campaign
1997, 176 in 1998, promoting law launched two
and 113 in 199932
months before its
implementation32
36% in 199532
84% in 199932
66
Prince Edward Island
July 2003
120 or
3 tickets and multiple
participation in 2
warnings issued
hour safety
between 2003 and
seminar
2009†
No information available
No information
available
No information
available
51
Legislation applies to
cyclists aged <18
years:
Ontario
October 1995
60
Minimal
enforcement30
Prelegislation helmet
discounts, media
campaigns, and targeted
school helmet promotion
activities30 33
Young people:
44% in 199433
Young people: 66%
in 199733
34
Alberta
May 2002
69
16 tickets issued in
2003, 48 in 200437
Public health awareness
campaigns and targeted
school health activities
implemented in 200437
Young people:
28% in 2000,
adults: 49% in
200037
Young people: 83%
in 2004, adults:
48% in 200437
48
—
—
—
—
—
—
22
—
—
—
—
—
—
38
Saskatchewan
—
—
—
—
—
—
23
No legislation:
Manitoba‡
Newfoundland and
Labrador
Quebec
—
—
—
—
—
—
26
Northwest Territories
—
—
—
—
—
—
28
Yukon
—
—
—
—
—
—
51
Nunavut
—
—
—
—
—
—
—
*Information from: Bicycle helmet use, 2009. Statistics Canada; 2011. www.statcan.gc.ca/pub/82-625-x/2010002/article/11274-eng.htm. Estimates of helmet use
in Nunavut were too unreliable to be published.
†Information from: Bike helmet law needs better enforcement, says MLA. CBC News; 2009. www.cbc.ca/news/canada/prince-edward-island/story/2009/05/05/peibike-helmet-law.html.
‡Legislation mandating helmet use for cyclists less than 18 years of age was tabled by the Manitoba government 23 May 2012.
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7. BMJ 2013;346:f2674 doi: 10.1136/bmj.f2674 (Published 14 May 2013)
Page 7 of 10
RESEARCH
Table 2| Characteristics of cyclists admitted to hospital in Canada, 1 April 1994 to 31 March 2008
Injured cyclists (n=66 716)
Characteristics
Head injured cyclists (n=19 732)
No
% (95% CI)
No
% (95% CI)
Brain
—
—
13 340
67.6 (67.0 to 68.3)
Scalp or skull
—
—
4770
24.2 (23.6 to 24.8)
Face
—
—
7010
35.5 (34.9 to 36.2)
Type of head injury*:
Age (years):
<18
29 844
44.7 (44.4 to 45.1)
10 369
52.6 (51.9 to 53.3)
18-24
5765
8.6 (8.4 to 8.9)
1847
9.4 (9.0 to 9.8)
25-44
15 217
22.8 (22.5 to 23.1)
3798
19.3 (18.7 to 19.8)
≥45
15 890
23.8 (23.5 to 24.1)
3718
18.8 (18.3 to 19.4)
Males
50 004
75.0 (74.6 to 75.3)
15 249
77.3 (76.7 to 77.9)
267
0.4 (0.3 to 0.5)
224
1.1 (1.0 to 1.3)
Discharge status dead
*Cyclists may have had more than one type of head injury.
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8. BMJ 2013;346:f2674 doi: 10.1136/bmj.f2674 (Published 14 May 2013)
Page 8 of 10
RESEARCH
Figures
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9. BMJ 2013;346:f2674 doi: 10.1136/bmj.f2674 (Published 14 May 2013)
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RESEARCH
Fig 1 Annual rate of hospital admissions for cycling related head injuries, 1994 to 2008, in Canadian provinces and territories,
and in Canadian provinces and territories grouped by bicycle helmet legislation status. Rates are connected by a LOESS
regression line. Vertical bars indicate year legislation was enacted. Legislation in Ontario and Alberta targeted only cyclists
aged less than 18 years
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10. BMJ 2013;346:f2674 doi: 10.1136/bmj.f2674 (Published 14 May 2013)
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RESEARCH
Fig 2 Change in rate of hospital admissions for head injuries per injured cyclist among cyclists aged less than 18 years one
year after implementation of bicycle helmet legislation. Rate ratios <1 suggest a protective effect of helmet legislation. The
area of the square is proportionate to the weight of each province in the summary estimate
Fig 3 Change in rate of hospital admissions for head injuries per injured cyclist among cyclists aged 18 years and older
one year after implementation of bicycle helmet legislation. Rate ratios <1 suggest a protective effect of helmet legislation.
The area of the square is proportionate to the weight of each province in the summary estimate
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