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Aims: To measure the quality of life in children with impaired walking who receive a mobility assistance dog (MAD)., Methods: The parents of ten children who received a MAD completed the cerebral palsy quality of life questionnaire, before receiving their dog and at one, three, and six-month follow-up. Data were analyzed to assess changes for each participant and to the group., Results: The group showed a positive change in the domains of social well-being and acceptance, feelings about functioning, and emotional well-being and self-esteem after six months. Children with less impairment (GMFCS I-II) showed a change in social-wellbeing and acceptance, feelings about functioning, participation, physical health, and emotional-wellbeing and self-esteem after six months. Children with more impairment (GMFCS III-IV) showed no change at any timepoint measured., Conclusions: This novel therapeutic area of receiving a MAD demonstrated some positive quality of life changes after six months for a small group of children with impaired walking. These are preliminary findings in a small sample and this intervention would benefit from further study.

Bike positional configuration changes strongly affect cycling performance. While consensus has emerged on saddle height optimisation, there is none for the relationship between other bike positional variables and cycling performance. Accordingly, this systematic review examines the effect of all major positional variables on performance in cycling, assessing differences between cycling disciplines and sex where possible. The systematic review, conducted per PRISMA guidelines, searched databases including Embase, Web of Science, Medline, and CINAHL, screening 16,578 studies. Of these, 47 were fully analysed. Study quality assessment using the NIH tool revealed none rated "good", 5 "fair" and 33 "poor". The analysis involved 724 participants (90 female, 454 male, 180 sex unstated). Studies focused on trunk angle/upper body position, handlebar height, Q factor, foot position, saddle fore-aft/height, seat tube angle and crank length. Participant cycling disciplines were often unspecified and few papers address women cyclists specifically. Key findings were associated with changing saddle height, trunk angle and saddle fore-aft. For trunk angle, accounting for the biomechanical and physiological effects as well as aerodynamic changes is important. Saddle fore-aft affects the hip angle and trunk angle. There are no clear recommendations for crank length, handlebar height, Q factor or cleat position.

The tackle contest is the most common and most injurious match contact event in rugby and is an indicator of performance. Tackle Ready is World Rugby's tackle technique education program. Limited research has characterized the tackle contest in women's rugby. The purpose of this study is to: (1) identify the match situational characteristics, ball-carrier and tackler technical actions demonstrated in elite women's Rugby Union and (2) to determine the extent to which Tackle Ready recommended tackle techniques were exhibited. Technical characteristics for 1500 tackle events in the 2022-2023 Women's Six Nations Championship were visually assessed according to a predefined coding framework and the Tackle Ready program. Tackles lacked full completion (0.2%) of the 22 coded Tackle Ready techniques with 47% of the recommended techniques demonstrated in each tackle on average (range 15%-98%). A high proportion of tackles involved two defenders (48%), approaching ball-carriers from the side (38%) or oblique angles (39%), in an upright position (30%), and with initial contact made with the arm (51%). Incorrect pre-contact head positioning and head placement upon contact accounted for 50% and 15% of tackles, respectively, and there was a mean of 14 (95% CI 11-18) head and neck contacts to a tackler and 18 (95% CI 14-22) head and neck contacts to a ball-carrier per game. Targeted interventions to encourage adoption of recommended techniques are needed to reduce tackle-related injury risk in women's rugby. This study provides valuable context for future discussion across law enforcement, coach education and gender-specific tackle coaching in the women's game., (© 2024 The Authors. European Journal of Sport Science published by Wiley‐VCH GmbH on behalf of European College of Sport Science.)

Sports physiotherapists and coaches are tasked with evaluating the movement quality of athletes across the spectrum of ability and experience. However, the accuracy of visual observation is low and existing technology outside of expensive lab-based solutions has limited adoption, leading to an unmet need for an efficient and accurate means to measure static and dynamic joint angles during movement, converted to movement metrics useable by practitioners. This paper proposes a set of pose landmarks for computing frequently used joint angles as metrics of interest to sports physiotherapists and coaches in assessing common strength-building human exercise movements. It then proposes a set of rules for computing these metrics for a range of common exercises (single and double drop jumps and counter-movement jumps, deadlifts and various squats) from anatomical key-points detected using video, and evaluates the accuracy of these using a published 3D human pose model trained with ground truth data derived from VICON motion capture of common rehabilitation exercises. Results show a set of mathematically defined metrics which are derived from the chosen pose landmarks, and which are sufficient to compute the metrics for each of the exercises under consideration. Comparison to ground truth data showed that root mean square angle errors were within 10° for all exercises for the following metrics: shin angle, knee varus/valgus and left/right flexion, hip flexion and pelvic tilt, trunk angle, spinal flexion lower/upper/mid and rib flare. Larger errors (though still all within 15°) were observed for shoulder flexion and ASIS asymmetry in some exercises, notably front squats and drop-jumps. In conclusion, the contribution of this paper is that a set of sufficient key-points and associated metrics for exercise assessment from 3D human pose have been uniquely defined. Further, we found generally very good accuracy of the Strided Transformer 3D pose model in predicting these metrics for the chosen set of exercises from a single mobile device camera, when trained on a suitable set of functional exercises recorded using a VICON motion capture system. Future assessment of generalization is needed., Competing Interests: 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., (© 2024 The Authors.)

Objective: Occupant impact safety is critical for train development. This paper proposes a systematic procedure for developing validated numerical occupant crash scenarios for high-speed trains by integrating experimental, computational, and inverse methods., Methods: As the train interior is the most potentially injury-causing factor, the material properties were acquired by mechanical tests, and constitutive models were calibrated using inverse methods. The validity of the seat material constitutive model was further verified via drop tower tests. Finite element (FE) and multibody (MB) models of train occupant-seat interactions in frontal impact were established in LS-DYNA and MADYMO software, respectively, using the experimentally acquired materials/mechanical characteristics. Three dummy sled crash tests with different folding table and backrest configurations were conducted to validate the numerical occupant-seat models and to further assess occupant injury in train collisions. The occupant impact responses between dummy tests and simulations were quantitatively compared using a correlation and analysis (CORA) objective rating method., Results: Results indicated that the experimentally calibrated numerical seat-occupant models could effectively reproduce the occupant responses in bullet train collisions (CORA scores >80%). Compared with the train seat-occupant MB model, the FE model could simulate the head acceleration with slightly more acceptable fidelity, however, the FE model CORA scores were slightly less than for the MB models. The maximum head acceleration was 30 g but the maximum HIC score was 17.4. When opening the folding table, the occupant's chest injury was not obvious, but the neck-table contact and "chokehold" may potentially be severe and require further assessment., Conclusions: This study demonstrates the value of experimental data for occupant-seat model interactions in train collisions and provides practical help for train interior safety design and formulation of standards for rolling stock interior passive safety.

Single bicycle crashes, i.e., falls and impacts not involving a collision with another road user, are a significantly underestimated road safety problem. The motions and behaviours of falling people, or fall kinematics, are often investigated in the injury biomechanics research field. Understanding the mechanics of a fall can help researchers develop better protective gear and safety measures to reduce the risk of injury. However, little is known about cyclist fall kinematics or dynamics. Therefore, in this study, a video analysis of cyclist falls is performed to investigate common kinematic forms and impact patterns. Furthermore, a pipeline involving deep learning-based human pose estimation and inverse kinematics optimisation is created for extracting human motion from real-world footage of falls to initialise forward dynamics computational human body models. A bracing active response is then optimised for using a genetic algorithm. This is then applied to a case study of a cyclist fall. The kinematic forms characterised in this study can be used to inform initial conditions for computational modelling and injury estimation in cyclist falls. Findings indicate that protective response is an important consideration in fall kinematics and dynamics, and should be included in computational modelling. Furthermore, the novel reconstruction pipeline proposed here can be applied more broadly for traumatic injury biomechanics tasks. The tool developed in this study is available at https://kevgildea.github.io/KinePose/., Competing Interests: Declaration of competing interest The authors declare the following potential competing interest: Ciaran Simms is a co-founder of a start-up company that uses pose estimation for sports exercise quantification. Apart from this disclosure, the other authors declare that they have no additional financial and non-financial interests., (Copyright © 2024 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Introduction: Single Bicycle Brashes (SBCs) are common, and underreported in official statistics. In urban environments, light rail tram tracks are a frequent factor, however, they have not yet been the subject of engineering analysis., Method: This study employs video-based analysis at nine Dublin city centre locations and introduces a predictive model for crossing success on tram tracks, utilising cyclist crossing angles within a Surrogate Measure of Safety (SMoS) framework. Additionally, Convolutional Neural Networks (CNNs) were explored for automatic estimation of crossing angles., Results: Modelling results indicate that cyclist crossing angle is a strong predictor of crossing success, and that cyclist velocity is not. Findings also highlight the prevalence of external factors which limit crossing angles for cyclists. In particular, kerbs are a common factor, along with passing/approaching vehicles or other cyclists. Furthermore, results indicate that further training on a relatively small sample of 100 domain-specific examples can achieve substantial accuracy improvements for cyclist detection (from 0.31AP 0.5 to 0.98AP 0.5 ) and crossing angle inference from traffic camera footage., Conclusions: Ensuring safe crossing angles is important for cyclist safety around tram tracks. Infrastructural planners should aim for intuitive, self-explainable road layouts that allow for and encourage crossing angles of 60° or more - ideally 90°., Practical Applications: The SMoS framework and the open-source SafeCross 1 application offer actionable insights and tools for enhancing cyclist safety around tram tracks., 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 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

