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This article presents a case where the issue was to determine who was the driver and who was the passenger at the time of a fatal car accident involving two persons, one of whom died in the accident. The presence of the two persons in the car was not contested, only the mechanisms that led to the deposition of the DNA (i.e., the activities) were. To our knowledge, few cases are evaluated considering the alleged activities. The reasons for this include the lack of knowledge, and data, as well as the difficulties encountered for the formulation of conclusions. In this case report, we present the architecture of the Bayesian Network (BN) used to evaluate the DNA results of the traces recovered from the steering wheel, driver's and passenger's airbags. The following propositions were considered: "The person of interest (POI) was driving the car and the alternative person (AP) was the passenger at the time of the accident" or vice versa. We discuss the assumptions that were made and how data from the literature was used to parametrize into the BN. A likelihood ratio of the order of 90 was finally assigned. The statement proposed to the mandating authority indicated that, given the information that was made available to us, our observations were of the order of 90 times more probable if the POI was driving the car at the time of the accident rather than if the AP was. A sensitivity analysis was performed (5000 simulations): this shows that our likelihood ratio is robust., Competing Interests: Declaration of Competing Interest No conflict of interest., (Copyright © 2024 The Authors. Published by Elsevier B.V. All rights reserved.)

Active wearable devices such as protective smart belts have been proposed to reduce hip impact in the event of a fall. This study primarily evaluated the feasibility and acceptance of a specific protective belt among selected patients identified as being at risk of falling who were admitted to an ICS Maugeri Neurorehabilitation Unit from September 2022 to April 2023. According to previous institutional observations, the device was worn between the 6th and 21st days of recovery. Out of 435 admitted patients, 118 were considered eligible, but 101 declined to participate (about 50% refused to wear the belt without first trying it on; the other 50% found it too heavy or difficult to manage). Among the 17 patients who accepted (users), 9 used the belt correctly. The remaining eight patients refused to wear it after 24 h, due to discomfort. Out of 435 patients admitted, we observed at least one fall in 49 patients, of whom 5 were eligible patients; 1 was a user who had quickly refused to use the belt and fell with mild damage. Two non-eligible patients and one eligible non-user patient experienced falls resulting in hip fractures; only in the latter case could the use of the belt have limited the damage to the hip. Difficulties in recruiting patients and low acceptance of the proposed intervention present further challenges., Competing Interests: The authors declare no conflicts of interest.

Background: We have previously studied the physiological and mechanical responses of the eye to blunt trauma in various situations using finite element analysis (FEA). In this study, we evaluated the volume kinetics of an airbag impact on the eye using FEA to sequentially determine the volume change rates of intraocular segments at various airbag deployment velocities., Methods: The human eye model we created was used in simulations with the FEA program PAM-GENERIS TM (Nihon ESI, Tokyo, Japan). Different airbag deployment velocities, 30, 40, 50, 60 and 70 m/s, were applied in the forward direction. The volume of the deformed eye impacted by the airbag was calculated as the integrated value of all meshes in each segment, and the decrease rate was calculated as the ratio of the decreased volume of each segment at particular timepoints to the value before the airbag impact., Results: The minimum volume of the anterior chamber was 63%, 69% and 50% at 50, 60 and 70 m/s airbag impact velocity, respectively, showing a curve with a sharp decline followed by gradual recovery. In contrast to the anterior chamber, the volume of the lens recovered promptly, reaching 80-90% at the end of observation, except for the case of 60 m/s. Following the decrease, the volume increased to more than that of baseline at 60 m/s. The rate of volume change of the vitreous was distributed in a narrow range, 99.2-100.4%., Conclusion: In this study, we found a large, prolonged decrease of volume in the anterior chamber, a similar large decrease followed by prompt recovery of volume in the lens, and a time-lag in the volume decrease between these tissues. These novel findings may provide an important insight into the pathophysiological mechanism of airbag ocular injuries through this further evaluation, employing a refined FEA model representing cuboidal deformation, to develop a more safe airbag system., Competing Interests: The authors report no conflict of interest in this work., (© 2024 Ikeda et al.)

Injuries due to automobile safety devices have been reported and we report a rare fatality due to a defective airbag system. A compact hybrid car driven by a 37-year-old male at moderate speed had crashed through an unprotected manhole. The car had moved around 200 m before it came to a halt. The passers-by had noticed that the driver was unconscious, partly leaning forward with an inflated airbag. He was pronounced dead on admission. The car had sustained minor indentation on front bumper. Autopsy revealed a circular perforated laceration on the neck associated with completely transected right carotid artery and partially transected jugular vein. There was a 2 × 2-cm cylindrical metal object lodged at C 4 -C 5 vertebrae level, and the remaining part of this was retrieved during scene investigation and identified as a part of a metal canister in the inflator component of the airbag system. There was a perforation in the airbag which was similar in size to the retrieved foreign body. The cause of death was ascertained as hemorrhagic shock due to bleeding from ruptured neck vessels caused by primary shrapnel projected from the faulty airbag system. Following the incident, the manufacturers replaced faulty airbag systems in similar models. If abnormally fatal injuries are observed, a scene visit along with automotive expert opinion would provide valuable insight into the incident. Such information would alert the general public on regular screening of safety measures and prompt manufacturers to recall faulty products., (© 2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Side and frontal airbag deployment represents the main injury mechanism to the upper extremity during automotive collisions. Previous dynamic injury limit research has been limited to testing the forearm at either the assumed most vulnerable location to fracture, the distal 1/3rd, or the midpoint. Studies have varied the surface to which impacts were applied, with no clear consensus on the site of greatest vulnerability. The unpredictability of airbag impact location, especially with altered hand positioning, limits the effectiveness of existing forearm injury limits determined from impacts at only one location. The current study quantified the effect of impacts at alternative locations on injury risk along the forearm using the THUMS FE model. Airbag-level impacts were simulated along the forearm on all four anatomical surfaces. Results showed the distal 1/3rd is not the most vulnerable location (for any side), indicating forearm fracture is not solely driven by area moment of inertia (as previously assumed). The posterior forearm was the weakest, suggesting that current test standards underestimate the fracture risk of the forearm. Linear regression models showed strong correlation between forearm fracture risk and bone geometry (cross-sectional area and area moment of inertia) as well as soft-tissue depth, potentially providing the ability to predict forearm injury tolerances for any location or forearm size. This study demonstrated the forearm's vulnerability to fracture from airbag deployments, indicating the need for safety systems to better address injury mechanisms for the upper limb to effectively protect drivers., (Copyright © 2024 by ASME.)

