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The popularity of electric scooters (ES) during the last five years due to climate neutrality and public availability led to increased numbers in traffic accidents with significant injuries. This study was conducted to overview e-scooter related computed tomography (CT) positive traumatic brain injuries, exploring circumstances, clinical course, outcomes and possible relations to behavioral patterns. We retrospectively reviewed medical data of all patients treated in our center during the period 2019 to 2023, medical records were analysed and statistically processed. This review included 45 patients, 75.7% were males and median age was 40 years old. Patient numbers did not differ between weekdays, working days versus weekends and time of the day. Eighty percent of patients were injured from falling off the scooter, the rest were hit by another vehicle while riding. None of the patients were known using helmet, significant alcohol intoxication was found in 68.8% of cases. The most common traumatic intracranial features were subarachnoid hemorrhage (55.6%), followed by brain contusions (48.9%), epidural (26.7%), subdural (26.7%) hemorrhages. Age had a positive correlation with alcohol intoxication (r = 0.596, p = 0.007) and poor outcomes (r = 0.522, p = 0.004), also, men over 40 years old were more likely to undergo surgery (p = 0.024), meanwhile operated patients suffered more infections (p = 0.011) and more often ended with poor outcomes (p < 0.001). [ABSTRACT FROM AUTHOR]

Brain injuries in warfighters due to low-level blasts, even while wearing a helmet, are common. Understanding how the form of a shock wave changes when impacting a head donning a helmet may present solutions to reducing shock loading on the head, thereby reducing the prevalence of blast-induced traumatic brain injury. A manikin with PCB piezoelectric transducers throughout the head was exposed to low-pressure free-field blasts using an RDX-based explosive charge designed to output a side-on overpressure of 4 pounds per square inch (psi) [27.5 kilopascals (kPa)] with and without a helmet. Orientations of 0, 45, 90, 135, and 180 degrees were evaluated to observe changes in overpressure versus time (p(t)) waveforms. The waveforms were compared to schlieren imagery in which a shock wave impacted 3D-printed silhouettes of a warfighter donning a helmet, showing shock wave flow under the helmet at 0-, 90-, and 180-degree orientations. It was found that trapped shock waves under the helmet create regions of high overpressure and increase the duration of exposure, resulting in higher impulses imparted onto the head. While wearing a helmet, the 90-degree orientation resulted in the greatest reduction in overall peak overpressure, with an 8% decrease compared to the 0-degree orientation. In contrast, the 180-degree orientation led to an increase by 30%. For impulse, the 90-degree orientation showed the greatest reduction, with a decrease of 21%. The 0-degree orientation had the highest overall impulse among all orientations when wearing a helmet. [ABSTRACT FROM AUTHOR]

This paper presents here a novel electrical sensor for detecting alcohol concentration in the exhale of an individual. We highlight fabrication of the sensor followed by subsequent assemblage into a handheld unit. The prototype yields a remarkable sensitivity along with a linear range of ~ 250–800 ppm. Additionally, we demonstrate the implementation of it in the helmet of a biker—which is further validated by in situ results related to monitoring exhale activity of few subjects. Through proper tuning with the ignition control system, the prototype can act as a protective gear for drunken drivers. Once the concentration of alcohol is sensed above a permissible level, the ignition system can be momentarily stopped; thereby averting plausible accidents. We believe that this sensor can be upgraded to more advanced protocol via a little tweaking with Internet of Things. [ABSTRACT FROM AUTHOR]

Purpose: To provide additional information on optimal start times and therapeutic effectiveness based on treatment outcome of Japanese infants with positional plagio- and brachycephaly (PPB) receiving cranial molding helmet therapy (CMHT). Methods: In this retrospective cohort study, data from a 3D head scanning system was analyzed from 2173 Japanese infants who completed CMHT. Anterior and posterior symmetry ratio (ASR and PSR) and longitudinal to transverse diagonal ratios (LD/TDR) were calculated based on skull shape at helmet design and at completion of therapy. The outcomes were evaluated using the regression analysis and a predictive model using cranial parameters was developed. Results: The earlier the start of therapy, the greater the therapeutic effect on ASR, PSR, and LD/TDR (ASR, −0.134 percent points (ppt)/day; PSR, −0.086 ppt/day; and LD/TDR, −0.131 ppt/day). In the predictive model, in addition to starting age of the therapy, sex (male), the degree of deformity of the head (DoD) (moderate and severe), quadrant volume, PSR, and head circumference at the start of treatment also had a positive effect on changes in ASR, DoD (moderate and severe), ASR, LD/TDR and transverse diameter for PSR, sex (male), DoD (moderate), quadrant volume, PSR, and head circumference for LD/TDR. Conclusion: The starting age of therapy had a relatively smaller contribution to outcome effects. Applying the cranial parameter obtained at the start of treatment to the predictive model helps to predict the effect of CMHT and whether PPB can be treated with CMHT in infants of older age. [ABSTRACT FROM AUTHOR]

