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Objectives: To assess the incidence of head injury and predictors of complication across the care continuum., Design: Retrospective cohort study using data from a research network. We calculated the incidence of overall head injury in a longitudinal cohort covering 1-year interval (31 369 patient-years), and the incidence of complicated head injury in a longitudinal cohort covering 10 years interval (220 352 patient-ears). Incidence rates were calculated per 1000 patient-years with 95% CI using the Mid-P exact test. We calculated ORs to assess potential risk factors for a complicated head injury., Setting: A practice-based research network covering a population of >30 000 patients., Participants: All patients listed in practices within the research network during the years 2005-2014., Main Outcome Measures: Incidence of (complicated) head injury and predictors for clinical complications., Results: The incidence of overall head injury was 22.1 per 1000 person-years and the incidence of a complicated course following head injury was 0.16 per 1000 person-years. The following determinants were risk factors for a complicated course: high energy trauma, bicycle accident, traffic accident in general, use of anticoagulants, alcohol intoxication, age above 60 years and low Glasgow Coma Scale at initial presentation. A complicated course was very unlikely when the patients' first encounter with a healthcare professional was in primary care (OR 0.03, 95% CI 0.01 to 0.07)., Conclusions: Complication after head injury are rarely seen in general practice. Patients who do experience complications are often easily identifiable as requiring specialist care. A more reserved referral policy for general practice may be desirable, suggesting that current guidelines are too defensive., Competing Interests: Competing interests: None declared., (© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.)

Objective: First, to determine whether procalcitonin (PCT) significantly adds diagnostic value in terms of sensitivity and specificity to a common set of markers of infection, including C-reactive protein (CRP), at the Emergency Department. Second, to create a simple scoring rule implementing PCT values. Third, to determine and compare associations of CRP and PCT with clinical outcomes., Design: The additional diagnostic value of PCT was determined using multiple logistic regression analysis. A score was developed to help distinguish patients with a culture-proven bacterial infection from patients not needing antibiotic treatment using 16 potential clinical and laboratory variables. The prognostic value of CRP and PCT was determined using Spearman's correlation and logistic regression., Setting: Emergency Department of a 310-bed teaching hospital., Patients: Patients between 18 and 85 years old presenting with fever to the Emergency Department., Interventions: None., Measurements and Main Results: A total of 211 patients were studied (infection confirmed, n = 73; infection likely, n = 58; infection not excluded, n = 46; no infection, n = 34). CRP and chills were the strongest predictors for the diagnosis of bacterial infection. After addition of PCT to these parameters, model fit significantly improved (p = .003). The resulting scoring rule (score = 0.01 * CRP + 2 * chills + 1 * PCT) was characterized by an AUC value of 0.83 (sensitivity 79%; specificity of 71%), which was more accurate than physician judgment or SIRS (systemic inflammatory response syndrome). PCT levels were significantly associated with admission to a special care unit, duration of intravenous antibiotic use, total duration of antibiotic treatment, and length of hospital stay, whereas CRP was related only to the latter two variables., Conclusions: These data suggest that PCT may be a valuable addition to currently used markers of infection for diagnosis of infection and prognosis in patients with fever at the Emergency Department.

During the weekend of Saturday 31 January to Sunday 1 February 1953, a storm tide raged across the northwest European shelf and flooded the low-lying coastal areas of the countries around the North Sea. The peak high waters occurred during the night and the storm surprised many people in their sleep. The resulting disaster in terms of loss of life and damage to infrastructure was enormous. In the Netherlands, 1836 people fell victim to the flood; in the UK and Belgium, the casualties were 307 and 22, respectively. The large number of fatalities in the Netherlands was related to the fact that much of the affected area is below sea-level.This paper focuses on the case of the Netherlands. It discusses the history of land reclamation, and the fact that living in low-lying areas protected by dykes, often below sea-level, is an accepted fact of life in the Netherlands. The historical approach to dyke maintenance is then outlined, and the state of the dykes in the early twentieth century and after the war is discussed. The characteristics of the storm and the flood are discussed, along with people's experiences of the first hours and days following the flood. The impact of this human stress has often been lasting--many survivors continue to live with daily memories of the flood. Attention is given to the large-scale rescue and relief efforts, the closure of the dykes during the following nine months and the concept of the Delta Plan, designed to prevent such a large-scale disaster ever happening again. Although the 1953 storm was indeed a low probability event leading to very high storm-induced water-levels, and occurred in combination with spring tide, several arguments are presented that explain why this flood turned into a disaster of such a large scale. Equally, the question is raised whether the disaster could have been prevented. The paper concludes by noting the importance of awareness and preparedness in order to prevent a future storm threat of this scale turning into a disaster of the scope of the Big Flood of 1953.

In the 50 years since the catastrophic southern North Sea storm surge of 31 January-1 February 1953, there have been technological advances in the engineering of flood protection, increased understanding of physical processes in shallow seas and estuaries, and developments in the mathematical statistics of extreme events. This introductory paper reviews how the scientific understanding of surge events, their impacts and the human responses to them is evolving on many fronts, often across disciplinary boundaries. The question of how the long-term nature of the problem itself will be influenced by possible climate, land use and policy changes is addressed, along with their associated uncertainties.

This paper reviews practices and trends in hydrodynamic and statistical analyses and modelling in the Netherlands with regard to the risk of coastal flooding. We restrict ourselves to the physical phenomena of tides, storm surges and wind waves. We first give a brief outline of established policy in the Netherlands regarding accepted levels of risk of flooding, and current changes therein. This is followed by a summary of a statistical reanalysis of historical storm-surge data combined with numerical hydrodynamic modelling, aimed at improved estimates of probabilities of occurrence of extreme water levels along the Dutch coast. Recent developments concerning the physical and numerical modelling of inundation of low-lying areas are presented. State-of-the-art modelling of wind waves in coastal areas is also reviewed. Research issues in the area of coastal modelling for flood defence are indicated.