Objective: Few large studies have investigated the factors and outcomes related to concomitant injuries occurring alongside mild traumatic brain injury (mTBI) after motor vehicle collisions (MVCs). Thus, the objective of this study was to assess whether MVC characteristics predict which patients with mTBI will have concomitant whiplash injury, and whether concomitant whiplash injury affects care utilization for these patients., Methods: This retrospective cohort study included 22,213 patients with mTBI after MVC identified from the American College of Surgeons Trauma Quality Programs dataset. A hierarchical logistic regression model was constructed to investigate patient and MVC factors associated with concomitant whiplash injury. Propensity score matching on whiplash status, in conjunction with a multivariable logistic regression model, assessed if concomitant whiplash affected odds of hospitalization. In the subgroup of patients who were hospitalized, associations with hospital length of stay (LOS) and discharge disposition were investigated., Results: The median (IQR) age was 34 (24-51) years, with a median Glasgow Coma Scale score at presentation of 15 (15-15). Patients with concomitant whiplash were older (median 36 years vs 34 years, p = 0.03) and had higher rates of hospitalization (75% vs 64%, p < 0.001). In the hierarchical model for associations with concomitant whiplash injury, patients with blood alcohol content (BAC) greater than the federal driving limit had lower odds of concomitant whiplash (OR 0.63, 95% CI 0.49-0.81) along with those who had airbag deployment (OR 0.80, 95% CI 0.68-0.95), but seatbelt use was associated with greater odds (OR 1.41, 95% CI 1.16-1.71). After matching, concomitant whiplash was independently associated with increased odds of hospitalization (OR 1.67, 95% CI 1.40-1.99) while seatbelt use was associated with decreased odds (OR 0.88, 95% CI 0.81-0.95). Among hospitalized patients, concomitant whiplash was not associated with hospital LOS or discharge disposition., Conclusions: MVC characteristics such as alcohol consumption and airbag deployment were protective toward development of concomitant whiplash for mTBI patients, while seatbelt use was associated with higher risk. Concomitant whiplash increases the odds of hospitalization for mTBI patients but does not affect hospital LOS or discharge disposition, while seatbelt use is associated with lower rates of hospitalization and a more favorable hospital course. These findings provide context to injury patterns and care provision after a common mechanism of injury.

Purpose: We studied the kinetic phenomenon of an airbag impact on eyes after trabeculectomy using finite element analysis (FEA), a computerized method for predicting how an object reacts to real-world physical effects and showing whether an object will break, to sequentially determine the responses at various airbag deployment velocities., Methods: A human eye model was used in the simulations using the FEA program PAM-GENERIS TM (Nihon ESI, Tokyo, Japan). A half-thickness incised scleral flap was created on the limbus and the strength of its adhesion to the outer sclera was set at 30%, 50%, and 100%. The airbag was set to hit the surface of the post-trabeculectomy eye at various velocities in two directions: perpendicular to the corneal center or perpendicular to the scleral flap (30° gaze-down position), at initial velocities of 20, 30, 40, 50, and 60 m/s., Results: When the airbag impacted at 20 m/s or 30 m/s, the strain on the cornea and sclera did not reach the mechanical threshold and globe rupture was not observed. Scleral flap lacerations were observed at 40 m/s or more in any eye position, and scleral rupture extending posteriorly from the scleral flap edge and rupture of the scleral flap resulting from extension of the corneal laceration through limbal damage were observed. Even in the case of 100% scleral flap adhesion strength, scleral flap rupture occurred at 50 m/s impact velocity in the 30° gaze-down position, whereas in eyes with 30% or 50% scleral flap adhesion strength, scleral rupture was observed at an impact velocity of 40 m/s or more in both eye positions., Conclusion: An airbag impact of ≥40 m/s might induce scleral flap rupture, indicating that current airbags may induce globe rupture in the eyes after trabeculectomy. The considerable damage caused by an airbag on the eyes of short-stature patients with glaucoma who have undergone trabeculectomy might indicate the necessity of ocular protection to avoid permanent eye damage., Competing Interests: The authors have no competing interests to declare that are relevant to the content of this article., (© 2024 Suzuki et al.)

Background: We studied the kinetic phenomenon of an airbag impact on eyes with different axial lengths using finite element analysis (FEA) to sequentially determine the physical and mechanical responses of intraocular segments at various airbag deployment velocities., Methods: The human eye model we created was used in simulations with the FEA program PAM-GENERIS TM . The airbag was set to impact eyes with axial lengths of 21.85 mm (hyperopia), 23.85 mm (emmetropia) and 25.85 mm (myopia), at initial velocities of 20, 30, 40, 50 and 60 m/s. The deformation rate was calculated as the ratio of the length of three segments, anterior chamber, lens and vitreous, to that at the baseline from 0.2 ms to 2.0 ms after the airbag impact., Results: Deformation rate of the anterior chamber was greater than that of other segments, especially in the early phase, 0.2-0.4 ms after the impact (P < 0.001), and it reached its peak, 80%, at 0.8 ms. A higher deformation rate in the anterior chamber was found in hyperopia compared with other axial length eyes in the first half period, 0.2-0.8 ms, followed by the rate in emmetropia (P < 0.001). The lens deformation rate was low, its peak ranging from 40% to 75%, and exceeded that of the anterior chamber at 1.4 ms and 1.6 ms after the impact (P < 0.01). The vitreous deformation rate was lower throughout the simulation period than that of the other segments and ranged from a negative value (elongation) in the later phase., Conclusion: Airbag impact on the eyeball causes evident deformation, especially in the anterior chamber. The results obtained in this study, such as the time lag of the peak deformation between the anterior chamber and lens, suggest a clue to the pathophysiological mechanism of airbag ocular injury., Competing Interests: The authors report no conflict of interest in this work., (© 2024 Ueno et al.)

Objective: This study aims to establish best practices and guidelines to ensure that experimental research utilizing Postmortem Human Subjects (PMHS) for injury prevention adheres to relevant ethical principles, which are also commonly accepted in research involving human tissues and living subjects. Furthermore, it reviews existing literature to underscore the pivotal role of PMHS testing in evaluating the efficacy of safety systems, with a particular focus on airbag performance., Methods: This paper conducts an examination of the primary ethical principles governing human subject research as outlined in the Declaration of Helsinki (1965) and traces their evolution up to the latest framework proposed by the Council for International Organizations of Medical Sciences (CIOMS) in 2002. Input was solicited from international experts and laboratories experienced in PMHS testing to understand how these ethical principles are implemented in practice. This is complemented by a comprehensive review of literature that assesses the contribution of PMHS testing to airbag performance enhancements in frontal impacts., Results: The findings underscore the importance of informed consent from donors or their next-of-kin, as highlighted in CIOMS declarations, to ensure the ethical integrity of the donation process in line with international standards. The study also finds it customary for an independent review board to evaluate the research methodology and the necessity of employing PMHS tissue over alternative methods, such as computational models or crash test dummies. Despite various national regulations on human subject participation and living tissue research, no specific legal framework governing PMHS tissue use was identified. The systematic literature review revealed that PMHS testing has been crucial in identifying potential injury mechanisms not detected by Anthropomorphic Test Devices (ATD), significantly contributing to the enhancement of computer human body models and the biofidelity of crash test dummies., Conclusion: The International Council on the Biomechanics of Injury (IRCOBI) recognizes the need to provide guidance for research involving human cadaveric tissue to be conducted with the highest ethical standards. This study proposes five recommendations to ensure adherence to these ethical principles in PMHS testing, highlighting the paramount importance of obtaining informed consent and securing independent committee approval. Moreover, IRCOBI emphasizes that until a thorough understanding of tissue damage tolerance levels is achieved and human surrogates, such as ATDs or Human Body Models (HBM), reach full biofidelity, the use of human cadavers remains indispensable for developing effective injury prevention strategies and measures.

Although various soft pneumatic actuators have been studied, their performance, including load capacity, has not been satisfied yet. Enhancing their actuation capability and using them to develop soft robots with high performance is still an open and challenging issue. In this study, we developed novel pneumatic actuators based on fiber-reinforced airbags as a solution to this problem, of which the maximum pressure reaches more than 100 kPa. Through cellular rearrangement, the developed actuators could bend uni- or bidirectionally, achieving large driving force, large deformation, and high conformability. Hence, they could be used to develop soft manipulators with relatively large payload (up to 10 kg, about 50 times the body self-weight) and soft climbing robots with high mobility. In this article, we first present the design of the airbag-based actuators and then model the airbag to obtain the relationship between the pneumatic pressure, external force, and deformation. Subsequently, we validate the models by comparing the simulated and measured results and test the load capacity of the bending actuators. Afterward, we present the development of a soft pneumatic robot that can rapidly climb horizontal, inclined, and vertical poles with different cross-sectional shapes and even outdoor natural objects, like bamboos, at a speed of 12.6 mm/s generally. In particular, it can dexterously transition between poles at any angle, which, to the best of our knowledge, has not been achieved before.