Background: Noninvasive ventilation (NIV) is commonly used in clinical practice to reduce intubation times and enhance patient comfort. However, patient-ventilator interaction (PVI) during NIV, particularly with helmet interfaces, can be challenging due to factors such as dead space and compliance. Neurally adjusted ventilatory assist (NAVA) has shown promise in improving PVI during helmet NIV, but limitations remain. A new mode, neural pressure support (NPS), aims to address these limitations by providing synchronized and steep pressurization. This study aims to assess whether NPS per se improves PVI during helmet NIV compared to standard pressure support ventilation (PSV). Methods: The study included adult patients requiring NIV with a helmet. Patients were randomized into two arms: one starting with NPS and the other with PSV; the initial ventilatory parameters were always set as established by the clinician on duty. Physiological parameters and arterial blood gas analysis were collected during ventilation trials. Expert adjustments to initial ventilator settings were recorded to investigate the impact of the expertise of the clinician as confounding variable. Primary aim was the synchrony time (Timesync), i.e., the time during which both the ventilator and the patient (based on the neural signal) are on the inspiratory phase. As secondary aim neural-ventilatory time index (NVTI) was also calculated as Timesync divided to the total neural inspiratory time, i.e., the ratio of the neural inspiratory time occupied by Timesync. Results: Twenty-four patients were enrolled, with no study interruptions due to safety concerns. NPS demonstrated significantly longer Timesync (0.64 ± 0.03 s vs. 0.37 ± 0.03 s, p < 0.001) and shorter inspiratory delay (0.15 ± 0.01 s vs. 0.35 ± 0.01 s, p < 0.001) compared to PSV. NPS also showed better NVTI (78 ± 2% vs. 45 ± 2%, p < 0.001). Ventilator parameters were not significantly different between NPS and PSV, except for minor adjustments by the expert clinician. Conclusions: NPS improves PVI during helmet NIV, as evidenced by longer Timesync and better coupling compared to PSV. Expert adjustments to ventilator settings had minimal impact on PVI. These findings support the use of NPS in enhancing patient-ventilator synchronization and warrant further investigation into its clinical outcomes and applicability across different patient populations and interfaces. Trial registration: This study was registered on www.clinicaltrials.gov NCT06004206 Registry URL: https://clinicaltrials.gov/study/NCT06004206 on September 08, 2023. [ABSTRACT FROM AUTHOR]

The article discusses the use of helmets as an interface for delivering positive end expiratory pressure (PEEP), high FiO2, and non-invasive ventilation (NIV) to hypoxic patients, particularly during the COVID-19 pandemic. Helmets consist of a plastic hood sealed around the patient's neck and have separate ports for inflow and outflow gases. Different configurations and options are available for helmet-delivered ventilator support. The article highlights the importance of adequate flow to prevent CO2 rebreathing and discusses the mechanical properties of PEEP valves. It also mentions the use of humidified gases for patient comfort. The article cites several studies that compare the use of helmets with other ventilation methods and concludes that helmets can be a valuable tool in the treatment of acute respiratory failure, but proper application and patient selection are crucial for success. [Extracted from the article]

Scaphocephaly is the most common type of craniosynostosis and various surgical techniques are used for treatment. Due to late postoperative changes of the head shape, long-term outcome data is important for evaluating any new surgical technique. At our institution, minimally invasive strip craniectomy without regular helmet therapy is the standard treatment in scaphocephalic patients. Between October 2021 and February 2023, we retrospectively examined the skull shape of patients who underwent minimally invasive strip craniectomy for scaphocephaly using a 3D surface scan technique. The cephalic index (CI), the need for helmet therapy and additional cosmetic outcome parameters were investigated. We included 70 patients (72.5% male). The mean follow-up time was 46 (10–125) months and the mean CI was 75.7 (66.7–85.2). In 58 patients, the final cosmetic result was rated as "excellent/good" (mean CI: 76.3; 70.4–85.0), in 11 as "intermediate" (mean CI: 73.3; 66.7–77.6), and in one case as "unsatisfactory" (CI 69.3). The presence of a suboccipital protrusion was associated with a "less than good" outcome. The CI correlated significantly with the overall outcome, the presence of frontal bossing, and the interval between scan and surgery (age at scan). Minimally invasive strip craniectomy is an elegant and safe method to correct scaphocephaly. Our data show good cosmetic results in the long term even without regular postoperative helmet therapy. [ABSTRACT FROM AUTHOR]

Purpose: To the best of our knowledge, this is the first study conducted in Tunisia on the neurosurgical management of child cranial trauma. The objectives of the present work were to identify the causes of pediatric head injuries, explore epidemiological and clinical specificities, and analyze the short- and long-term postoperative evolution. Methods: A retrospective review was conducted on one hundred children with head injuries over a five-year period at one of the largest neurosurgery departments in Tunisia. The collected data encompassed demographic information, clinical presentation features, neuroimaging characteristics, surgical management, complications, and outcomes. Results: Over a five-year period, we have found 118 children who have undergone surgery, representing an annual incidence of twenty-four children per year. The average age was 10 years. Falls emerged as the primary cause of childhood head injuries in our series, followed by road traffic accidents. The most frequently encountered initial sign was the loss of consciousness (52%), followed by headaches (28%), vomiting (25%), and seizures (8%). The average time between the accident and admission to the operating unit was 10 h. Various neurosurgeries were performed, with the evacuation of an epidural hematoma being the most common procedure. At a median follow-up of 24 months, the outcomes were favorable in 88% of cases. Conclusion: The main prognostic factors for head trauma in children included age, circumstances of the accident, association with polytrauma, the initial Glasgow Coma Scale, the nature of the initial cerebral lesions, and the timeliness and quality of initial management. [ABSTRACT FROM AUTHOR]