The mechanical and structural properties of passive skeletal muscle are important for musculoskeletal models in impact biomechanics, rehabilitation engineering and surgical simulation. Passive properties of skeletal muscle depend strongly on the architecture of the extracellular matrix (ECM), but the structure of ECM and its realignment under applied deformation remain poorly understood. We apply second harmonic generation (SHG) microscopy to study muscle ECM in intact muscle samples both under deformation and in the undeformed state. A method for regional relocation was developed, so that the same ECM segment could be viewed before and after applying deformations. Skeletal muscle ECM was viewed at multiple scales and in three states: undeformed, under compression and under tension. Results show that second harmonic generation microscopy provides substantial detail of skeletal muscle ECM over a wide range of length scales, especially the perimysium structure. We present images of individual portions of skeletal muscle ECM both undeformed and subjected to tensile/compressive deformation. We also present data showing the response of the perimysium to a partial thickness cut applied to a section under tensile deformation. STATEMENT OF SIGNIFICANCE: Second Harmonic Generation (SHG) microscopy is an imaging technique which takes advantage of a non-linear and coherent frequency doubling optical effect that is present in a small number of biological molecules, primarily collagen Type I, II and myosin. Collagen I is the most abundant collagen type in skeletal muscle, making SHG a promising option for visualisation of the skeletal muscle extracellular matrix (ECM). SHG microscopy does not require fixing or staining. This short communication presents the application of SHG microscopy to skeletal muscle ECM to improve our understanding of how collagen fibres reorganise under applied tensile and compression, including microscopic observations of collagen fibre reorganisation for intact samples by using a method to re-identify specific regions in repeated deformation tests., 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 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Background: Incisional hernias occur after up to 40 per cent of laparotomies. Recent RCTs have demonstrated the role of prophylactic mesh placement in reducing the risk of developing an incisional hernia. An onlay approach is relatively straightforward; however, a variety of techniques have been described for mesh fixation. The biomechanical properties have not been interrogated extensively to date., Methods: This ex vivo randomized controlled trial using porcine abdominal wall investigated the biomechanical properties of three techniques for prophylactic onlay mesh placement at laparotomy closure. A classical onlay, anchoring onlay, and novel bifid onlay approach were compared with small-bite primary closure. A biomechanical abdominal wall model and ball burst test were used to assess transverse stretch, bursting force, and loading characteristics., Results: Mesh placement took an additional 7-15 min compared with standard primary closure. All techniques performed similarly, with no clearly superior approach. The minimum burst force was 493 N, and the maximum 1053 N. The classical approach had the highest mean burst force (mean(s.d.) 853(152) N). Failure patterns fell into either suture-line or tissue failures. Classical and anchoring techniques provided a second line of defence in the event of primary suture failure, whereas the bifid method demonstrated a more compliant loading curve. All mesh approaches held up at extreme quasistatic loads., Conclusion: Subtle differences in biomechanical properties highlight the strengths of each closure type and suggest possible uses. The failure mechanisms seen here support the known hypotheses for early fascial dehiscence. The influence of dynamic loading needs to be investigated further in future studies., (© The Author(s) 2023. Published by Oxford University Press on behalf of BJS Society Ltd. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Women's participation in field collision sports is growing worldwide. Scoping reviews provide an overview of scientific literature in a developing area to support practitioners, policy, and research priorities. Our aim is to explore published research and synthesise information on the physical and technical demands and preparation strategies of female field collision sports. We searched four databases and identified relevant published studies. Data were extracted to form (1) a numerical analysis and (2) thematic summary. Of 2318 records identified, 43 studies met the inclusion criteria. Physical demands were the most highly investigated (n+=+24), followed by technical demands (n+= 18), tactical considerations (n+=+8) and preparatory strategies (n=1). The key themes embody a holistic model contributing to both performance and injury prevention outcomes in the context of female field collision sports. Findings suggest a gender data gap across all themes and a low evidence base to inform those preparing female athletes for match demands. Given the physical and technical differences in match-demands the review findings do not support the generalisation of male-derived training data to female athletes. To support key stakeholders working within female field collision sports there is a need to increase the visibility of female athletes in the literature., Competing Interests: The authors declare that they have no conflict of interest., (Thieme. All rights reserved.)

Injury assessment during sporting collisions requires estimation of the associated kinematics. While marker-based solutions are widely accepted as providing accurate and reliable measurements, setup times are lengthy and it is not always possible to outfit athletes with restrictive equipment in sporting situations. A new generation of markerless motion capture based on deep learning techniques holds promise for enabling measurement of movement in the wild. The aim of this work is to evaluate the performance of a popular deep learning model "out of the box" for human pose estimation, on a dataset of ten staged rugby tackle movements performed in a marker-based motion capture laboratory with a system of three high-speed video cameras. An analysis of the discrepancy between joint positions estimated by the marker-based and markerless systems shows that the deep learning approach performs acceptably well in most instances, although high errors exist during challenging intervals of heavy occlusion and self-occlusion. In total, 75.6% of joint position estimates are found to have a mean absolute error (MAE) of less than or equal to 25 m m , 17.8% with MAE between 25 and 50 m m and 6.7% with MAE greater than 50 m m . The mean per joint position error is 47 m m .

Introduction: The required fidelity of synthetic materials in surgical simulators to teach tissue handling and repair requirements should be as accurate as possible. There is a poor understanding of the relationship between choice of muscle surrogates and training outcome for trainee surgeons. To address this, the mechanical characteristics of several candidate synthetic muscle surrogates were measured, and their subjective biofidelity was qualitatively assessed by surgeons., Methods: Silicone was selected after assessing several material options and 16 silicone-based surrogates were evaluated. Three of the closest samples to muscle (Samples 1.1, 1.2, 1.3) and one with inserted longitudinal fibres (1.2F) were mechanically tested in the following: compression and tension, needle puncture force and suture pull-out in comparison with real muscle. The four samples were evaluated by 17 Plastic and Orthopaedic surgeons to determine their views of the fidelity with regard to the handling properties, needle insertion and ease of suture pull-out., Results: The mechanical testing showed the surrogates exhibited varying characteristics that matched some of the properties of muscle, though none recreated all the mechanical characteristics of native muscle. Good biofidelity was generally achieved for compression stiffness and needle puncture force, but it was evident that tensile stiff was too low for all samples. The pull-out forces were variable and too low, except for the sample with longitudinal fibres. In the qualitative assessment, the overall median scores for the four surrogate samples were all between 30 and 32 (possible range 9-45), indicating limited differentiation of the samples tested by the surgeons., Conclusions: The surrogate materials showed a range of mechanical properties bracketing those of real muscle, thus presenting a suitable combination of candidates for use in simulators to attain the requirements as set out in the learning outcomes of muscle repair. However, despite significant mechanical differences between the samples, all surgeons found the samples to be similar to each other., (Copyright © 2022. Published by Elsevier Ltd.)