Background and Objectives : Protective equipment, including seatbelts and airbags, have dramatically reduced the morbidity and mortality rates associated with motor vehicle collisions (MVCs). While generally associated with a reduced rate of injury, the effect of motor vehicle protective equipment on patterns of chest wall trauma is unknown. We hypothesized that protective equipment would affect the rate of flail chest after an MVC. Materials and Methods : This study was a retrospective analysis of the 2019 iteration of the American College of Surgeons Trauma Quality Program (ACS-TQIP) database. Rib fracture types were categorized as non-flail chest rib fractures and flail chest using ICD-10 diagnosis coding. The primary outcome was the occurrence of flail chests after motor vehicle collisions. The protective equipment evaluated were seatbelts and airbags. We performed bivariate and multivariate logistic regression to determine the association of flail chest with the utilization of vehicle protective equipment. Results : We identified 25,101 patients with rib fractures after motor vehicle collisions. In bivariate analysis, the severity of the rib fractures was associated with seatbelt type, airbag status, smoking history, and history of cerebrovascular accident (CVA). In multivariate analysis, seatbelt use and airbag deployment (OR 0.76 CI 0.65-0.89) were independently associated with a decreased rate of flail chest. In an interaction analysis, flail chest was only reduced when a lap belt was used in combination with the deployed airbag (OR 0.59 CI 0.43-0.80) when a shoulder belt was used without airbag deployment (0.69 CI 0.49-0.97), or when a shoulder belt was used with airbag deployment (0.57 CI 0.46-0.70). Conclusions : Although motor vehicle protective equipment is associated with a decreased rate of flail chest after a motor vehicle collision, the benefit is only observed when lap belts and airbags are used simultaneously or when a shoulder belt is used. These data highlight the importance of occupant seatbelt compliance and suggest the effect of motor vehicle restraint systems in reducing severe chest wall injuries.

Objective: The advent of automated vehicles (AVs) provides an opportunity to design integrated wheelchair seating stations that provide an equivalent level of safety for occupants using wheelchairs as those using vehicle seating. This study designed a frontal occupant protection system for an integrated second-row wheelchair seating station that includes optimized airbags and seatbelt systems., Methods: MADYMO models were used to optimize belt geometry for a midsized male ATD seated in a surrogate wheelchair fixture, with and without inclusion of a Self Conforming Rearseat Air Bag (SCaRAB). Sled tests were performed to confirm the benefits of airbag use and optimized belt geometry. Additional modeling was performed with commercial manual and power wheelchairs, to identify the effects of wheelchair design and forward clear space on occupant kinematics and injury measures. Additional sled tests were performed with manual and power wheelchairs to demonstrate effectiveness of the restraint system with commercial products., Results: Simulations and tests both showed improved kinematics using an optimized seatbelt system geometry compared to a commonly used suboptimal D-ring location that places the shoulder belt at a more outboard location. Use of the SCaRAB helped compensate for suboptimal geometry. Results include specific recommendations for belt geometry relative to the wheelchair seating station and airbag parameters suitable for protecting occupants seated in wheelchairs. Restraint systems initially optimized using the surrogate wheelchair also performed well with the two commercial wheelchairs. The clear space required for maneuvering a wheelchair will likely prevent injurious head contact in frontal crashes., Conclusions: This study is the first to design a frontal optimal occupant protection system for an integrated second-row wheelchair seating station, demonstrating that it should be feasible once integrated wheelchair seating stations are included in AVs., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

We analyzed and compared the effectiveness of the rotating seat of autonomous vehicles and that of an airbag in traditional vehicles as head protection measures in a frontal crash. Driver frontal crash models of traditional and autonomous vehicles and a head finite element model were established. Four evaluation indexes were used for comparison. The airbag proved more effective than seat rotation in terms of injury criteria and brain tissue injury risk under frontal crash conditions with and without brake involvement. A segmented protection measure based on crash acceleration values is proposed to improve crash safety in future autonomous vehicles.

Purpose: Airbags have substantially reduced mortality and morbidity, while ocular injuries caused by airbags have been reported. We applied a three-dimensional finite element analysis (FEA) model we have established for evaluation of the deformation of an intact eyeball of various axial lengths induced by an airbag impact at various impact velocities., Methods: A model human eye we have created was used in simulations with an FEA program, PAM-GENERIS™ (Nihon ESI, Tokyo, Japan). The airbag was set to impact eyes with various axial lengths of 21.85 mm (hyperopia), 23.85 mm (emmetropia) and 25.85 mm (myopia), at initial velocities of 30, 40, 50 and 60 m/s. Changes in the shape of the eye and the strain induced were calculated. Deformation of the eye in a cross-sectional view was displayed sequentially in slow motion., Results: We found that considerable damage, such as corneal or scleral lacerations, was observed especially at higher impact velocities, such as 50 or 60 m/s, in eyes with any axial length. Deformation was most evident in the anterior segment. The decrease rate of axial length was greatest in the hyperopic eye, followed by the myopic eye, and the emmetropic eye., Conclusions: It was shown that hyperopic eyes are most susceptible to deformation by an airbag impact in this simulation. The considerable deformation by an airbag impact on the eye during a traffic accident shown in this study might indicate the necessity of ocular protection to avoid permanent eye damage., (© 2022. The Author(s).)

Introduction: Backcountry skiers and snowboarders are increasingly using avalanche airbags to improve safety. New safety devices can cause risk compensation, the concept in which users take more risks given the larger safety margin provided by the device. This may limit overall benefits. We sought to elucidate attitudes toward risk-taking behaviors and risk compensation in backcountry users relating to avalanche airbags., Methods: A convenience sample of 144 backcountry skiers and snowboarders was surveyed after a backcountry tour in the Wasatch Mountains of Utah and the Tetons of Wyoming during the winter 2020-21 season. Demographic and experiential data were compared with risk propensity scores and attitudes toward risk compensation. Respondents were stratified into high-, medium-, and low-risk groupings based on risk propensity scores and whether an airbag was carried., Results: Thirty-two (22%) respondents carried an airbag. Airbag users were more likely to endorse risk compensation behavior, ski terrain over 30 degrees, and fall into the high-risk cohort. The high-risk cohort was also more likely to endorse risk compensation behavior than medium- and low-risk individuals., Conclusions: Risk compensation was more prevalent in 2 groups: 1) those carrying an airbag and 2) those falling within the high-risk cohort. Given the prevalence of avalanche airbags, risk compensation should be considered alongside other human factors in avalanche safety and education so that users can mitigate these effects. Although risk compensation appears to be occurring, the magnitude of this effect remains unknown and likely does not obviate the safety benefits of the airbag altogether., (Copyright © 2023 Wilderness Medical Society. Published by Elsevier Inc. All rights reserved.)