Purpose: The objective was to determine the incidence of surgically treated chronic subdural hematoma (cSDH) within six months after head trauma in a consecutive series of head injury patients with a normal initial computed tomography (CT). Methods: A total of 1941 adult patients with head injuries who underwent head CT within 48 h after injury and were treated at the Tampere University Hospital's emergency department were retrospectively evaluated from medical records (median age = 59 years, IQR = 39–79 years, males = 58%, patients using antithrombotic medication = 26%). Patients with no signs of acute traumatic intracranial pathology or any type of subdural collection on initial head CT were regarded as CT negative (n = 1573, 81%). Results: Two (n = 2) of the 1573 CT negative patients received surgical treatment for cSDH. Consequently, the incidence of surgically treated cSDH after a normal initial head CT during a six-month follow-up was 0.13%. Both patients sustained mild traumatic brain injuries initially. One of the two patients was on antithrombotic medication (warfarin) at the time of trauma, hence incidence of surgically treated cSDH among patients with antithrombotic medication in CT negative patients (n = 376, 23.9%) was 0.27%. Additionally, within CT negative patients, one subdural hygroma was operated shortly after trauma. Conclusion: The extremely low incidence of surgically treated cSDH after a normal initial head CT, even in patients on antithrombotic medication, supports the notion that routine follow-up imaging after an initial normal head CT is not indicated to exclude the development of cSDH. Additionally, our findings support the concept of cSDH not being a purely head trauma-related disease. [ABSTRACT FROM AUTHOR]

This paper focuses on the problem of motorcyclist helmet detection in single images. Although some previous works have been developed to deal with this problem, yet most of them are designed for videos and not suitable for single-image helmet detection. In view of this, in this paper, we propose a novel dual-detection framework for single-image motorcyclist helmet detection with multi-head self-attention. Particularly, two types of detectors are first trained, namely the rider detector and the head-shoulder detector, which are jointly leveraged in the dual-detection scheme. To take advantage of the contextual relevance information, the multi-head self-attention mechanism is incorporated, where multiple self-attention layers are integrated to capture the complex relationships among the input features so as to further enhance the detection accuracy. A new benchmark dataset, termed the SCAU helmet detection on motorcyclists (SCAU-HDM) dataset, is presented, which consists of 8000 training images and 2000 test images. Extensive experiments on the benchmark dataset demonstrate the effectiveness of the proposed framework. The code is available at https://github.com/LiChunHong2020/SCAUHDM. [ABSTRACT FROM AUTHOR]

Equestrian sports are popular around the world; however, sustaining injuries can occur, with the most common catastrophic injury events involving the head. Helmets are used to help reduce the risk of head and brain injury; however, the rates of concussion remain unaffected. Recently, technology designed to reduce the rotational accelerations associated with concussion have been incorporated into equestrian helmets, but it is unknown the efficacy of these technologies under the impact conditions within this sporting environment. The purpose of this research was to investigate the efficacy of rotational technology in managing linear and rotational acceleration, rotational velocity, and predicted maximum principal strain of the brain using a test protocol representative of equestrian fall events. Helmets with and without rotational technology were fitted to a Hybrid III headform and impacted under conditions that simulated the helmet loading characteristics of falling in equestrian sports. The resulting linear and rotational acceleration time histories from the headform was then used for finite element modeling to predict the strain to the brain tissues. The helmets that included rotational technology did lead to a significant reduction in the peak resultant rotational accelerations and rotational velocity at the rear boss location, and a reduction in strain for the side location under the high-compliance condition. The results from the present study show that the helmet with rotational technology worked under certain impact conditions; however, it is not a universal improvement. [ABSTRACT FROM AUTHOR]

Bicycles are an eco-friendly mode of transportation, and in the capital city of South Korea, Seoul, efforts are being made to encourage citizens to use bicycles. However, without appropriate safety measures, these efforts can lead to an increase in bicycle-related traffic accidents. To promote bicycle usage while ensuring safety, this study identified various factors that influence bicycle accidents. Data were utilized that had not been properly considered in previous bicycle accident-related studies, including slope and the level of public transportation services. By considering the factors influencing bicycle traffic accidents, various models were constructed, and through comparisons of statistical indicators, the optimal model was selected geographically weighted negative binomial regression. Ultimately, three significant conclusions to ensure bicycle safety were drawn. First, across all areas of Seoul, an increase in road slope leads to a decrease in bicycle-related accidents. Furthermore, for certain Traffic Analysis Zones (TAZs), as the number of local buses (or neighborhood/community buses) increases, the bicycle traffic volume decreases, resulting in a reduction in bicycle accidents. Lastly, for some TAZs, an increase in bicycle lanes to be installed into the roadway was associated with an increase in bicycle accidents. [ABSTRACT FROM AUTHOR]

The increased number of accidents involving UAVs striking people has caused great societal concern. Therefore, it is necessary to study the threat potential and severity of ground collision accidents of UAVs. This study analyzed the head and neck injury risk resulting from the impact of medium-mass UAVs. First, the finite element (FE) model of the M200-Hybrid III 50th dummy was established, in which the M200 itself had been validated against drop tests, and then the M200-Hybrid III 50th model was validated based on the experimental data of the M200 impacting on the dummy head. High consistency between the simulations and the experiments was observed. Second, simulations were conducted to analyze the head and neck injury severity at different impact speeds, angles, and locations of the M200. As the impact speed increases, HIC15 increases exponentially and N ij increases linearly. It is found that the critical speed range causing injury for both vertical and horizontal impacts is 7–9 m/s. As the impact angle increases, HIC15 varies in the form of the sum of an inverse proportional function and a linear function, and N ij increases in the form of the sum of power and quadratic function. In addition, the battery-first and the top of mainframe impacts lead to the highest probability of head and neck injury among different impact locations, while the landing gear-first is the lowest. Finally, a biomechanical model (THUMS) was incorporated to develop the M200-THUMS model to study the tissue-level injury of the head and neck under different impact conditions. The simulation results show that neck is prone to ligament injury under vertical impact, while the skull is more likely to be fractured under horizontal impact. [ABSTRACT FROM AUTHOR]