Summary Statement: This review aimed to explore the published evidence with regard to the types and composition of both full- and part-task trainers to teach surgeons extremity exploration procedures in limb trauma management. Studies were included if they reported the development and/or validation of synthetic or virtual task trainers. Studies were evaluated to determine their derivation, usability, and clinical utility.A total of 638 citations were identified and 63 satisfied the inclusion criteria. Twenty-five articles addressed simulator validation and 36 addressed level of learning achieved with simulator engagement. Two studies described a dedicated limb simulator. Simulators were developed to repair limb structures including skin (n = 15), tendon (n = 7), nerve (n = 1), fascia (n = 1), muscle (n = 1), vascular (n = 24), and bone (n = 11). Considerations such as material fidelity, learning outcomes, cost or reusability, validity, and effectiveness are inconsistently reported. Future studies should address design standards for the effective production of synthetic or virtual simulators for limb trauma management., Competing Interests: The authors declare no conflict of interest., (Copyright © 2021 Society for Simulation in Healthcare.)

Kicking is fundamental in many field-based sports. Most studies investigating kicking performance have been conducted with male athletes, resulting in a dearth of specific data to inform coaching of this skill in female players. This systematic review aimed to compare kicking biomechanics in male and female athletes in field-based sports. As per PRISMA guidelines, articles were retrieved from searches across five online databases. Studies investigating kicking biomechanics in field-based athletes of both sexes were eligible for inclusion. Articles were screened using Covidence and data extracted based on STROBE recommendations. The review included 23 studies, featuring 455 soccer players. Male athletes produced significantly greater ball velocities and linear velocities of the ankle, foot, and toe than females. Males had greater ankle plantarflexion angles than females at ball strike, while females used larger trunk flexion ranges than males. Hip and knee torques and ball-to-foot velocity ratios were greater in men than women. Skilled players generated power using tension arcs; a technique not seen in novices. Skill level within sex may have a greater influence on kicking performance than differences between the sexes. This review highlights the need for further research investigating kicking performance in both sexes across the spectrum of sports.

Lower severity cycling collisions, and single cyclist collisions (or single bicycle crashes) are significantly underreported in police statistics, introducing biases into the types of collisions that are available for analysis. Furthermore, many lower severity collisions do not appear in other collision data sources (e.g. hospital and insurance data). This in turn affects priorities for cyclist safety and puts an underemphasis on certain collision types. Due to an absence of data, little is known of the configurations of unreported collisions. In this paper, data from a recent self-reporting survey of cycling collisions in Ireland is used to provide details of cyclist collisions with motorised vehicles and single cyclist collisions, with the inclusion of unreported collision types. Pre-crash scenarios and impact configurations for cyclist collisions with bonnet-type vehicles, and collision factors and fall types for single cyclist collisions are coded. Injury patterns and police underreporting levels are compared, and representative collision scenarios are identified. This study highlights the relative importance of collisions resulting from the cyclist and vehicle travelling in the same direction, specifically, nearside-hook, vehicle lane changing, and overtaking manoeuvres are emphasised. Furthermore, cases involving the cyclist struck from the side by vehicle fronts comprise a smaller share than previous studies. Specifically, side to side impacts, impacts between the front of the cyclist/bicycle and the side of the vehicle, and impacts with open(ing) doors emerge as important impact configurations with the inclusion of self-reported cases. For single cyclist collisions, the importance of loss of traction of the tyres due to slippery road conditions and interactions with tram tracks and kerbs are emphasised. Fall types differ between single cyclist collision scenarios and are related to differences in injury severity. These findings add to existing knowledge for fatal and higher severity collisions, demonstrating that cyclist safety priorities change with inclusion of underreported, and lower severity collisions. The findings are particularly relevant to road infrastructural planners, as well as in the fields of injury biomechanics, and automated vehicle safety (ADAS). Representative scenarios for collisions with bonnet-type vehicles and single cyclist collisions have been identified, allowing for their future inclusion in development of collision and injury prevention strategies. The dataset generated in this study is available from the authors on reasonable request., (Copyright © 2021 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

As both a utility mode of transport and recreational activity, cycling has well-known health, environmental, and economic benefits. For these reasons it has been encouraged in many countries, including the Republic of Ireland. However, with increasing popularity there have been concurrent increases in road traffic related cyclist injuries. This study aims to characterise cyclist collisions, which are known to be underreported in Police statistics. For data collection, a survey addressing collisions was distributed to cyclists across the country in 2018. Univariable testing was used to identify differences in collision factors and injury outcomes for cyclist collisions with motorised vehicles, and those where a motorised vehicle is not involved as a collision partner i.e. single cyclist, cyclist-pedestrian, or cyclist-cyclist collisions. Furthermore, binary logistic regression modelling was used to clarify biasing factors for Police reporting of collisions. The largest proportion of collisions was between cyclists and motorised vehicles (56%), followed by single cyclist collisions (29%), collisions with other cyclists (8%), and pedestrians (7%). The odds of Police reporting for collisions with motorised vehicles in this study was 20 times greater than single cyclist collisions, 10 times greater than cyclist-cyclist collisions, and 4 times greater than collisions with pedestrians. The odds of Police reporting of serious injury collisions was 7 times greater than minor injury collisions. There were several differences in road, environmental, and human factors, and injury patterns between cyclist-motorised vehicle collisions and non-motorised vehicle collisions. The findings of this study indicate that greater attention should be paid to the following underreported collision types: 1) those that do not involve collisions with motorised vehicles (single cyclist collisions in particular), which have been shown to have differing collision characteristics to motorised vehicle collisions, and 2) less severe injuries, which have been shown to be a substantial contributor to the cyclist safety problem. Furthermore, surveys have been shown to be a valuable mechanism for investigation of lower severity cyclist injuries, which are largely unrecorded in Police or hospital data., (Copyright © 2020 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Pedestrian injuries occur in both the primary vehicle contact and the subsequent ground contact. Currently, no ground contact countermeasures have been implemented and no pedestrian model has been validated for ground contact, though this is needed for developing future ground contact injury countermeasures. In this paper, we assess the predictive capacity of the MADYMO ellipsoid pedestrian model in reconstructing six recent pedestrian cadaver ground contact experiments. Whole-body kinematics as well as vehicle and ground contact related aHIC (approximate HIC) and BrIC scores were evaluated. Reasonable results were generally achieved for the timings of the principal collision events, and for the overall ground contact mechanisms. However, the resulting head injury predictions based on the ground contact HIC and BrIC scores showed limited capacity of the model to replicate individual experiments. Sensitivity studies showed substantial influences of the vehicle-pedestrian contact characteristic and certain initial pedestrian joint angles on the subsequent ground contact kinematics and injury predictions. Further work is needed to improve the predictive capacity of the MADYMO pedestrian model for ground contact injury predictions., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

There are growing concerns about the risk of neurodegenerative diseases associated with heading in football. It is essential to understand the biomechanics of football heading to guide player protection strategies to reduce the severity of the impact. The aim of this study was to assess the effect of football speed, mass, and stiffness on the forces experienced during football heading using mathematical and human body computational model simulations. Previous research indicates that a football header can be modeled as a lumped mass mathematical model with elastic contact. Football headers were then reconstructed using a human body modeling approach. Simulations were run by independently varying the football mass, speed, and stiffness. Peak contact force experienced by the head was extracted from each simulation. The mathematical and human body computational model simulations indicate that the force experienced by the head was directly proportional to the speed of the ball and directly proportional to the square root of the ball stiffness and mass. Over the practical range of ball speed, mass, and stiffness, the force experienced by the head during football heading is mainly influenced by the speed of the ball rather than its mass or stiffness. The findings suggest that it would be more beneficial to develop player protection strategies that aim to reduce the speed at which the ball is traveling when headed by a player. Law changes reducing high ball speeds could be trialed at certain age grades or as a phased introduction to football heading., (© 2020 The Authors. Scandinavian Journal of Medicine & Science In Sports published by John Wiley & Sons Ltd.)