Objective: Previous research on occupant protection systems for wheelchair-seated occupants focused on frontal impacts, while similar studies on side impacts are very limited. The objective of this study was to identify the major injury concerns for wheelchair-seated occupants in side impacts and develop restraint systems to mitigate such injury concerns. Methods: Seven sled tests in side impact conditions were first conducted at 30 km/h with a 24 g peak deceleration. An ES2-RE ATD and surrogate wheelchair base (SWCB) were used in all tests, which varied armrest design, width of the SWCB, and wheelchair tiedown conditions. These sled tests set up the baseline performance and provided validation data for computational models. A set of validated MADYMO models were then used to investigate the safety concerns and potential restraint solutions for wheelchair-seated occupants in side impacts. Simulations covered nearside and farside impacts, inboard or outboard D-ring locations, varied wheelchair locations relative to the side door, varied seatbelt anchorage locations, and a few Center Airbag To Contain Humans (CATCH) designs. Finally, another set of sled tests were conducted to demonstrate the effectiveness of varied CATCH designs for protecting wheelchair-seated occupants in farside impacts. Results: Simulations suggested that wheelchair-seated occupants might fall from the wheelchair in farside impacts, while in nearside impacts the seatbelt and curtain airbag can provide reasonable protection to occupants using wheelchairs. The CATCH design, a curtain airbag mounted to the roof centerline with tethers attached outboard of the wheelchair station, was effective at preventing the ATD from falling off the wheelchair. Results from sled tests to iterate CATCH parameters confirmed that the concept was effective at retaining occupants seated in wheelchairs under farside impact loading. Conclusions: This study is the first to investigate wheelchair-seated occupant protection in both nearside and farside impacts. The injury concerns identified in farside impacts and the CATCH design can potentially help improve the protection of wheelchair-seated occupants in side impacts in the future. The CATCH design has potential to improve farside protection for occupants in traditional seating.

Introduction: High-speed motor vehicle accidents (MVAs) are an important cause of brachial plexus injury (BPI). Some case reports have demonstrated shoulder seat belt use resulting in traction injuries to the brachial plexus. We used a national trauma registry to determine the association between seat belt use and brachial plexus injury in MVAs., Methods: The authors queried the National Trauma Databank between 2016 and 2017 for patients with a hospital admission following an MVA. Cases with BPI were identified using International Classification of Diseases, Tenth Edition, Clinical Modification, diagnosis codes. Case-control matching by age and sex was performed to identify 2 non-BPI controls for every case of BPI. Multivariable conditional logistic regression adjusting for body mass index, alcohol use, and drug use was then performed to determine the adjusted association between safety equipment use (seat belt use and airbag deployment) and BPI., Results: A total of 526,007 cases of MVAs were identified, of which 704 (0.13%) sustained a BPI. The incidences of BPI in patients were the following without any protective device (0.16%), with airbag deployment alone (0.08%), with seat belt use alone (0.08%), and with combined airbag deployment and seat belt use (0.07%). Following 1:2 case-control matching by age and sex and multivariable conditional logistic regression, seat belt use (odds ratio [OR] 0.55; 95% confidence interval [CI] 0.42-0.71; P < 0.001) and airbag deployment (OR 0.52; 95% CI 0.33-0.82; P = 0.004) were found to be associated with decreased odds for BPI, with the least odds observed with combined seat belt use and airbag deployment (OR 0.49; 95% CI 0.33-0.74; P = 0.001)., Conclusions: Despite anecdotal evidence suggesting increased likelihood of BPI with shoulder seat belt use, case-control analysis from a national trauma registry demonstrated that both seat belt use and airbag deployment are associated with lower odds of sustaining BPIs in MVAs, with the greatest protective effect observed with combined use. Future studies adjusting for rider location (passenger vs. driver) and other potential confounders such as make, type and speed of vehicle may help further characterize this association., (Copyright © 2021 Elsevier Inc. All rights reserved.)

In this study, a novel expandable bicycle helmet, which integrates an airbag system into the conventional helmet design, was proposed to explore the potential synergetic effect of an expandable airbag and a standard commuter-type EPS helmet. The traumatic brain injury mitigation performance of the proposed expandable helmet was evaluated against that of a typical traditional bicycle helmet. A series of dynamic impact simulations on both a helmeted headform and a representative human head with different configurations were carried out in accordance with the widely recognised international bicycle helmet test standards. The impact simulations were initially performed on a ballast headform for validation and benchmarking purposes, while the subsequent ones on a biofidelic human head model were used for assessing any potential intracranial injury. It was found that the proposed expandable helmet performed admirably better when compared to a conventional helmet design-showing improvements in impact energy attenuation, as well as kinematic and biometric injury risk reduction. More importantly, this expandable helmet concept, integrating the airbag system in the conventional design, offers adequate protection to the cyclist in the unlikely case of airbag deployment failure.

The traffic accident occurrence rate is increasing relative to the increase in the number of people using personal mobility device (PM). This paper proposes an airbag system with a more efficient algorithm to decide the deployment of a wearable bike airbag in case of an accident. The existing wearable airbags are operated by judging the accident situations using the thresholds of sensors. However, in this case, the judgment accuracy can drop against various motions. This study used the long short-term memory (LSTM) model using the sensor values of the inertial measurement unit (IMU) as input values to judge accident occurrences, which obtains data in real time from the three acceleration-axis and three angular velocity-axis sensors on the driver motion states and judges whether or not an accident has occurred using the obtained data. The existing neural network (NN) or convolutional neural network (CNN) model judges only the input data. This study confirmed that this model has a higher judgment accuracy than the existing NN or CNN by giving strong points even in "past information" through LSTM by regarding the driver motion as time-series data.

Objective: Field data have shown significant benefit from driver airbag for occupant protection in frontal crashes. However, vehicle modifiers almost always permanently deactivate airbags for wheelchair-seated drivers. The objective of this study was to conduct sled tests and computational simulations to answer whether driver airbags should be deactivated for drivers seated in wheelchairs., Methods: Five sled tests were conducted under a 48-kph 20-g frontal crash pulse all with driver airbag. Seat-belt fit (good, poor, and unbelted), airbag deployment time (proper and late), and occupant size (midsize male and small female HIII ATDs) were varied in the tests. The 2006 Chrysler Town-and-Country minivan was selected as the nominal vehicle environment, and a surrogate wheelchair with a docking securement system was used for all sled tests. ATD injury measures for the head, neck, chest, and lower extremities were recorded in each test, and were used for validating a set of MADYMO models. Parametric studies with a total of 28 MADYMO simulations were then conducted to investigate the airbag effects on occupant injury risks with varied occupant size, belt fit, and impact angle (0, 15, and 30 deg)., Results: The sled tests showed potential safety concerns for wheelchair-seated drivers with a poor belt fit or without a belt. Specifically, the unbelted midsize male ATD sustained high femur forces and the small female ATD with poor belt fit sustained high chest deflections. The parametric simulations showed that airbag generally improved the protection for wheelchair-seated drivers. It is especially useful for unbelted wheelchair-seated drivers, and is also helpful for reducing the head and neck injury risks regardless of the belt condition, occupant size, and impact angle., Conclusions: This is the first study using sled tests and computational simulations to investigate the effects of airbag deployment on injury risks of wheelchair-seated drivers. Overall, the results showed little basis for concern that the energy of deploying a driver airbag in today's vehicles will cause serious-to-fatal injuries to drivers seated in wheelchairs. The results of this study therefore support the idea that driver airbags generally offer tangible safety benefits for a wide range of wheelchair-seated drivers in frontal crashes.