Optically pumped magnetometers (OPM) are a new technology that has shown promise in the diagnosis and presurgical workup of focal epilepsy. OPM-MEG sensors operate at room temperature and offer portability and quicker data acquisition compared to traditional SQUID-MEG sensors. Several studies have demonstrated the effectiveness of OPM-MEG in detecting abnormal neural activity in epilepsy patients, with similar results to EEG and SQUID-MEG. OPM-MEG has the potential to be a valuable clinical tool in the field of neurophysiology, although further research and development are needed. [Extracted from the article]

The continuous development of smart industrial parks has imposed increasingly stringent requirements on safety helmet detection in environments such as factories, construction sites, rail transit, and fire protection. Current models often suffer from issues like false alarms or missed detections, especially when dealing with small and densely packed targets. This study aims to enhance the YOLOv5 target detection method to provide real-time alerts for individuals not wearing safety helmets in complex scenarios. Our approach involves incorporating the ECA channel attention mechanism into the YOLOv5 backbone network, allowing for efficient feature extraction while reducing computational load. We adopt a weighted bi-directional feature pyramid network structure (BiFPN) to facilitate effective feature fusion and cross-scale information transmission. Additionally, the introduction of a decoupling head in YOLOv5 improves detection performance and convergence rate. The experimental results demonstrate a substantial improvement in the YOLOv5 model's performance. The enhanced YOLOv5 model achieved an average accuracy of 95.9% on a custom-made helmet dataset, a 3.0 percentage point increase compared to the original YOLOv5 model. This study holds significant implications for enhancing the accuracy and robustness of helmet-wearing detection in various settings. [ABSTRACT FROM AUTHOR]

Very few clinical entities have undergone so many different treatment approaches over such a short period of time as craniosynostosis. Surgical treatments for this condition have ranged from simple linear craniectomies, accounting for the specific role of cranial sutures in assuring the normal growth of the skull, to more complex cranial vault reconstructions, based on the perceived role of the skull base in affecting the growth of the skull. While a great deal of evolution has occurred, there remains controversy regarding the ideal treatment including the best surgical technique, the optimal age for surgery, and the long-term morphological and neurodevelopmental outcomes. The evolution of the surgical management of craniosynostosis in the last 50 years has been affected by several factors. This includes the awareness of needing to operate on affected children during infancy to achieve the best results, the use of multistage operations, the availability of more sophisticated surgical tools, and improved perioperative care. In some forms of craniosynostosis, the operations can be carried out at a very young age with low morbidity, and with the postoperative use of a molding helmet, springs, or distractors, these operations prove to be as effective as traditional larger cranial reconstructions performed in older children. As a consequence, complex surgical operations have become progressively less utilized. A second relevant advance was the more recent advent of a molecular diagnosis, which allowed us to understand the pathogenesis of some associated malformations and neurodevelopmental issues that were observed in some children despite appropriate surgical treatment. Future research should focus on improving the analysis of longer-term outcomes and understanding the natural history of craniofacial conditions, including what issues persist despite optimal surgical correction. Progress in molecular investigations concerning the normal and pathological development of cranial sutures could be a further significant step in the management of craniosynostosis, possibly favoring a "medical" treatment in the near future. Artificial intelligence will likely have a role in establishing the diagnosis with less reliance on radiographic studies and in assisting with surgical planning. Overall, much progress has been made, but there remains much to do. [ABSTRACT FROM AUTHOR]

In order for the offshore drilling platform to operate properly, workers need to perform regular maintenance on the platform equipment, but the complex working environment exposes workers to hazards. During inspection and maintenance, the use of personal protective equipment (PPE) such as helmets and workwear can effectively reduce the probability of worker injuries. Existing PPE detection methods are mostly for construction sites and only detect whether helmets are worn or not. This paper proposes a high-precision and high-speed PPE detection method for the offshore drilling platform based on object detection and classification. As a first step, we develop a modified YOLOv4 (named RFA-YOLO)-based object detection model for improving localization and recognition for people, helmets, and workwear. On the basis of the class and coordinates of the object detection output, this paper proposes a method for constructing position features based on the object bounding box to obtain feature vectors characterizing the relative offsets between objects. Then, the classifier is obtained by training a dataset consisting of position features through a random forest algorithm, with parameter optimization. As a final step, the PPE detection is achieved by analyzing the information output from the classifier through an inference mechanism. To evaluate the proposed method, we construct the offshore drilling platform dataset (ODPD) and conduct comparative experiments with other methods. The experimental results show that the method in this paper achieves 13 FPS as well as 93.1% accuracy. Compared to other state-of-the-art models, the proposed PPE detection method performs better on ODPD. The method in this paper can rapidly and accurately identify workers who are not wearing helmets or workwear on the offshore drilling platform, and an intelligent video surveillance system based on this model has been implemented. [ABSTRACT FROM AUTHOR]

Despite electric scooter use has proliferated in Italy since 2019, actionable data regarding injury incidence and patterns associated with electric scooter accidents are limited. This study aims at analyzing the rate, clinical, and demographic features of electric scooter accidents accessed to the Emergency Department (ED) of Fondazione Policlinico Universitario A. Gemelli IRCSS (Rome, Italy). This retrospective study included all patients older than 18 years riding an electric scooter in the ED from June 2019 to April 2022. Personal data, injury circumstances, helmet use, and health data were collected. Abbreviated Injury Scale (AIS) codes of all diagnoses were recorded, and the Injury Severity Score (ISS) was calculated for each patient. The analysis includes 92 patients admitted to the ED due to an e-scooter accident during the study period, with an increase in years. Thirty-two patients presented bone fractures especially concerning the extremities and the face districts. The median Injury Severity Score in the study cohort was 3, with the highest AIS represented by AIS Pelvic-Extremity and AIS External. Moreover, statistical significance was found between AIS Head-Neck and severity of trauma. E-scooters have become a familiar sight in cities worldwide recently, with many new companies renting them for use. But their arrival has also brought new safety concerns. Although most injuries reported are minor, the meager rate of helmet use is critical. Implementing compulsory helmet use for electric scooters for all ages could be a protective factor for being patient with head trauma on urban streets. [ABSTRACT FROM AUTHOR]