Introduction: Cycling as a means of transport or recreational activity is increasing in popularity in Ireland. However, increasing numbers of cyclists may lead to an increased number of bicycle collisions and fatalities. The Road Safety Authority is the statutory body for road safety in Ireland but uses police data alone to collate cycling collision statistics. This may lead to an underestimation of cycling injuries in Ireland. Using hospital statistics may provide a greater understanding of cycling trauma in Ireland., Objective: The present study examines cycling related trauma in Ireland using the Major Trauma Audit (MTA) data collected via the Trauma and Research Network (TARN) from hospitals in Ireland for the period 2014 to 2016. The database was interrogated for demographics, mechanism of injury, injury characteristics and patient outcomes., Results: There were 410 cycling collisions recorded in the TARN database which represented 4.4% of trauma captured by TARN for the study period. Of this cohort 79% were male compared with 58% in the overall (TARN) trauma cohort (p < 0.001) and the median (IQR) age was 43.8 years (31.0, 55.7) which is younger than the median (IQR) of 58.9 (36.2, 76.0) years for the overall trauma cohort (p < 0.001). Cycling collisions had a median (IQR) injury severity score (ISS) of 10 (9, 20) which was higher than the overall trauma cohort ISS of 9 (9, 17). Of the mechanisms observed for cycling trauma, 31.7% (n = 130) had a collision with a motor vehicle. Of those who did not wear a helmet, 52.2% (n = 47) sustained a head injury compared with 27.5% (n = 44) in the group who were wearing a helmet (p < 0.001)., Conclusion: The TARN data presented in this paper builds a more complete overview of the burden of cycling collisions in Ireland. Particular points of focus are that serious cycling injuries occur in a predominantly male population, and that only around 30% of cases are recorded as involving a motor vehicle, with the majority having an unknown mechanism of injury. There was an association between helmets and head injuries in this study, but there are likely other contributing factors such as mechanism of injury, velocity or cycling infrastructure. Using hospital data such as the MTA provides valuable information on the injuries sustained by cyclists, but more prospective studies to capture injury mechanism and contributing factors are needed., Competing Interests: Declaration of Competing Interest The authors whose names are listed above certify that they have NO affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

The constitutive response of passive skeletal muscle is important for many human body modelling applications, but modelling the tension-compression asymmetry and the anisotropy observed in ex-vivo samples is challenging. Existing microstructural models do not capture the full three-dimensional response while models suitable for application in finite element environments mostly have a limited microstructural basis and cannot capture the observed Poisson's ratios. The aim of this paper is to derive an inverse model based on the microstructure of a skeletal muscle that can predict its passive mechanical response. The model parameters and predictions were derived and assessed by comparison with published experimental stress-strain response and Poisson's ratio data. Results show a close match for both predicted stress-strain response for fibre and cross-fibre direction deformations and similar Poisson's ratio values. Some microstructural observations which strengthen our understanding of the role of the collagen network and intramuscular pressure are also provided., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

Head injury is one of the most common injury types in vehicle-to-pedestrian collisions, which leads to death and long-term disabilities. However, detailed analysis of pedestrian head injuries in real world collisions is scarce. Thus the current study used two samples of 120 cases and 184 cases extracted from 1060 pedestrian collision cases captured during 2000-2015 from the GIDAS (German In-Depth-Accident Study) database to investigate the detailed characteristics of AIS2+ pedestrian head injuries. Firstly, the interrelationship between different head injury types (skull fracture, focal brain injury, concussion and diffuse axonal injury (DAI)) was analysed using the sample of 120 cases which each had at least one AIS2+ head injury. Then the influences of impact speed, pedestrian age and car front shape parameters on the injury risk of skull fracture, focal brain injury and concussion were assessed using the logistic regression method, based on the sample of 184 AIS1+ cases where the primary head contact location was within the windscreen glass area. The results show that: skull fractures and focal brain injuries dominate for AIS3+ head injuries and are generally associated with each other; concussion is the most important injury type for AIS2 head injuries and usually occurs in isolation. Further, for head impacts to the windscreen glass area a higher bonnet leading edge helps to reduce concussion odds, and none of the selected car front shape parameters are significant for the odds of skull fracture and focal brain injury, and vehicle impact speed and pedestrian age are insignificant for concussion. These detailed characteristics of pedestrian head injuries provide a basis for future pedestrian head injury prevention strategies with skull fractures and focal brain injuries being the most important injuries to address., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

Protecting struck pedestrians during the ground contact phase has been a challenge for decades. Recent studies have shown how ground related injury is influenced by pedestrian kinematics. In this paper we further developed this approach by assessing the potential of controlling vehicle braking to reduce pedestrian ground contact injuries. Applying a recently proposed Simulation Test Sample, a series of simulations were run using the MADYMO software environment. The approach considered 6 vehicle shapes, 4 pedestrian models, 3 impact velocities and 2 pedestrian gaits and each case was considered with two different vehicle braking approaches. The first was full braking, while the second applied controlled braking, for which a strategy based on pedestrian kinematics was applied. The effect of vehicle braking was evaluated using the Weighted Injury Cost (WIC) of overall pedestrian injuries and the pedestrian-ground impact velocity change. The proximity of the vehicle and pedestrian at the instant of ground contact was also evaluated to assess the potential of future vehicle based intervention methods to cushion the ground contact. Finally real-world videos of pedestrian collisions were analyzed to estimate the available free vehicle stopping distances. Results showed substantial median reductions in WIC and head impact velocity for all vehicle shapes except the Van. The proximity of the pedestrian to the vehicle front at the instant of ground contact under controlled braking is less than 1.5 m in most cases, and the required stopping distance for the vehicle under controlled braking was within the available stopping distance estimated from the video footage in about 74% of cases. It is concluded that controlled braking has significant potential to reduce the overall burden of pedestrian ground contact injuries, but future efforts are required to establish an optimized braking strategy as well as a means to handle those cases where controlled braking is not beneficial or even harmful., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

The aim of this study was to use video evidence of tackles in elite level rugby union to identify ball carrier proficiency characteristics, for both lower and upper body tackles, that have a higher propensity to result in Head Injury Assessments(HIA) for the tackler. HIA (n = 74) and non-HIA tackles (n = 233) were categorised as either front-on or side-on upper or lower body tackles and scored for ball carrying proficiency characteristics. Side-on tackles included tackles from behind. A Chi-Square test (p < 0.05) and Cramer's V were calculated to compare proficiency characteristics in HIA and non-HIA cases. For front-on upper body tackles, the ball carrier "fending into contact" (p < 0.01;ES = Moderate) and "explosiveness on contact" (p = 0.04;ES = Moderate) had a higher propensity to result in a HIA for the tackler. Fending into contact was exhibited in 47% of all upper body Tackle front-on HIA cases. The fending arm contacted the tackler's head in 67% of these cases. Fending into contact can potentially be dangerous and therefore emphasis should be placed on safe fending during tackle-based training drills. Referees should also be alert to arm-to-head contact during the fend. Given the low number of ball carrier characteristics identified, focus should be placed on tackler characteristics for HIA prevention strategies.

Statement: The role of simulation to teach and access open surgical skills has become more prevalent in recent years. This systematic review synthesizes the totality of evidence with respect to the educational effectiveness of simulators used in open surgical training. A systematic literature search was conducted in PubMed, Embase, CINAHL, Scopus, and Web of Science. Only randomized controlled trials were included that explored the educational efficacy of theses simulators. Six randomized controlled trials were included from the 9934 studies found. The methodological quality of the included studies was variable. Overall, the use of the simulators was more educationally effective compared with standard teaching of the skill without a simulator (P < 0.05). Two studies showed that the simulator was as good as an animal model of much higher fidelity. Further studies are needed to secure higher evidence for the educational value, validity, and transferability of the skills to the hospital setting for all simulators.

Objectives: Tackle height laws are an area of controversy in rugby union. It is reported that the tackler is at most risk of a Head Injury Assessment (HIA). Therefore, the aim of this study was to use match video evidence of tackles in elite level rugby union to examine the effect of tackle heights on HIA risk for the tackler., Design: Qualitative observational case-control study., Methods: Each HIA (n=74) and control tackle (n=965) was categorised based on tackle direction (front- or side-on), tackle type (arm, shoulder or smother) and tackle height (upper trunk, mid-trunk, lower trunk, upper leg or lower leg). The Relative Risk (RR), 95% Confidence Interval (CI) and probability (p) values were calculated for each tackle height., Results: Intended primary contact at the upper trunk of the ball carrier had a greater propensity to result in a HIA for the tackler for front-on upper body shoulder tackles (RR=1.48; 95%CI=1.16-1.90; p<0.01) and side-on upper body smother tackles (RR=2.30; 95%CI=1.82-2.92; p<0.01). Intended primary contact at the upper leg of the ball carrier had a greater propensity to result in a HIA for the tackler for front-on (RR=2.60; 95%CI=1.70-3.97; p<0.01) and side-on (RR=3.34; 95%CI=1.65-6.79; p<0.01) lower body shoulder tackles., Conclusions: To reduce tackler HIA risk, the results suggest tackling below the upper trunk for upper body tackles. The results also suggest tackling at the lower trunk for lower body tackles and avoiding the upper legs. Prevention strategies should place emphasis on tackling lower risk body regions such as the mid- and lower trunk., (Copyright © 2018 Sports Medicine Australia. Published by Elsevier Ltd. All rights reserved.)