Fall-related injury is a common cause of mortality among the elderly. Hip fractures are especially dangerous and can even be fatal. In this study, a threshold-based preimpact fall detection algorithm was developed for wearable airbags that minimize the impact of falls on the user's body. Acceleration sum vector magnitude (SVM), angular velocity SVM, and vertical angle, calculated using inertial data captured from an inertial measurement unit were used to develop the algorithm. To calculate the vertical angle accurately, a complementary filter with a proportional integral controller was used to minimize integration errors and the effect of external impacts. In total, 30 healthy young men were recruited to simulate 6 types of falls and 14 activities of daily life. The developed algorithm achieved 100% sensitivity, 97.54% specificity, 98.33% accuracy, and an average lead time (i.e., the time between the fall detection and the collision) of 280.25 ± 10.29 ms with our experimental data, whereas it achieved 96.1% sensitivity, 90.5% specificity, and 92.4% accuracy with the SisFall public dataset. This paper demonstrates that the algorithm achieved a high accuracy using our experimental data, which included some highly dynamic motions that had not been tested previously.

Aim: The primary purpose of an avalanche airbag is to prevent burial during an avalanche. Approximately twenty percent of avalanche victims deploying airbags become critically buried, however. One avalanche airbag actively deflates three minutes after deployment, potentially creating an air pocket. Our objective was to evaluate this air pocket and its potential to prevent asphyxiation., Methods: Twelve participants were fitted with an airbag and placed prone on the snow. Participants deployed the airbag and were buried in 1.5 m of snow for 60 min with vital signs including oxygen saturation (SpO2) and end-tidal CO2 (ETCO2) measured every minute. Participants completed a post-burial survey to determine head movement within the air pocket., Results: Eleven of the 12 participants (92%) completed 60 min of burial. Preburial baseline SpO2 measurements did not change significantly over burial time (P > 0.05). Preburial baseline ETCO2 measurements increased over the burial time (P < 0.02); only one ETCO2 value was outside of the normal ETCO2 range (35-45 mmHg). Participants reported they could move their head forward 11.2 cm (SD 4.8 cm) and backward 6.6 cm (SD 5.1 cm) with the majority of participants stated that they had enough head movement to separate the oral cavity from opposing snow if necessary. Visual examination during extrication revealed a well-defined air pocket in all burials., Conclusion: The avalanche airbag under study creates an air pocket that appears to delay asphyxia, which could allow extra time for rescue and improve overall survival of avalanche victims., (Copyright © 2019. Published by Elsevier B.V.)

Background: Many studies have investigated the issue of facial injuries caused by car accidents, but only a few have addressed the technical and clinical aspects of such accidents and injuries in depth. The aim of this study was to identify risk factors and protective elements for facial injuries in car accidents., Methods: We analysed the technical and clinical data of patients with facial injuries caused by car accidents over a 16-year period (2000-2016) and investigated the following factors: sitting position, sex, age, accident time, use of a seatbelt, deployment of the front airbag, direction of impact, speed at the time of collision, and occurrence and location of facial injuries., Results: Of the 1291 patients involved in car accidents who were included in our study, 291 (22.5%) had suffered facial injuries. We found a significant association between occurrence of facial injuries and sex, speed at the time of collision, impact from the back, seatbelt usage, and deployment of the front airbag. In accidents occurring at speeds over 40 km/h, automobile security measures had no significant influence on the occurrence of facial injuries in drivers and front-seat passengers. In accidents occurring at speeds between 0 and 20 km/h, seatbelt usage (without airbag deployment) solely showed a significant protective influence against the occurrence of facial injuries (odd ratio [OR], 0.130; confidence interval [CI], 0.038-0.451). In contrast, patients who were in accidents at speeds between 21 and 40 km/h suffered significantly fewer facial injuries when wearing a seatbelt with the front airbag being deployed (OR, 0.245; CI, 0.091-0.665) or undeployed (OR, 0.216; CI, 0.084-0.561)., Conclusion: Male sex and a high speed at the time of collision are significant risk factors for the occurrence of facial injuries. The security measurements evaluated in this study only exerted a protective influence at low speeds (below 40 km/h). This indicates a possible weakness of these security systems with regard to preventing facial injuries. Engineers could benefit from these findings and improve the efficiency of existing security measures and eventually help decrease the incidence of facial injuries., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

Motorcycle accidents lead to a high rate of traffic mortality and morbidity. While helmet development and mandatory wearing have reduced head injuries, little progress has been made regarding trunk protection. Wearable airbag devices represent a promising solution to prevent trunk injuries. Nevertheless, research investigations need to be performed to assess and optimise the efficiency of such devices. This work consisted in the analysis of motorcyclist trunk impact conditions involved in various crash configurations to provide critical information in order to evaluate and improve the performances of airbag devices. First, an epidemiological and an accidentological analysis of data collection related to 252 real accidents, focusing on victims admitted into the shock rooms of two French trauma centres were performed. The data obtained was combined with numerical multibody parametric investigations, allowing the reproduction of 240 accident situations. An original and representative analysis of motorcyclists' impact conditions was provided, weighting the numerical study output data according to the real accident database. The impacted regions of the human body, the impact velocity and the accident chronology obtained in this work made it possible to define critical information for airbag efficiency assessment: the zones and levels of protection, the impacted surfaces as well as the airbag intervention time and the duration of maintained inflation of the airbag., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

Objectives: We aimed to profile the epidemiological changes of driving under the influence (DUI) in southern Taiwan after the legal blood alcohol concentration (BAC) limit was lowered from 50 to 30 mg/dL in 2013., Setting: Level 1 trauma medical centre in southern Taiwan., Participants: Data from 7447 patients (4375 males and 3072 females) were retrieved from the trauma registry system of a single trauma centre to examine patient characteristics (gender, age and BAC), clinical outcome variables (Abbreviated Injury Score, Injury Severity Score and mortality) and vehicular crash-related factors (vehicle type, airbag use in car crashes, helmet use in motorcycle crashes and time of crash) before and after the BAC limit change., Results: Our results indicated that the percentage of DUI patients significantly declined from 10.99% (n=373) to 6.64% (n=269) after the BAC limit was lowered. Airbag use in car crashes (OR: 0.30, 95% CI 0.10 to 0.88, p=0.007) and helmet use in motorcycle crashes (OR: 0.20, 95% CI 0.15 to 0.26, p<0.001) was lower in DUI patients compared with non-DUI patients after the BAC limit change, with significant negative correlation. DUI behaviour increased crash mortality risk before the BAC limit change (OR: 4.33, 95% CI 2.20 to 8.54), and even more so after (OR: 5.60, 95% CI 3.16 to 9.93). The difference in ORs for mortality before and after the change in the BAC legal limit was not significant (p=0.568)., Conclusion: This study revealed that lowering the BAC limit to 30 mg/dL significantly reduced the number of DUI events, but failed to result in a significant reduction in mortality in these trauma patients., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

The pulse measurement instrument is based on traditional Chinese medicine (TCM) and is used to collect the pulse of patients to assist in diagnosis and treatment. In the existing pulse measurement system, desktop devices have large volumes, complex pressure adjusting operations, and unstable pressurization. Wearable devices tend to have no pressurization function or the function to pressurize three channels separately, which are not consistent with the diagnostic method in TCM. This study constructs a wearable pulse measurement system using airbags for pressurization. This system uses guide plates, guide grooves, and positioning screws to adjust the relative position of the wristband and locate Cun, Guan and Chi regions. The pulse signal measured by the sensor is collected and sent to a computer by microcontroller unit. In experiments, this system successfully obtains the best pulse-taking pressure, its pulse waveform under continuous decompression, and the pulse waveform of three regions under light, medium, and heavy pressure. Compared with the existing technology, the system has the advantages of supporting single-region and three-region pulse acquisition, independent pressure adjustment, and position adjustment. It meets the needs of home, medical, and experimental research, and it is convenient and comfortable to wear and easy to carry.