An early childhood skull deformity can have long-term health and aesthetic consequences for the growing toddler. Individual helmet therapy aims at a healthy growth of the skull shape, although not every helmet shape guarantees an optimal result. To ensure an optimal fit, a scanning procedure based on a hand-held surface scanner was evaluated. The new helmet orthosis has an inner layer adapted to the shape of the head, which can be exchanged depending on the growth stage without changing the outer layer. In collaboration with surgeons and engineers, a new helmet orthosis concept was developed that is intended to offer improvements in wearing comfort, overall weight, fit and user-friendliness compared to conventional systems. In the course of the development process and in constant exchange with parents, a multi-layer helmet system with generous perforations was created using additive manufacturing processes. The new helmet shape promises easier handling, especially through the closure system. The helmet shape developed in this study is of high quality, especially in terms of fitting accuracy. Unpleasant perspiration is significantly reduced. The integration of the closure as a direct component of the helmet represents a secure closure option. [ABSTRACT FROM AUTHOR]

Gillies method is widely used for zygomatic arch fractures. Many modifications were suggested over time but Gillies method is still carry on popularity. Seventeen patients with isolated zygomatic arch fractures who were treated with Gillies method between 2016 and 2021 were included in this study. All patients were male and the mean age was 23 years (20–32). All operations were performed under sedation anesthesia. All patients healed uneventfully. Only one transient frontal branch of facial nerve paralysis was seen in the follow-up. Etiology of zygomatic arc fractures were sports injury in 9 patients (53%), motorcycle accident in 3 patients (17.6%), assault in 3 patients (17.6), and sencop in 2 patients (11.7%). Zygomatic arch fractures were located on left zygomatic arch in 13 patients (76.5%), right zygomatic arch in 4 patients (23.5%). Eleven patients (64.7%) were operated in 1 week and 6 patients were operated on the second week (35.3%) after the injury. We think that Gillies method is still very useful in the treatment of isolated zygomatic arch fractures. Level of evidence: Level V, Therapeutic study. [ABSTRACT FROM AUTHOR]

The development of ground motion models is an essential part of seismic hazard analysis. Based on the stochastic finite-fault method, this study conducted a scenario-based seismic hazard analysis of the Moxi fault. Because of the variability in amplification coefficients caused by the complex terrain, a genetic algorithm based on four previous earthquakes was used to identify site amplification. The simulations of the Ms 6.8 Luding earthquake in 2022 indicated that the correction of site amplification effectively reduced the model deviation and resulted in a close match between the simulated 5%-damped spectral acceleration and the observations. Subsequently, utilizing the calibrated input parameters and a hybrid source model, the ground motion of the Mw 7.1 scenario earthquake was synthesized to reflect uncertainties in the source parameters. To represent the dynamic properties of the structures, effective peak acceleration was used as a ground motion intensity measure. The source model with the synthetic effective peak acceleration closest to the average simulation result from 30 hybrid source models was selected and used to generate a seismic hazard map for the entire area. The prediction of earthquake scenarios provides a basis for earthquake disaster loss evaluation and seismic fortification of engineering structures. [ABSTRACT FROM AUTHOR]

Acute subdural hematoma is a frequent complication of high-energy head injuries. Herein, we report an unusual case of this condition that occurred in a young footballer after he head-balled a football. A 37-year-old footballer, during a match, jumped and gave a head shot on the ball. Upon landing, he felt severe headaches forcing him out of the stadium. About 4 h later, he lost consciousness and went into a coma. After resuscitation, he remained clouded, with cephalalgia and had left hemiparesis. The performed brain scan revealed an acute right fronto-parietal subdural hematoma and the patient benefited from craniotomy surgery in our department with simple postoperative suites. The authors, after a brief discussion of the biomechanics of this serious condition, ask all the actors of this very popular sport, to consider the possibility of occurrence of this condition in players. [ABSTRACT FROM AUTHOR]

The complexity of infrastructure scenarios has led to a sustained increase in the global number of worksites related fatalities and injuries. Therefore, safety helmets play an essential role in protecting construction workers from accidents. It is essential to detect whether the helmets are correctly worn on the heads for smart construction site. However, due to the complex construction environments, it is challenging to precisely detect safety helmet wearing in real-time. This paper proposes an enhanced version of You Only Look Once version 5 (YOLOv5) to improve the detection accuracy, where bi-directional feature pyramid network (BiFPN), attention mechanism, and transfer learning are fully integrated. The BiFPN is taken to replace the original feature pyramid network (FPN) via adding additional cross layer edges with adaptive connecting weights. Attention mechanism is added after the end of backbone and neck network to let the network pay more attention on the interested region. Transfer learning is adopted for model training. The model is pre-trained by a head detection database and then fine-tuned by the helmet database. The proposed enhanced YOLOv5 is tested on a public GDU-HWD dataset, where both helmet and its color can be identified. This study achieves the accuracy at 93.3%, which is 4.8% higher than that of the original YOLOv5, but does not bring in much computing burden to the network. It is believed that the enhance version can also be successfully used in other similar detection tasks. [ABSTRACT FROM AUTHOR]