Background: The mechanisms of ACL injury in rugby are not well defined., Aim: To describe the mechanisms of ACL injury in male professional rugby players using systematic video analysis., Methods: 36 cases from games played in top professional leagues and international matches were analysed. 5 analysts independently assessed all videos to record the estimated frame/time of initial ground contact, frame/time of ACL tear and a range of play specific variables. This included contact versus non-contact ACL injuries, injury timing, joint flexion angles and foot contact with the ground. 37 side-stepping manoeuvres from a control game were analysed to allow comparison of non-injury versus injury situations., Results: 57% of ACL injuries occurred in a contact manner. 2 main scenarios were identified: (1) offensive running and (2) being tackled, indicating that the ball carrier might be at higher risk of ACL injury. The majority of non-contact ACL injuries resulted from a side-stepping manoeuvre. In most non-contact cases, initial ground contact was through heel strike. Statistical assessment of heel strike at initial ground contact versus non-heel strike cases showed a significant difference in injury versus non-injury outcomes, with heel strike associated with higher injury risk. Non-contact ACL injuries had lower median knee flexion angles and a more dorsiflexed ankle when compared with a control group (10° vs 20°, p≤0.001 and 10° vs 0°, p=0.033 respectively)., Conclusions: Over half of ACL injuries in rugby in our analysis resulted from a contact mechanism. For non-contact injuries, lower knee flexion angles and heel-first ground contact in a side-stepping manoeuvre were associated with ACL injury., Competing Interests: Competing interests: None declared., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.)

Subsystem impactor tests are the main approaches for evaluation of safety performance of vehicle front design for pedestrian protection in legislative regulations. However, the main aspects of vehicle safety for pedestrians are shape and stiffness, and though it is clear that subsystem impact tests encourage lower vehicle front stiffness, it is unclear whether they promote improved vehicle front shapes for pedestrian protection. The purpose of this paper is therefore to investigate the effects of European pedestrian safety regulations on passenger car front shape and pedestrian injury risk using recent German In-Depth Accident Study (GIDAS) pedestrian collision data and numerical simulations. Firstly, a sample of 579 pedestrian collision cases involving 190 different car models between 2000-2015 extracted from the GIDAS was used to compare front-end shapes of passenger cars manufactured before and after the legislative pedestrian safety regulations were introduced in Europe. The focus was on changes in passenger car front shape and differences in pedestrian AIS2+ (Abbreviated Injury Scale at least level 2) leg, pelvis/femur and head injury risk observed in collisions. Multi-body simulations were also used to assess changes in vehicle aggressivity due to the observed changes in vehicle shape. The results show that newer passenger cars tend to have a flatter and wider bumper, higher bonnet leading edge, shorter and steeper bonnet and a shallower windscreen. Both the collision data and the numerical simulations indicate that newer passenger car front bumper designs are significantly safer for pedestrians' legs. However, the results also show that the higher bonnet leading edge in newer passenger cars is poor for pedestrian pelvis/femur protection, even though newer cars show an obviously lower AIS2+ injury risk to younger pedestrians in collisions. Newer cars have a lower AIS2+ head injury risk for pedestrians in collisions, but the numerical analysis indicate that this is not likely due to shape changes in passenger car fronts. Overall, the introduction of pedestrian safety regulations has resulted in reductions in pedestrian injury risk, but further benefits would accrue from tests which promote a lower bonnet leading edge. The influence of vehicle shape on pedestrian head injury risk remains unclear., (Copyright © 2018 Elsevier Ltd. All rights reserved.)

There is mounting evidence of reduced long-term cognitive ability in rugby players, even in those without a reported history of concussion. The tackle height law is an area of controversy. However, little is known about the effects of repetitive inertial head loading in rugby. Furthermore, the magnitude and influencing factors for head kinematics are generally unknown. In this exploratory study, 45 multibody front-on shoulder tackles simulated with the MADYMO pedestrian model and 20 staged rugby tackles executed by professional rugby players in a marker-based 3D motion laboratory were used to assess the effect of tackle height on ball carrier head kinematics. The peak resultant head linear accelerations, angular accelerations and change in angular velocities were measured and examined. The results suggest that tackle height strongly affects the head kinematics experienced by the ball carrier. In particular, higher ball carrier head kinematic values were identified for upper trunk tackles compared to mid/lower trunk tackles in both the multibody simulations and the staged rugby tackles. Average ball carrier peak resultant head linear acceleration, angular acceleration and change in angular velocity values for upper trunk tackles were greater than for mid/lower trunk tackles by a factor of 1.5, 2.5 and 1.7, in the multibody simulations, respectively, and 1.8 (p = 0.102), 2.2 (p = 0.025) and 2.3 (p = 0.004), in the staged tackles, respectively. The results of the study support the proposition of lowering the current tackle height laws to below the chest., (Copyright © 2018 Elsevier Ltd. All rights reserved.)

Purpose: This study aimed to use match video evidence of tackles in elite-level rugby union to identify tackler proficiency characteristics, for both lower body and upper body tackles, that result in head injury assessments (HIA) for the tackler., Methods: A review of international rugby union matches (2013-2017) and Pro 12/European Rugby Champions Cup matches (2014-2017) from a professional rugby union club was conducted. HIA (n = 74) and non-HIA tackles (n = 233) were categorized as either front-on or side-on upper body or lower body tackles and were scored for tackling proficiency characteristics. A chi-square test (P < 0.05) and phi and Cramer's V were calculated to compare HIA and non-HIA tackling proficiency characteristics., Results: In both front- and side-on upper body and lower body tackles, "head up and forward/face up" and "head placement on correct side of ball carrier" were identified as having a lower propensity to result in an HIA for the tackler. For both front-on and side-on upper body tackles, "identify/track ball carrier onto shoulder" and "shortening steps" were identified. In addition, "straight back, centre of gravity forward of support base" and "identify/track ball carrier onto shoulder" were identified for front-on and side-on lower body tackles, respectively., Conclusions: This study identified tackle characteristics that had a lower propensity to result in an HIA for the tackler in both front-on and side-on upper body and lower body tackles.

Player-to-player contact inherent in many unhelmeted sports means that head impacts are a frequent occurrence. Model-Based Image-Matching (MBIM) provides a technique for the assessment of three-dimensional linear and rotational motion patterns from multiple camera views of a head impact event, but the accuracy is unknown for this application. The goal of this study is to assess the accuracy of the MBIM method relative to reflective marker-based motion analysis data for estimating six degree of freedom head displacements and velocities in a staged pedestrian impact scenario at 40 km/h. Results showed RMS error was under 20 mm for all linear head displacements and 0.01-0.04 rad for head rotations. For velocities, the MBIM method yielded RMS errors between 0.42 and 1.29 m/s for head linear velocities and 3.53-5.38 rad/s for angular velocities. This method is thus beneficial as a tool to directly measure six degree of freedom head positional data from video of sporting head impacts, but velocity data is less reliable. MBIM data, combined in future with velocity/acceleration data from wearable sensors could be used to provide input conditions and evaluate the outputs of multibody and finite element head models for brain injury assessment of sporting head impacts.

Objectives: It has been hypothesised that fatigue may be a major factor in tackle-related injury risk in rugby union and hence more injuries occur in the later stages of a game. The aim of this study is to identify changes in ball carrier or tackler proficiency characteristics, using elite level match video data, as player time-in-game increases., Design: Qualitative observational cohort study., Methods: Three 2014/15 European Rugby Champions Cup games were selected for ball carrier and tackler proficiency analysis. Analysis was only conducted on players who started and remained on the field for the entire game. A separate analysis was conducted on 10 randomly selected 2014/15 European Rugby Champions Cup/Pro 12 games to assess the time distribution of tackles throughout a game. A Chi-square test and one-way way ANOVA with post-hoc testing was conducted to identify significant differences (p<0.05) for proficiency characteristics and tackle counts between quarters in the game, respectively., Results: Player time-in-game did not affect tackle proficiency for both the ball carrier and tackler. Any results that showed statistical significance did not indicate a trend of deterioration in proficiency with increased player time-in-game. The time distribution of tackles analysis indicated that more tackles occurring in the final quarter of the game than the first (p=0.04) and second (p=<0.01)., Conclusions: It appears that player time-in-game does not affect tackler or ball carrier tackle technique proficiency at the elite level. More tackles occurring in the final quarter of a game provides an alternative explanation to more tackle-related injuries occurring at this stage., (Copyright © 2017 Sports Medicine Australia. Published by Elsevier Ltd. All rights reserved.)