Purpose: Seatbelts and airbags are the most important devices protecting drivers from cervical spine injury (CSI) following motor vehicle collisions (MVCs). However, there have been few reports on the radiographic characteristics of CSI sustained by restrained, airbag-deployed drivers., Methods: A single-center, retrospective observational study was conducted using prospectively acquired data. Between January 2011 and December 2017, 564 restrained drivers, whose vehicle had been severely damaged in MVCs, underwent whole-body computed tomography for evaluation of bodily injuries. The drivers were dichotomized into airbag (+) group (n = 218) and airbag (-) group (n = 139), after excluding 207 drivers in whom airbag deployment status was unknown., Results: Eight and nine drivers sustained CSIs in the airbag (+) and airbag (-) group, respectively. The frequency of CSI did not differ significantly between the two groups (3.7% vs. 6.5%, p = 0.31). All eight CSIs in the airbag (+) group were classified as hyperextension injuries, and four of them sustained concomitant spinal cord injuries caused by dislocation. Within the airbag (+) group, the drivers with CSIs were significantly older than those without CSIs (65.2 ± 18.5 vs. 44.8 ± 18.7 years, p = 0.002)., Conclusion: Although it is without doubt that the combination of seatbelt and airbag reduces the frequency and severity of CSIs following MVCs, the CSIs sustained in restrained, airbag (+) drivers may not always be mild, and elderly drivers may be at an elevated risk of CSI. In addition, the possibility of a causal role of airbags in CSI requires consideration in this population.

This study aimed to determine the effectiveness of airbags and seatbelts in the prevention of facial fractures and slight facial injuries in relation to the speed and kinetic energy experienced in frontal collisions. All cases of vehicle occupants who had been in frontal collisions and had subsequently been examined in the Institute for Emergency Medical Assistance and the Clinical Center of Montenegro in 2017 were analyzed. There were 29 cases of facial fractures (Group 1), 35 cases of slight facial injuries (including nondisplaced nasal fractures) (Group 2), and 26 cases of occupants who had suffered no facial injuries (control Group 3). In all assessed cases all of the subjects had been wearing a seatbelt and the airbag had deployed at the time of impact. A frontal collision is defined as a collision in which the principal force acts within a range of 90° from the longitudinal axis of the vehicle. Using the mass and the speed of the vehicles, the total kinetic energy (KE) of all frontal collisions being analyzed was calculated. The cut-off value of total KE in frontal collisions that were associated with either facial fractures or slight facial injury was estimated using a receiver operating characteristic (ROC) curve. The cut-off amounts of KE were then used to calculate the barrier equivalent velocity (BEV). The BEV for a vehicle of average mass was estimated to be 55.7 km/h (34.6 mph) in Group 1, and 49.2 km/h (30.6 mph) in Group 2. Airbags and seatbelts are effective in preventing facial injuries in vehicles of average mass that are traveling at speeds under 49.2 km/h (30.6 mph) at the point of impact, but they do not protect from facial fractures when the vehicle speed exceeds 55.7 km/h (34.6 mph).

We present a case of a fatal motor vehicle collision of a 22-year-old car driver, who died at the scene after losing control of his car, and subsequently collided with a tree by the roadside. The subsequent autopsy revealed penetrating injuries on the neck, severing the larynx, carotid artery, jugular vein and fracturing the cervical vertebrae. Internal examination showed the offending material to be a semi-cylindrical metal fragment, which had lodged within the paravertebral muscle. Examination of the car with the authorities found that the metal fragment originated from a defective airbag booster cannister, which shattered upon deployment., (Copyright © 2018 Elsevier B.V. All rights reserved.)

Objective: The goal of the study was to develop experimental chest loading conditions that would cause up to Abbreviated Injury Scale (AIS) 2 chest injuries in elderly occupants in moderate-speed frontal crashes. The new set of experimental data was also intended to be used in the benchmark of existing thoracic injury criteria in lower-speed collision conditions., Methods: Six male elderly (age >63) postmortem human subjects (PMHS) were exposed to a 35 km/h (nominal) frontal sled impact. The test fixture consisted of a rigid seat, rigid footrest, and cable seat back. Two restraint conditions (A and B) were compared. Occupants were restrained by a force-limited (2.5 kN [A] and 2 kN [B]) seat belt and a preinflated (16 kPa [A] and 11 kPa [B]; airbag). Condition B also incorporated increased seat friction. Matching sled tests were carried out with the THOR-M dummy. Infra-red telescoping rod for the assessment of chest compression (IRTRACC) readings were used to compute chest injury risk. PMHSs were exposed to a posttest injury assessment. Tests were carried out in 2 stages, using the outcome of the first one combined with a parametric study using the THUMS model to adjust the test conditions in the second. All procedures were approved by the relevant ethics board., Results: Restraint condition A resulted in an unexpected high number of rib fractures (fx; 10, 14, 15 fx). Under condition B, the adjustment of the relative airbag/occupant position combined with a lower airbag pressure and lower seat belt load limit resulted in a reduced pelvic excursion (85 vs. 110 mm), increased torso pitch and a substantially lower number of rib fractures (1, 0, 4 fx) as intended., Conclusions: The predicted risk of rib fractures provided by the THOR dummy using the C max and PC Score injury criteria were lower than the actual injuries observed in the PMHS tests (especially in restraint condition A). However, the THOR dummy was capable of discriminating between the 2 restraint scenarios. Similar results were obtained in the parametric study with the THUMS model.

Objective: Though the mortality rate for motor vehicle collisions (MVCs) has been decreasing since the 1960s with the advent of the first federal seat belt laws in 1968, MVC remains a leading cause of death for individuals aged 1 to 44 years. The purpose of this study is to examine the effects of frontal (FABs) and side airbags (SABs) and electronic stability control (ESC) on the components of the MVC mortality rate., Methods: The MVC mortality rate from 1994 to 2015 was separated into its components of exposure of vehicles, exposure of travel, collision density, injury incidence, and case fatality rate. Year was categorized on the availability of safety technology in vehicles: 1994-1997 (first-generation FABs mandated), 1998-2001 (sled-certified, second-generation FABs mandated), 2002-2006 (increasing prevalence of SABs and ESC), 2007-2011 (advanced airbags mandated), and 2012-2015 (ESC mandated, SAB in over 90% of vehicles, introduction of advanced safety systems). Relative contributions (RCs) of the components to changes in the MVC-related mortality rate were calculated as the absolute value of the component's beta coefficient divided by the sum of the absolute values of all components' beta coefficients. Negative binomial regression-estimated rate ratios (RRs) for the changes in the rate of each component by year category compared to the prior year category., Results: Significant decreases in the MVC mortality rate were observed for 2007-2011 and 2012-2015. The decrease in 2007-2011 was due in most part to an 18% decrease in the injury incidence (RR = 0.82, P < .0001, RC = 63%), though there was a noted contribution by the decrease in vehicle miles traveled (RR = 0.95, P < .0001, RC = 15%). The continued decrease in mortality in 2012-2015 was due is most part to the 10% decreased case fatality rate (RR = 0.90, P < .0001, RC = 66%) because there was no significant change in the vehicle miles traveled and injury incidence., Conclusions: The results of this study highlight the effects of vehicle safety technologies on the MVC-related mortality rate and can help direct prevention efforts. Through the study period, there was no meaningful contribution to decreases in the MVC-related mortality rate due to components related to exposure (i.e., vehicles per population and the rate of vehicle miles traveled), suggesting that prevention efforts at decreasing exposure prevalence would have little effect on the MVC-related mortality rate. Instead, prevention efforts should continue to focus on event-phase methods to decrease injury occurrence and mitigate injury severity during the collision.