Standards and Codes of Practice for designing new constructions and for assessing and strengthening existing ones are usually based on uniform hazard maps, where different Limit States (LSs) are associated with different hazard-exceedance probabilities. This approach yields non-homogeneous LS-exceedance probabilities across a territory, thus failing to achieve the goal of uniform risk throughout a territory. Such lack of uniformity stems from estimating the probability of failure using capacity and demand models. If the capacity of new constructions—or the capacity increase of strengthened existing constructions—are designed based on a prescribed hazard-exceedance probability, then the seismic risk depends on both the structure (depending on the design philosophy and corresponding design objectives), through the capacity model, and the location, through the hazard model. The aim of this study is threefold. First, it provides a seismic probability assessment formulation and a risk-targeted intensity measure based on a linear model in log–log coordinates of the hazard, under the assumption of log-normal capacity and demand. The proposed framework introduces a factor that multiplies the code hazard-based demand to account either for intentional (from design) over-capacity or for undesired (e.g., in existing constructions) under-capacity. Second, this paper shows an application to peak ground accelerations in Europe considering parameters taken from Standards and Codes of Practice. The developed framework is used to determine the risk-target levels of peak ground acceleration used for design in Europe, for both new and existing constructions. Third, the obtained target risk levels are used to determine a risk-based intensity modification factor and a risk-based mean return period modification factor, which can be readily implemented in current Standards to achieve risk-targeted design actions, with equal LS-exceedance probability across the territory. The framework is independent of the chosen hazard-based intensity measure, be it the commonly used peak ground acceleration or any other measure. The results highlight that in large areas of Europe the design peak ground acceleration should be increased to achieve the proposed seismic risk target and that this is particularly significant for existing constructions, given their larger uncertainties and typical low capacity with respect to the code hazard-based demand. [ABSTRACT FROM AUTHOR]

To mitigate the risk of injuries, many countries recommend bicycle helmets. The current paper seeks to examine the effectiveness of bicycle helmets by performing a systematic review focusing on meta-analyses. First, the current paper explores the findings of studies that employ meta-analyses using bicycle crash data. Second, the results are discussed considering the findings from research analyzing bicycle helmet effectiveness in a laboratory using simulation, and then are complemented with key methodological papers that address cycling and the overall factors contributing to the injury severity. The examined literature confirms that wearing a helmet while cycling is beneficial, regardless of age, crash severity, or crash type. The relative benefit is found to be higher in high-risk situations and when cycling on shared roads and particularly preventing severe head injuries. The results from the studies performed in laboratories also suggest that the shape and size of the head itself play a role in the protective effects of helmets. However, concerns regarding the equitability of the test conditions were found as all reviewed studies used a fifty-percentile male head and body forms. Lastly, the paper discusses the literature findings in a broader societal context. [ABSTRACT FROM AUTHOR]

This study presents the validation of a multi-camera videogrammetry approach for measuring football helmet impact velocities, wherein the effect of camera angle, camera distance and impact speed were assessed. Helmet-to-ground impacts were simulated within two zones on a field using free fall drop tests of a helmeted head and neck assembly at heights of 1.04 m (slow: 4.52 m/s) and 1.83 m (fast: 5.99 m/s). Helmet motion was manually tracked using 3D motion analysis software for different camera combinations (e.g., orthogonal, coincident, overhead, and parallel camera pairs) in each zone. Maximum errors of the 3D calibrations were < 3 cm; mean maximum uncertainty (±) error for 3D tracking was ≤ 2.4 cm across all test conditions, except parallel angles (4.3–10.0 cm). Helmet impact velocities from orthogonal, coincident and overhead angles compared favorably to the reference velocities (slow: 4.50 ± 0.05 m/s; fast: 6.09 ± 0.06 m/s) with relatively low errors overall (relative error (RE), absolute error (AE): ≤ 3.39%; root-mean-square error (RMSE): ≤ 0.22 m/s). Parallel angles had the highest errors (RE, AE: 3.79–10.94%; RMSE: 0.18–0.55 m/s) due to inaccuracies with horizontal measurements in-line with the camera views. In general, increases in camera distance and impact speed did not appreciably influence video tracking accuracy. [ABSTRACT FROM AUTHOR]

Objective: Despite the continuous development of occupational safety, the prevalence of work-related head injuries is excessive. To promote prevention, we conducted a study evaluating the risks and pathways that precede head injuries in different economic activity sectors. Methods: In Finland, more than 90% of employees are covered by inclusive statutory workers' compensation. We obtained data on occupational head injuries in 2010–2017 from an insurance company database. The European Statistics on Accidents at Work (ESAW) variables represented the characteristics of the accidents and the injury. We analysed the risk factors, contributing events and injury mechanisms in 20 industry sectors, based on the Statistical Classification of Economic Activities in the European Community (NACE). Results: In the 32,898 cases, the most commonly affected area was the eyes (49.6%). The highest incidence of head injuries was in construction (15.7 per 1000 insurance years). Construction, manufacturing, and human health and social work activities stood out due to their distinctive ESAW category counts. 'Working with hand-held tools' [risk ratio (RR) 2.23, 95% confidence interval (CI) 2.14–2.32] in construction and 'operating machines' (RR 3.32, 95% CI 3.01–3.66) and 'working with hand-held tools' (1.99, 1.91–2.07) in manufacturing predicted head injury. The risk related to parameters of violence and threats in health and social work activities was nearly ninefold the risk of other sectors. Conclusion: The risks and pathways preceding head injuries varied considerably. The highest head injury rates were in construction and manufacturing. Violence emerged as a major risk factor in human health and social work activities. [ABSTRACT FROM AUTHOR]

