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Medical experts may be instructed by designated bodies such as the coroner or the court, to provide expert witness statements concerning patients treated under their care. Such reports are factual and are prepared on the basis of the medical records and personal recollection of events. Other authorities such as the Driving Vehicle and Licensing Agency can also seek information on patients with traumatic brain injury. In the civil court, experts may advise on matters relating to personal injury and medical negligence. Reports are usually based upon review of records, and often medical examination of the claimant. The expert may be instructed to provide reports on condition, prognosis and/or causation. This chapter discusses liaison with the various authorities that require medico-legal input relevant to head injury and whiplash.
The major determinant of outcome from TBI is the severity of the primary injury; however, not all brain damage happens at that time point. Invariably, primary injury activates cellular and molecular cascades which mediate potentially reversible, secondary injury in the ensuing hours and days. These events can lead to progressive brain swelling and increased intracranial pressure (ICP) thus compromising cerebral perfusion pressure (CPP) and cerebral blood flow (CBF) resulting in tissue ischaemia, hypoxia and cellular energy failure. Further cell damage exacerbates the brain swelling, forming part of a vicious circle that can lead to life-threatening brain herniation. A large body of evidence links post-traumatic intracranial hypertension at levels above 20 to 25 mmHg with excess mortality and worse functional outcomes.
Intracranial pressure (ICP) is well recognised as a critical parameter to both measure and influence in the management of the head injured patient. Since Lundberg’s seminal studies, ICP has arguably become the major focus of monitoring in head injury, as well as a number of other neurosurgical scenarios.1 Mean ICP and the features that make up the ICP waveform provide insight into the state of elastance and compliance of the injured brain, impending trends and events related to changes in intracranial pathophysiology, and also end-prognosis in traumatic brain injury (TBI).
Advocating a pragmatic and multidisciplinary approach to the management of patients with brain injuries, Traumatic Brain Injury provides a detailed description of care along the whole-patient pathway. Delivering an evidence-based update on the optimal care of both adult and paediatric patients who have sustained injuries ranging from mild to severe, information from on-going multi-centre studies in neurotrauma is included. The basic scientific principles of neuropathology, head injury research and scoring systems are presented before detailed sections on emergency department care, patient transfer, intensive care and longer-term care. Rehabilitation is reviewed in detail with chapters discussing the aims and roles of physiotherapy, occupational therapy and neuropsychology amongst others. Discussing medico-legal issues in detail, the effect of injury on the individual and their family are also examined. Emphasising a holistic approach to caring for patients with brain injuries, this is an essential guide for all involved.
We report an experimental study of photocarrier lifetime, transport, and excitation spectra in silicon-on-insulator doped with sulfur far above thermodynamic saturation. The spectral dependence of photocurrent in coplanar structures is consistent with photocarrier generation throughout the hyperdoped and undoped sub-layers, limited by collection of holes transported along the undoped layer. Holes photoexcited in the hyperdoped layer are able to diffuse to the undoped layer, implying (μτ)h ∼ 5 × 10−9 cm2/V. Although high absorptance of hyperdoped silicon is observed from 1200 to 2000 nm in transmission experiments, the number of collected electrons per absorbed photon is 10−4 of the above-bandgap response of the device, consistent with (μτ)e < 1 × 10−7cm2/V.