Objective: We studied the correlation between airbag deployment and eye injuries using 2 different data sets., Methods: The registry of the Finnish Road Accident (FRA) Investigation Teams was analyzed to study severe head- and eyewear-related injuries. All fatal passenger car or van accidents that occurred during the years 2009-2012 (4 years) were included (n = 734). Cases in which the driver's front airbag was deployed were subjected to analysis (n = 409). To determine the proportion of minor, potentially airbag-related eye injuries, the results were compared to the data for all new eye injury patients (n = 1,151) recorded at the Emergency Clinic of the Helsinki University Eye Hospital (HUEH) during one year, from May 1, 2011, to April 30, 2012., Results: In the FRA data set, the unbelted drivers showed a significantly higher risk of death (odds ratio [OR] = 5.89, 95% confidence interval [CI], 3.33-10.9, P = 2.6E-12) or of sustaining head injuries (OR = 2.50, 95% CI, 1.59-3.97, P = 3.8E-5). Only 4 of the 1,151 HUEH patients were involved in a passenger car accident. In one of the crashes, the airbag operated, and the belted driver received 2 sutured eye lid wounds and showed conjunctival sugillation. No permanent eye injuries were recorded during the follow-up. The calculated annual airbag-related eye injury incidence was less than 1/1,000,000 people, 4/100,000 accidents, and 4/10,000 injured occupants., Conclusions: Airbag-related eye injuries occurred very rarely in car accidents in cases where the occupant survived and the restraint system was appropriately used. Spectacle use did not appear to increase the risk of eye injury in restrained occupants.

Objective: The objective of this study was to obtain information about the current knowledge and habits of parents who transport children in cars in Brazil., Methods: A cross-sectional survey was conducted using specifically designed self-report questionnaires to parents of children attending a private pediatric office in a town in southwest Brazil. Data were collected regarding children's age, gender, height, and weight and possession of an automobile child restraint system (CRS), its type, frequency and adequacy of use, and reasons for not possessing or not using the devices. Parents were asked whether their cars were equipped with airbags and about the use of the restraints in seats with airbags., Results: We interviewed parents of 293 children transported in cars who met the criteria for use of a CRS. Children were younger than 1 year in 15.3% of the cases, between 1 and 4 years in 38.6%, and older than 4 in 46.1%. Cars were equipped with CRS in 78.5% of the cases, but in only 58% of the cases was the device proper for child's age and adequately installed in the seat. Among owners of the devices, 84.3% reported that they always used it. Reasons for infrequency were forgetting the device at home or in another car (6.4%), the child disliking the device (3.2%), or the false impression that the child was grown enough not to use it (3.2%)l 87.1% did not justify why they did not always use the CRS. Considering type of CRS, correct installation of the seat, and frequency of use, only 44.4% of children under 1 year, 69.9% of those 1 to 4 years, and 52.6% over age 4 were protected. Only 28.6% of the parents knew that children should never be positioned in a seat with active airbags., Conclusion: Considering appropriateness for age, correctness of installation (in the back seat in the correct orientation), and frequency of use, only 50.85% (149/293) of the children were reported as always protected with a CRS. Children between 1 and 4 years were more likely to always use a CRS in this Brazilian survey. We were also able to identify an important gap in the knowledge about airbags among parents. Further efforts are needed to correct those distortions.

Objectives: We report on a patient who suffered traumatic axonal injury (TAI) of various neural tracts despite airbag deployment following mild traumatic brain injury (TBI), which was demonstrated by diffusion tensor tractography (DTT)., Case Description: A 58-year-old female patient suffered from head trauma resulting from an in-car traffic accident. At the time of head trauma, her head and face hit the deployed airbag after flexion-hyperextension-rotation injury. The patient's Glasgow Coma Scale score was 15. Since the day of head trauma, she began to feel headache and upper back pain at the mid-thoracic area. At 7 days after onset, she began to feel pain on the left hand, which spread to the right hand and leg: throbbing and cold pain without allodynia or hyperalgesia (visual analogue scale score: 5). She also felt mild weakness of all four extremities and mild memory impairment. On 4-week DTT, the corticospinal tract showed partial tearing at the subcortical white matter level in both hemispheres . The right fornical crus and right anterior cingulum were discontinued, and narrowing and partial tearing were observed in both spinothalamic tracts., Conclusions: TAI of four kinds of neural tracts was demonstrated in a patient with mild TBI despite airbag deployment, using DTT.

Packing soft-sheet materials of approximately zero bending stiffness using Soft Origami (origami patterns applied to soft-sheet materials) into cylindrical volumes and their deployment via mechanisms or internal pressure (inflation) is of interest in fields including automobile airbags, deployable heart stents, inflatable space habitats, and dirigible and parachute packing. This paper explores twofold patterns, the 'flasher' and the 'inverted-cone fold', for packing soft-sheet materials into cylindrical volumes. Two initial packing methods and mechanisms are examined for each of the flasher and inverted-cone fold patterns. An application to driver's side automobile airbags is performed, and deployment tests are completed to compare the influence of packing method and origami pattern on deployment performance. Following deployment tests, two additional packing methods for the inverted-cone fold pattern are explored and applied to automobile airbags. It is shown that modifying the packing method (using different methods to impose the same base pattern on the soft-sheet material) can lead to different deployment performance. In total, two origami patterns and six packing methods are examined, and the benefits of using Soft Origami patterns and packing methods are discussed. Soft Origami is presented as a viable method for efficiently packing soft-sheet materials into cylindrical volumes.

This study evaluated the biofidelity of the WorldSID and the ES-2re under whole-body side impact conditions with and without a side airbag using the biomechanical cadaveric response data generated from 4.3m/s whole-body side impact tests. Impact forces, spinal kinematics, and chest deflections were considered in the biofidelity evaluation. Average responses and response corridors of PMHS were created using a time-alignment technique to reduce variability of the PMHS responses while maintaining the sum of the time shifts to be zero for each response. Biofidelity of the two dummies was compared using a correlation and analysis (CORA) method. The WorldSID demonstrated better biofidelity than the ES-2re in terms of CORA ratings in the conditions with airbag (0.53 vs. 0.46) and without an airbag (0.57 vs. 0.49). Lastly, the kinematic analysis of the two dummies indicated an overly compliant shoulder response of the WorldSID and excessive forward rotation of the ES-2re relative to the PMHS., (Copyright © 2016 Elsevier Ltd. All rights reserved.)