At construction sites, wearing hard hats is an important and effective measure to protect workers from accidental injury. In order to remind workers to wear hard hats at all times, it is necessary to automate the detection process of hard hat-wearing. Limited to the environment, human posture, personal privacy and other elements, traditional detection methods often cannot detect the wearing of hard hats in a handy and quick manner. In the paper, an improved deep learning model based on yolov4 is proposed to detect hard hat-wearing. The accuracy and speed of the model are optimized by replacing the cumbersome overlapping of multiple convolution modules in the feature pyramid of yolov4 with cross-stage hierarchy modules. At the same time, since hard hat detection is to detect small targets, we improve the performance of yolov4 to detect small targets by changing the yolov4 feature layer output and linear transformation of anchors. The final algorithm obtains a mean average precision of 93.37% in hard hat detection, with an increase of 3.15% compared with that of the original yolov4. [ABSTRACT FROM AUTHOR]

This review presents an overview of the design and functionality of protective headgear, including its components and their ability to protect against low- and high-velocity impacts. It discusses the transmission of load from the helmet to the head, as well as the biomechanics involved. This insight provides a comprehensive understanding of the effect that head trauma can have on the tolerance limits and thresholds of protective headgear. Furthermore, the fundamental elements of the helmet and its primary function are discussed. The review focuses on the use of various textile preforms in the design of helmet shells and liners to enhance protection. It explores the use of innovative materials such as shear thickening fluid, ZnO nanorods, polymeric coatings, and graphene to improve impact performance. Additionally, various energy-absorbing materials, including lattice structures, bioinspired structures, shape-changing materials, and honeycomb-based structures, are discussed to improve energy absorption. The purpose of this review is to offer a comprehensive overview of the topic and suggest new ideas for designing protective helmets to enhance their protection performance. [ABSTRACT FROM AUTHOR]

This study evaluated the long-term myopia control effect and safety in children wearing Defocus Incorporated Multiple Segments (DIMS) spectacle lenses. Participants who completed the 2-year RCT were followed for a total of 6 years; their cycloplegic refractions and axial length were measured. Group 1 (n = 36) wore DIMS spectacles for 6 years; Group 2 (n = 14) wore DIMS lens for the first 3.5 years and SV spectacles afterwards; Group 3 (n = 22) wore SV spectacles in the first 2 years and switched to DIMS; Group 4 (n = 18) wore SV spectacles in the first 2 years, switched to DIMS for 1.5 years and then SV spectacles again. Group 1 showed no significant differences in myopia progression (− 0.52 ± 0.66 vs. − 0.40 ± 0.72D) and axial elongation (0.32 ± 0.26 vs. 0.28 ± 0.28 mm, both p > 0.05) between the first and the later 3 years. In the last 2.5 years, DIMS lens groups (Groups 1 and 3) had less myopia progression and axial elongation than the single vision groups (Groups 2 and 4). There was no evidence of rebound after stopping the treatment. Post-wear visual functions in all groups were within norms. The results supported that DIMS lenses provided sustained myopia control without adverse effects over the 6-year study period. Trial registration: clinicaltrials.gov; NCT02206217. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this study was to investigate the biomechanics of endoscopically assisted strip craniectomy treatment for the management of sagittal craniosynostosis while undergoing three different durations of postoperative helmet therapy using a computational approach. Methods: A previously developed 3D model of a 4-month-old sagittal craniosynostosis patient was used. The strip craniectomy incisions were replicated across the segmented parietal bones. Areas across the calvarial were selected and constrained to represent the helmet placement after surgery. Skull growth was modelled and three variations of helmet therapy were investigated, where the timings of helmet removal alternated between 2, 5, and 8 months after surgery. Results: The predicted outcomes suggest that the prolonging of helmet placement has perhaps a beneficial impact on the postoperative long-term morphology of the skull. No considerable difference was found on the pattern of contact pressure at the interface of growing intracranial volume and the skull between the considered helmeting durations. Conclusion: Although the validation of these simulations could not be performed, these simulations showed that the duration of helmet therapy after endoscopically assisted strip craniectomy influenced the cephalic index at 36 months. Further studies require to validate these preliminary findings yet this study can lay the foundations for further studies to advance our fundamental understanding of mechanics of helmet therapy. [ABSTRACT FROM AUTHOR]

Introduction: Despite increasing vaccination rates, new viral variants of SARS-CoV-2 (severe acute respiratory syndrome coronavirus type 2) are advancing the COVID 19 (coronavirus disease 2019) pandemic and continue to challenge the entire world. Surgical care of SARS-CoV-2 positive patients requires special protective measures. We hypothesized that "COVID-19" personal protective equipment (PPE) during surgery of SARS-CoV-2 positive or potentially positive patients would negatively affect the surgeon and thus the surgical outcome. Materials and methods: Ten experienced trauma surgeons participated in the study. Each surgeon performed two simulated surgeries of a distal tibial fracture on a Sawbone® under standardized conditions either wearing regular PPE or special COVID-19 PPE. Baseline values at rest were acquired for heart rate, blood pressure, saturation of peripheral oxygen (SpO2), respiratory rate and capillary blood gas (CBG) analysis including capillary partial pressure of oxygen (pO2) and carbon dioxide (pCO2), followed by four different standardized tests of attentional performance (TAP). Subsequently, the surgeon performed the first surgery according to a randomly determined order, with regular or COVID-19 PPE conditions in an operation theatre. After each surgery vital signs were acquired and CBG and TAP were performed again. Results: In our simulated surgical procedure heart rate, respiratory rate, systolic and diastolic blood pressure did not show relevant differences. Percutaneously measured SpO2 decreased with additional layers of PPE, while CBG parameters were not affected. TAP tests showed a significant impairment of attention if PPEs were compared to the baseline, but both PPEs had similar results and no meaningful differences could be measured. Conclusions: According to our results, for surgical procedures additional PPE required during COVID-19 pandemic does not relevant affect the surgeon's mental and physical performance. Surgeries under COVID-19 PPE conditions appear safe and do not increase patient risk. Level of evidence: Level I. [ABSTRACT FROM AUTHOR]