Background: Increased loading at the lumbar spine, particularly in the coronal plane, has been reported in children with cerebral palsy (CP). As pelvic and trunk movements associated with Trendelenburg and Duchenne type gait are most significant in the coronal plane, the potential exists for lower lumbar spinal loading to be negatively affected in children with CP and these types of movement patterns., Objective: The objective of this study was to assess trunk and pelvic kinematics and lower lumbar spinal loading patterns in children with CP and Trendelenburg and Duchenne type gait., Design: This was a cross-sectional study., Methods: Three-dimensional kinematic (lower limb and thorax) and L5-S1 kinetic data were recorded. Children were divided according to clinical presentation of Trendelenburg or Duchenne type gait. Several discrete kinematic and kinetic parameters were assessed between groups., Results: Three distinct pelvic and trunk movement patterns were identified for children with CP: Trendelenburg, Duchenne, and complex Trendelenburg-Duchenne. Peak L5-S1 lateral bending moments were increased by 62% in children with CP and Duchenne type gait. Children with CP and complex Trendelenburg-Duchenne gait demonstrated the largest deviations from normal, with increased peak ipsilateral and contralateral directed moments of 69% and 54%, respectively, compared with children with typical development., Limitations: A test-retest reliability analysis or measure of minimal detectable change was not conducted as part of this study. Results suggest that measures of minimal detectable change may be high for some of the reported variables. In addition, the inverse dynamic approach determines only the net intersegmental reactive forces that reflect the effect of external loads. Previous studies have shown that spinal loads may be larger than the net intersegmental force., Conclusions: Trendelenburg and Duchenne type movements were not always distinct, and a third type of movement, a combination of the two, was the most common in this study. Clinicians should be aware that children with CP and the Duchenne type or the complex Trendelenburg-Duchenne type of gait pattern experience abnormal loading that may have significant implications for the lower spine in the long term., (© 2017 American Physical Therapy Association)

Most pedestrians struck by vehicles receive injuries from contact with the vehicle and also from the subsequent ground contact. However, ground related pedestrian injuries have received little focus. This paper uses 1221 German pedestrian collision cases occurring between 2000 and 2015 to assess the distribution and risk factors for pedestrian ground related injuries. Results show that for MAIS 2, the ground accounted for 24% of cases, for MAIS 3 the ground accounted for 20% of cases and for MAIS 4-5, the ground accounted for 14% of cases. There were no AIS 6 ground related injuries, though there were several fatal cases where the ground was coded as the most serious injury. The head, thorax and spine dominate AIS 4-5 ground contact injuries. Vehicle impact speeds were higher for ground related AIS 4-5 compared to AIS 2 injury cases and the average impact speed for ground related injuries to the upper and lower extremities was lower than for body regions like head, thorax and spine. There was a significant age effect on pedestrian ground related injury outcome, with older pedestrians suffering more severe injuries and the median age for thorax injuries was higher than for all other body regions. There was no significant difference in the proportions of AIS 2+ head injuries produced by ground contact for more recent vehicles (model year since 2005) compared to older vehicles (model year before 2005). However, logistic regression analysis showed that the normalised bonnet leading-edge height is a risk factor for adult pedestrian AIS2+ ground related head injuries, and this provides empirical support for recent computational modelling predictions which implied a relationship between vehicle shape and pedestrian ground contact injuries. Considering the potential benefits of preventing pedestrian ground contact, for collisions below 40km/h two thirds of the injury costs would be eliminated if ground contact could be prevented, and even higher benefits are likely at lower speeds (20 and 30km/h). These data demonstrate the importance of ground related pedestrian injuries and show that vehicle shape influences pedestrian injury outcome in ground contact. The data therefore provides significant motivation for countermeasures to prevent or moderate pedestrian ground related injuries., (Copyright © 2017 Elsevier Ltd. All rights reserved.)

The tension/compression asymmetry observed in the stress-stretch response of skeletal muscle is not well understood. The collagen network in the extracellular matrix (ECM) almost certainly plays a major role, but the details are unknown. This paper reports qualitatively and quantitatively on skeletal muscle ECM reorganization during applied deformation using confocal imaging of collagen through use of a fluorescently-tagged specific collagen binding protein (CNA35-EGFP) of porcine and chicken muscle samples under tensile and compressive deformation in both the fibre and cross-fibre directions. This reveals the overall three-dimensional structure of collagen in perimysium in planes perpendicular and parallel to the muscle fibres in both species. Furthermore, there is clear evidence of the reorganization of these structures under compression and tension applied in both the muscle fibre and cross-fibre directions. These observations improve our understanding of perimysium structure and response to three-dimensional deformations and are an important basis for constitutive models of passive skeletal muscle. Although overall behaviour was similar, some differences in perimysium structure were observed between chicken and porcine muscle tissue. Further work is required to better understand which structures are responsible for the tension and compression stress-strain asymmetry previously observed in the mechanical response of passive skeletal muscle., (Copyright © 2017 Elsevier Ltd. All rights reserved.)

Experiments on passive skeletal muscle on different species show a strong asymmetry in the observed tension-compression mechanical behavior. This asymmetry shows that the tension modulus is two orders of magnitude higher than the compression modulus. Until now, traditional analytical constitutive models have been unable to capture that strong asymmetry in anisotropic solids using the same material parameters. In this work we present a model which is able to accurately capture five experimental tests in chicken pectoralis muscle, including the observed tension-compression asymmetry. However, aspects of the anisotropy of the tissue are not captured by the model., (Copyright © 2017 Elsevier Ltd. All rights reserved.)

There is a substantial prevalence of post-operative incisional hernia for both laparoscopic and laparotomy procedures, but there have been few attempts at quantifying abdominal wound closure methodology in the literature. One method to ascertain a more robust method of wound closure is the identification of the influence of suture placement parameters on suture pullout force. Current surgical practice involves a recommended bite depth and bite separation of 10mm, but the evidence base for this is not clear. In this paper, the suture pullout characteristics of both porcine and human linea alba were investigated to ascertain a suture placement protocol for surgical wound closure. Uniaxial suture pullout force testing on fresh frozen porcine and human linea alba samples was performed using standard materials testing machines. The influence of the number of suture loops, the bite depth and the bite separation of the sutures and the orientation of the sutures with respect to the principal fibre direction in the linea alba were assessed. Results showed a clearly identifiable relationship between pullout force of the suture, bite separation and bite depth, with low suture separation and high suture depth as optimal parameters for increasing pullout force. Resistance to pullout could be improved by as much as 290% when optimizing test conditions. Both human and porcine tissue were observed to exhibit very similar pullout force characteristics, corroborating the use of a porcine model for investigations into wound closure methodology. Orientation of suture application was also found to significantly affect the magnitude of suture pullout, with suturing applied longitudinally across a transverse defect resulting in higher pullout forces for small suture bite separations. Although further assessment in an environment more representative of in vivo conditions is required, these findings indicate that increasing the bite depth and reducing the bite separation with respect to the current surgical recommendations may reduce the risk of post-operative incisional hernia., (Copyright © 2017 Elsevier Ltd. All rights reserved.)