Introduction: Restraint systems (seat belts and airbags) are important tools that improve vehicle occupant safety during motor vehicle crashes (MVCs). We aimed to identify the pattern and impact of the utilization of passenger restraint systems on the outcomes of MVC victims in Qatar., Methods: A retrospective study was conducted for all admitted patients who sustained MVC-related injuries between March 2011 and March 2014 inclusive., Results: Out of 2,730 road traffic injury cases, 1,830 (67%) sustained MVC-related injuries, of whom 88% were young males, 70% were expatriates, and 53% were drivers. The use of seat belts and airbags was documented in 26 and 2.5% of cases, respectively. Unrestrained passengers had greater injury severity scores, longer hospital stays, and higher rates of pneumonia and mortality compared to restrained passengers (P = .001 for all). There were 311 (17%) ejected cases. Seat belt use was significantly lower and the mortality rate was 3-fold higher in the ejected group compared to the nonejected group (P = .001). The overall mortality was 8.3%. On multivariate regression analysis, predictors of not using a seat belt were being a front seat passenger, driver, or Qatari national and young age. Unrestrained males had a 3-fold increase in mortality in comparison to unrestrained females. The risk of severe injury (relative risk [RR] = 1.82, 95% confidence interval [CI], 1.49-2.26, P = .001) and death (RR = 4.13, 95% CI, 2.31-7.38, P = .001) was significantly greater among unrestrained passengers., Conclusion: The nonuse of seat belts is associated with worse outcomes during MVCs in Qatar. Our study highlights the lower rate of seat belt compliance in young car occupants that results in more severe injuries, longer hospital stays, and higher mortality rates. Therefore, we recommend more effective seat belt awareness and education campaigns, the enforcement of current seat belt laws, their extension to all vehicle occupants, and the adoption of proven interventions that will assure sustained behavioral changes toward improvements in seat belt use in Qatar.

Purpose: To determine the biomechanical response of an impacting airbag on eyes with different axial lengths with transsclerally fixated posterior chamber intraocular lens (PC IOL)., Materials and Methods: Simulations in a model human eye were performed with a computer using a finite element analysis program created by Nihon, ESI Group. The airbag was set to be deployed at five different velocities and to impact on eyes with three different axial lengths. These eyes were set to have transsclerally fixated PC IOL by a 10-0 polypropylene possessing a tensile force limit of 0.16 N according to the United States Pharmacopeia XXII., Results: The corneoscleral opening was observed at a speed of 40 m/second or more in all model eyes. Eyes with the longest axial length of 25.85 mm had the greatest extent of deformity at any given impact velocity. The impact force exceeded the tensile force of 10-0 polypropylene at an impact velocity of 60 m/second in all eyes, causing breakage of the suture., Conclusion: Eyes with transsclerally fixated PC IOL could rupture from airbag impact at high velocities. Eyes with long axial lengths experienced a greater deformity upon airbag impact due to a thinner eye wall. Further basic research on the biomechanical response for assessing eye injuries could help in developing a better airbag and in the further understanding of ocular traumas.

Objectives: An airbag system for motorcycle applications was developed and marketed in 2006 followed by many research projects on the system. In the airbag system, the bag should be supported during the kinetic energy-absorbing period of a rider in a collision. The previously developed system employed a configuration in which motorcycle structures support the airbag, such as a gauge unit and/or a steering structure. The supporting structure functions to receive the reaction force to hold the airbag during a crash to properly absorb the rider's kinetic energy. However, the previous system requires a larger area for this reaction structure and is applicable only to the motorcycles that can provide that area. To overcome this limitation, we propose an airbag system employing another concept. In this concept, the airbag does not use its vehicle structures as a reaction structure but uses the structures of an opposing vehicle, such as doors and/or pillars of an opposing vehicle. In this project, we aim to verify the effectiveness of the proposed system when installed in a motorcycle that cannot provide a larger area for the reaction structure., Methods: In the system with this concept, it is assumed that the occupant protection performance is largely affected depending on impact configurations. Accordingly, full-scale motorcycle-to-car crash tests using 125 cm3 scooter-type models with and without the proposed system were conducted in various impact configurations. The 7 impact configurations specified in ISO 13232 were selected as the test configurations. Injury variables and injury indices of head, neck, chest, and abdomen were evaluated with the motorcyclist dummy., Results: Injury variables and indices obtained from the crash tests with the airbag were compared to those of the baseline tests. In 2 impact configurations, the airbags were supported by the side structures of the opposing vehicle and performed to reduce the injury variable of head and/or chest compared to that of the baseline test., Conclusion: Through the crash tests, beneficial protection effects of the airbag system were confirmed in particular impact configurations. No significant risk for the occupant due to the airbag was observed in the conducted crash tests. It was concluded that the proposed airbag system has feasibility to reduce rider injury in a collision of a motorcycle without sufficient reaction structure.

A healthy 40-year-old man, restrained in the front passenger seat, suffered visually disabling blunt ocular trauma following spontaneous release of the passenger side air-bag module, during vehicular deceleration, without an automobile crash. Though the driver-side airbag was also released, the driver was unharmed. The passenger suffered bilateral hyphema, bilateral vitreous hemorrhage and suspected posterior scleral rupture in the left eye and also had an eyebrow laceration, from impact with the dashboard panel covering the air-bag module, which was detached by the force of airbag deployment. This is the first reported case from West Africa and the first case in which part of the airbag module detached to cause additional trauma. This report adds to the growing burden of evidence world-wide, for a review of the safety aspects of the automobile airbag. This case clearly illustrates that although airbags reduce mortality, they carry a high risk of ocular morbidity, even with seat belt restraint.

Background: Balloon bionic midwifery has been applied in clinical obstetrics in China for 10 years, although played a certain role in controlling and improving the quality of obstetrics and caesarean section rate, but some questions have not been resolved., Objective: The aim of this study was to investigate the efficacy and safety of airbag midwifery., Materials and Methods: Primiparas (2410 cases) with various medical conditions were randomly divided into airbag and control groups undergoing the same obstetrical treatments, but airbag midwifery as a birthing option was chosen twice when the cervix was dilated to 2-4 cm during labor., Results: The duration of the first and second stages, as well as the total delivery process, of the airbag group was shorter than that for the controls. The natural delivery rate of the airbag group was higher than that of the control group. The forcep delivery rate, cesarean section rate, amount of vaginal bleeding within 2 h after delivery, rate of postpartum hemorrhage, fetal distress, and pitocin use in the airbag group were all lower than those in the control group. No significant difference in the rate of maternal and fetal complications was observed in the two groups. The bionic airbag midwifery approach did not contribute to the incidence rate of urine retention, leukocyte count, neutrophil proportion, and level of creactive protein and IL-6 24 h after delivery., Conclusion: Airbag midwifery skill is a simple, effective, and safe procedure.

While airbags have saved many lives and are clearly beneficial overall, sodium hydroxide (NaOH) powder produced by the inflation reaction can cause significant alkali ocular injury if not irrigated promptly. Here we report a case of severe airbag related ocular alkali injury as a way to bring attention to the need for prompt ocular irrigation following motor vehicle accidents (MVA) with airbag deployment. A 47-year-old man was involved in a MVA with airbag deployment in a rural setting. Attention was paid to several other life-threatening traumatic injuries, however, ocular irrigation was not performed until some 6-7 hours after the MVA. Over the course of 6 months, airbag related alkali injury caused severe limbal ischemia, conjunctivalization of the cornea, corneal epithelial defects, cicatricial scarring, haze, and corneal/limbal vascularization despite amniotic membrane graft. Awareness of the importance of ocular irrigation following airbag deployment must be raised both in the ophthalmology and emergency medicine communities.

Although air bags have reduced the incidence of fatal and severe injuries in automobile collisions, they have been shown to carry a risk of injury themselves. Ocular injury in particular can often be a direct consequence of air bag deployment. We report a 14-year-old child who sustained facial burn and bilateral ocular injuries affecting both the anterior and posterior segments due to an inflated air bag in a low speed motor vehicle accident.