Quantified relationships between passenger car front shape and pedestrian injury risk derived from accident data are sparse, especially considering the significant recent changes in car front design. The purpose of this paper is therefore to investigate the detailed effects of passenger car front shape on injury risk to a pedestrian's head, thorax, pelvis and leg in the event of a vehicle pedestrian impact. Firstly, an accident sample of 594 pedestrian cases captured during 2000-2015 from the German In-Depth Accident Study (GIDAS) database was employed. Multicollinearity diagnostic statistics were then used to detect multicollinearity between the predictors. Following this, logistic regression was applied to quantify the effects of passenger car front shape on injury risks while controlling for impact speed and pedestrian age. Results indicate that the bumper lower depth (BLD), bumper lower height (BLH), bumper upper height (BUH) and normalised bumper lower/upper height (NBLH/NBUH) are statistically significant for AIS2+ leg injury risk. The normalised bonnet leading edge height (NBLEH) has a statistically significant influence on AIS2+ femur/pelvis injury occurrence. The passenger car front shape did not show statistical significance for AIS3+ thorax and head injuries. The impact speed and pedestrian age are generally significant factors influencing AIS2+ leg and pelvis injuries, and AIS3+ thorax and head injuries. However, when head impacts are fixed on the central windscreen region both pedestrian age and impact speed are not statistically significant for AIS3+ head injury. For quantified effects, when controlling for speed, age and BUH, an average 7% and 6% increase in AIS2+ leg injury odds was observed for every 1cm increase in BLD and BLH respectively; 1cm increase in BUH results in a 7% decrease in AIS2+ leg injury odds when the BLD or BLH are fixed respectively (again controlling for impact speed and pedestrian age); the average AIS2+ femur/pelvis injury odds increase by 74% for a 10% increase in NBLEH. These findings suggest that passenger car bumpers should support the lower leg with a low and flat lower bumper and even contact up to the femur area with a high upper bumper which extends above the knee to protect the pedestrian's leg. A low passenger car bonnet leading edge helps to reduce femur/pelvis injury risk. The passenger car front shape parameters are less influential than impact speed and pedestrian age for pedestrian injury risk., (Copyright © 2017 Elsevier Ltd. All rights reserved.)

Vehicle front shape has a significant influence on pedestrian injuries and the optimal design for overall pedestrian protection remains an elusive goal, especially considering the variability of vehicle-to-pedestrian accident scenarios. Therefore this study aims to develop and evaluate an efficient framework for vehicle front shape optimization for pedestrian protection accounting for the broad range of real world impact scenarios and their distributions in recent accident data. Firstly, a framework for vehicle front shape optimization for pedestrian protection was developed based on coupling of multi-body simulations and a genetic algorithm. This framework was then applied for optimizing passenger car front shape for pedestrian protection, and its predictions were evaluated using accident data and kinematic analyses. The results indicate that the optimization shows a good convergence and predictions of the optimization framework are corroborated when compared to the available accident data, and the optimization framework can distinguish 'good' and 'poor' vehicle front shapes for pedestrian safety. Thus, it is feasible and reliable to use the optimization framework for vehicle front shape optimization for reducing overall pedestrian injury risk. The results also show the importance of considering the broad range of impact scenarios in vehicle front shape optimization. A safe passenger car for overall pedestrian protection should have a wide and flat bumper (covering pedestrians' legs from the lower leg up to the shaft of the upper leg with generally even contacts), a bonnet leading edge height around 750mm, a short bonnet (<800mm) with a shallow or steep angle (either >17° or <12°) and a shallow windscreen (≤30°). Sensitivity studies based on simulations at the population level indicate that the demands for a safe passenger car front shape for head and leg protection are generally consistent, but partially conflict with pelvis protection. In particular, both head and leg injury risk increase with increasing bumper lower height and depth, and decrease with increasing bonnet leading edge height, while pelvis injury risk increases with increasing bonnet leading edge height. However, the effects of bonnet leading edge height and windscreen design on head injury risk are complex and require further analysis., (Copyright © 2017 Elsevier Ltd. All rights reserved.)

Detection and visualisation of Collagen structure are important to understand the relationship between mechanical behaviour and microstructure in skeletal muscle since Collagen is the main structural protein in animal connective tissues, and is primarily responsible for their passive load-bearing properties. In the current study, the direct detection and visualization of Collagen using fluorescently tagged CNA35 binding protein (fused to EGFP or tdTomato) is reported for the first time on fixed skeletal muscle tissue. This Technical Note also establishes a working protocol by examining tissue preparation, dilution factor, exposure time etc. for sensitivity and specificity. Penetration of the binding protein into intact mature skeletal muscle was found to be very limited, but detection works well on tissue sections with higher sensitivity on wax embedded sections compared to frozen sections. CNA35 fused to tdTomato has a higher sensitivity than CNA35 fused to EGFP but both show specific detection. Best results were obtained with 15μm wax embedded sections, with blocking of non-specific binding in 1% BSA and antigen retrieval in Sodium Citrate. There was a play-off between dilution of the binding protein and time of incubation but both CNA35-tdTomato and CNA35-EGFP worked well with approximately 100μg/ml of purified protein with overnight incubation, while CNA35-tdTomato could be utilized at 5 fold less concentration. This approach can be applied to study the relationship between skeletal muscle micro-structure and to observe mechanical response to applied deformation. It can be used more broadly to detect Collagen in a variety of fixed tissues, useful for structure-functions studies, constitutive modelling, tissue engineering and assessment of muscle tissue pathologies., (Copyright © 2016 Elsevier Ltd. All rights reserved.)

Background: Given the global nature of schoolbag carriage, there has been extensive research on schoolbag weight and use with resultant guidance on many aspects of carrying a schoolbag. However, there is limited evidence of knowledge translation or parents' awareness of schoolbag carriage., Objective: This study investigated parental awareness of factors related to schoolbag carriage., Method: A cross-sectional survey using an anonymous 30-item questionnaire and purposive sampling was used. Questionnaires were distributed to parents of primary school children through the schools. Descriptive statistics of frequencies and percentages were used and associations were tested using Chi-square analysis in SPSS v23., Results: A total of 700 parents in Ireland (Ire) and the United States (US) participated in the study (n = 444 [Ire] and n = 256 [US]). Generally, parents had satisfactory awareness of appropriate schoolbag type and carriage. The majority of children owned a backpack (89.9% [Ire] vs. 93.7% [US]), although fewer parents considered this to be the most suitable bag for their child (69.6% [Ire] vs. 88.2% [US]). More Irish parents (29.2%) favoured a wheeled schoolbag compared to US parents (6.2%) (p < 0.001). The majority (70.8% [Ire] vs. 55.7% [US]) wanted more information. The preferred platforms for receiving information were a handout (78.1% [Ire] vs. 71.6% [US]) and on-line (44.6% [Ire] vs. 53.9% [US])., Conclusions: Despite gaps identified, parents had good awareness of factors relating to schoolbag carriage, but this study shows that they would like more information. The preferred platform for knowledge translation was a handout. Parents are the best advocates for safety promotion and represent the group most likely to improve schoolbag carriage among children.

Objective: There is evidence of chronic injury to the head-and-neck region of Rugby Union players. The aim of this study was to use multibody simulations to examine the effects of tackle height on both Tackler and Ball Carrier head kinematics and neck dynamics., Research Design: Quantitative Exploratory Study Methods and procedures: 45 front-on shoulder tackles with no direct contact to the head/neck were simulated with the MADYMO pedestrian model and used to assess differences between upper body tackles and lower body tackles. The average resultant head linear and angular accelerations as well as neck forces and moments were assessed., Main Outcomes and Results: Much higher Ball Carrier head kinematic values and neck loading were predicted for upper body tackles compared to lower body tackles, and principal findings were unaffected by a sensitivity analysis. Tackler results were less straightforward and trends were influenced by the sensitivity analysis for muscle activation., Conclusion: Although further model validation is required, the results of this study indicate the need for further research on tackle heights and inertial head-and-neck loading in the tackle phase of play in Rugby Union.

There are few studies on the stress-stretch behaviour of human linea alba, yet understanding the mechanics of this tissue is important for developing better methods of abdominal wound closure. Published data focuses mainly on porcine linea alba and for human tissue there are conflicting results and no bi-axial data available. This variability is likely due to challenges with the physical dimensions of the tissue and differences in experimental methodology. This study focussed on the tensile mechanical characterisation of the human linea alba using uniaxial and equi-load biaxial testing performed using image-based strain measurement methods. Thirteen freshly frozen human cadaveric abdominal walls were obtained and used to prepare 7 samples in both the transverse and longitudinal directions for uniaxial testing, and 13 square samples for bi-axial testing. The results showed significant anisotropy and for the equi-load biaxial tests the deformation was heavily biased in the longitudinal direction. In comparison with similar tests on porcine tissue from a previous study, it was found that the response of porcine linea alba to uniaxial loading is similar to that of human linea alba, with no statistically significant differences observed. Under biaxial loading human and porcine linea showed no statistical significance in the difference between their means in the transverse direction. However, a significant difference was observed in the longitudinal direction, and further study of the respective tissue structures is needed to better understand this result. These results provide the first data on the biaxial tensile properties of human linea alba and can aid in an improved assessment of wound closure mechanics., (Copyright © 2016 Elsevier Ltd. All rights reserved.)

The mechanics of passive skeletal muscle are important in impact biomechanics, surgical simulation, and rehabilitation engineering. Existing data from porcine tissue has shown a significant tension/compression asymmetry, which is not captured by current constitutive modelling approaches using a single set of material parameters, and an adequate explanation for this effect remains elusive. In this paper, the passive elastic deformation properties of chicken pectoralis muscle are assessed for the first time, to provide deformation data on a skeletal muscle which is very different to porcine tissue. Uniaxial, quasi-static compression and tensile tests were performed on fresh chicken pectoralis muscle in the fibre and cross-fibre directions, and at 45° to the fibre direction. Results show that chicken muscle elastic behaviour is nonlinear and anisotropic. The tensile stress-stretch response is two orders of magnitude larger than in compression for all directions tested, which reflects the tension/compression asymmetry previously observed in porcine tissue. In compression the tissue is stiffest in the cross-fibre direction. However, tensile deformation applied at 45° gives the stiffest response, and this is different to previous findings relating to porcine tissue. Chicken muscle tissue is most compliant in the fibre direction for both tensile and compressive applied deformation. Generally, a small percentage of fluid exudation was observed in the compressive samples. In the future these data will be combined with microstructural analysis to assess the architectural basis for the tension/compression asymmetry now observed in two different species of skeletal muscle., (Copyright © 2016 Elsevier Ltd. All rights reserved.)

Objectives: The purpose of this study is to define a computationally efficient virtual test system (VTS) to assess the aggressivity of vehicle front-end designs to pedestrians considering the distribution of pedestrian impact configurations for future vehicle front-end optimization. The VTS should represent real-world impact configurations in terms of the distribution of vehicle impact speeds, pedestrian walking speeds, pedestrian gait, and pedestrian height. The distribution of injuries as a function of body region, vehicle impact speed, and pedestrian size produced using this VTS should match the distribution of injuries observed in the accident data. The VTS should have the predictive ability to distinguish the aggressivity of different vehicle front-end designs to pedestrians., Methods: The proposed VTS includes 2 parts: a simulation test sample (STS) and an injury weighting system (IWS). The STS was defined based on MADYMO multibody vehicle to pedestrian impact simulations accounting for the range of vehicle impact speeds, pedestrian heights, pedestrian gait, and walking speed to represent real world impact configurations using the Pedestrian Crash Data Study (PCDS) and anthropometric data. In total 1,300 impact configurations were accounted for in the STS. Three vehicle shapes were then tested using the STS. The IWS was developed to weight the predicted injuries in the STS using the estimated proportion of each impact configuration in the PCDS accident data. A weighted injury number (WIN) was defined as the resulting output of the VTS. The WIN is the weighted number of average Abbreviated Injury Scale (AIS) 2+ injuries recorded per impact simulation in the STS. Then the predictive capability of the VTS was evaluated by comparing the distributions of AIS 2+ injuries to different pedestrian body regions and heights, as well as vehicle types and impact speeds, with that from the PCDS database. Further, a parametric analysis was performed with the VTS to assess the sensitivity of the injury predictions to changes in vehicle shape (type) and stiffness to establish the potential for using the VTS for future vehicle front-end optimization., Results: An STS of 1,300 multibody simulations and an IWS based on the distribution of impact speed, pedestrian height, gait stance, and walking speed is broadly capable of predicting the distribution of pedestrian injuries observed in the PCDS database when the same vehicle type distribution as the accident data is employed. The sensitivity study shows significant variations in the WIN when either vehicle type or stiffness is altered., Conclusions: Injury predictions derived from the VTS give a good representation of the distribution of injuries observed in the PCDS and distinguishing ability on the aggressivity of vehicle front-end designs to pedestrians. The VTS can be considered as an effective approach for assessing pedestrian safety performance of vehicle front-end designs at the generalized level. However, the absolute injury number is substantially underpredicted by the VTS, and this needs further development.

Motivated by the thousands of pedestrians killed each year in train impacts, this paper investigates the life-saving capability of four high-level locomotive bumper concepts. The head motions produced by the four concepts are modeled as one or two square acceleration pulses and are analyzed using the Head Injury Criterion (HIC). Surprisingly, the analyses show that all four concepts can achieve HIC values of less than 200 for an impact with a locomotive traveling at 100 km/h. Two of the concepts eject the pedestrian trackside with at a velocity of roughly 40 km/h and the risk of ground-impact injury is discussed in the context of related automobile accident data. The computed bumper lengths are a fraction of the overall length of a locomotive and are thus feasible for practical implementation. One concept involves an oblique impact and the potential for rotational head injury is analyzed. This basic feasibility research motivates future investigations into the detailed design of bumper shapes, multi-body pedestrian simulations, and finite-element injury models., (Copyright © 2016 The Authors. Published by Elsevier Ltd.. All rights reserved.)

This paper discusses tension-compression asymmetry properties of Ogden hyperelastic formulations. It is shown that if all negative or all positive Ogden coefficients are used, tension-compression asymmetry occurs the degree of which cannot be separately controlled from the degree of non-linearity. A simple hybrid form is therefore proposed providing separate control over the tension-compression asymmetry. It is demonstrated how this form relates to a newly introduced generalised strain tensor class which encompasses both the tension-compression asymmetric Seth-Hill strain class and the tension-compression symmetric Bažant strain class. If the control parameter is set to q=0.5 a tension-compression symmetric form involving Bažant strains is obtained with the property Ψ(λ1,λ2,λ3)=Ψ(1λ1,1λ2,1λ3). The symmetric form may be desirable for the definition of ground matrix contributions in soft tissue modelling allowing all deviation from the symmetry to stem solely from fibrous reinforcement. Such an application is also presented demonstrating the use of the proposed formulation in the modelling of the non-linear elastic and transversely isotropic behaviour of skeletal muscle tissue in compression (the model implementation and fitting procedure have been made freely available). The presented hyperelastic formulations may aid researchers in independently controlling the degree of tension-compression asymmetry from the degree of non-linearity, and in the case of anisotropic materials may assist in determining the role played by, either the ground matrix, or the fibrous reinforcing structures, in generating asymmetry., (Copyright © 2015 Elsevier Ltd. All rights reserved.)

Primary Objectives: To conduct video and statistical analysis on Rugby Union play, focusing mainly on the tackle, to establish the player to player configurations for significant direct head impacts and non-direct head impacts., Research Design: Quantitative, observational cohort study., Methods and Procedures: Video analysis of 52 significant direct head impacts (31 Tackle, 10 Ruck, 7 Dive and 4 Ground) and 40 non-direct head impact tackles from 2014/15 International Rugby Union matches. Relative risk, 95% CI and p-values were calculated for a range of tackle variables., Main Outcome and Results: Upper body tackles and lower body tackles accounted for 37% (19) and 23% (12) of cases, respectively, with the tackler as the head impacted player for 97% (30) of cases. The majority (81%) of tackle-related significant direct head impacts occurred in the second half of the game, with 63% of upper body tackle significant direct head impacts occurring in the final quarter. Tackler head placement and high speed tackles had statistical significance for causing tackle related significant direct head impacts as well as foot planting and difference in tackler and ball carrier mass for upper body tackles and ball carrier change in direction for lower body tackles., Conclusion: Tackle variables that statistically increased the risk of significant direct head impact were identified, which can aid player protection strategies.

The effect of pedestrian gait on lower limb kinematics and injuries has not been analyzed. The purpose of this paper was therefore to investigate the effect of pedestrian gait on kinematics and injury risk to the lower limbs using the Total Human Model for Safety adult male pedestrian model together with FE models of vehicle front structures. The modeling results indicate that the tibia and femur cortical bone von-Mises stress and the lateral knee bending angle of an adult pedestrian are strongly dependent on the gait stance when struck by both a sedan car and an SUV at 40km/h. The gait analysis shows that generally the leg of an adult pedestrian has lower injury risk when the knee is flexed and linear regressions show high negative correlation between knee flexion angle during impact and knee lateral bending angle and also high negative correlation between lower leg axial rotation during impact and knee lateral bending angle. Furthermore, in some gait stances a self-contact between the legs occurs, and the peak bones stresses and knee shearing displacement in the leg are then increased. Assessment of pedestrian lower limb injury should take account of these gait stance effects., (Copyright © 2015 Elsevier Ltd. All rights reserved.)