Helmet noninvasive ventilation has been used in patients with acute hypoxemic respiratory failure for over two decades, and its use has increased during the coronavirus disease 19 (COVID-19) pandemic [[1]]. In Helmet-COVID, a median PEEP of 10 cmH SB 2 sb O was applied in patients who received the helmet noninvasive ventilation and patients in the control group who received mask noninvasive ventilation. Although reporting the duration before enrollment may have not been standardized across the three trials, patients in the HENIVOT and Patel et al. appear to have studied interventions applied within a shorter time compared to the HELMET-COVID. The HENIVOT trial ( I n = i 109) compared helmet noninvasive ventilation with high-flow nasal oxygen (HFNO) in patients with acute respiratory failure due to COVID-19. [Extracted from the article]

Safety helmets can effectively prevent accidental head injuries to construction personnel. Helmet wearing detection is of great significance to the safety management of the construction site. The existing detection algorithms are difficult to detect small targets and dense targets, and the target occlusion and complex and changeable construction environment will reduce the detection accuracy. To solve the above problems, an intelligent helmet recognition system is designed, which combines multi-target tracking algorithm DeepSort and YOLOv5 detector. Firstly, the target bounding box is extracted by YOLOv5 algorithm and input into DeepSort framework. Further, the target trajectory prediction and tracking are realized by Kalman filter and Hungarian Algorithm. The actual test results on the complex construction sites show that the helmet recognition system based on YOLOv5 and DeepSort improves the detection speed and accuracy compared with the single detection algorithm and partial tracking algorithm. The average accuracy of the system is 94.5%, and the detection speed can reach 40fps, basically realizing real-time detection and providing an effective guarantee for the helmet-wearing detection task. [ABSTRACT FROM AUTHOR]

The reconstruction of traffic accidents involving powered two-wheelers (PTWs) frequently proves to be a challenging task. A case in which a fatal head-on crash of a PTW with a small truck where only minor vehicles damage was observed but resulted in isolated fatal chest trauma is discussed here. External examination of the corpse revealed two lacerations on the back, at the first glance implying sharp trauma. Based on the accident traces, the technical expert assumed an emergency break of the PTW rider resulting in a rotation of the PTW in terms of a wheelie on the front wheel. The first contact between the PTW rider and the tail end of the small truck probably occurred with the upper side of the helmet, and then, the back handle of the PTW caused the stab-like injuries followed by compression of the rider between the small truck or asphalt and the PTW. Based on the few accident traces available, neither a reconstruction of the pre-impact velocity nor a detailed reconstruction of the PTW rider kinematics was possible. However, using an interdisciplinary approach, the principal collision position as well as the injury mechanisms could be reconstructed. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate whether helmet noninvasive ventilation compared to usual respiratory support reduces 180-day mortality and improves health-related quality of life (HRQoL) in patients with acute hypoxemic respiratory failure due to COVID-19 pneumonia. Methods: This is a pre-planned follow-up study of the Helmet-COVID trial. In this multicenter, randomized clinical trial, adults with acute hypoxemic respiratory failure (n = 320) due to coronavirus disease 2019 (COVID-19) were randomized to receive helmet noninvasive ventilation or usual respiratory support. The modified intention-to-treat population consisted of all enrolled patients except three who were lost at follow-up. The study outcomes were 180-day mortality, EuroQoL (EQ)-5D-5L index values, and EQ-visual analog scale (EQ-VAS). In the modified intention-to-treat analysis, non-survivors were assigned a value of 0 for EQ-5D-5L and EQ-VAS. Results: Within 180 days, 63/159 patients (39.6%) died in the helmet noninvasive ventilation group compared to 65/158 patients (41.1%) in the usual respiratory support group (risk difference − 1.5% (95% confidence interval [CI] − 12.3, 9.3, p = 0.78). In the modified intention-to-treat analysis, patients in the helmet noninvasive ventilation and the usual respiratory support groups did not differ in EQ-5D-5L index values (median 0.68 [IQR 0.00, 1.00], compared to 0.67 [IQR 0.00, 1.00], median difference 0.00 [95% CI − 0.32, 0.32; p = 0.91]) or EQ-VAS scores (median 70 [IQR 0, 93], compared to 70 [IQR 0, 90], median difference 0.00 (95% CI − 31.92, 31.92; p = 0.55). Conclusions: Helmet noninvasive ventilation did not reduce 180-day mortality or improve HRQoL compared to usual respiratory support among patients with acute hypoxemic respiratory failure due to COVID-19 pneumonia. [ABSTRACT FROM AUTHOR]

Wearing a safety helmet can reduce the accident rate in production and construction, and it is a necessary part of safety production management. At present, the effective supervision of helmet wearing still relies on manual on-site work, which is inefficient and wastes manpower and material resources. Therefore, the automatic supervision of helmet wearing detection is of great significance. Due to the detection difficulties such as small helmet target, complex background and variety of helmet shape with the posture of workers, helmet wearing detection has always been one of the most difficult tasks in the field of computer vision. To address this issue, we propose a novel object detection model based on anchor-free mechanism—Recurrent Bidirectional Feature Pyramid Detector (RBFPDet). Different from most other detection methods, we regard helmet wearing detection as a strong semantic feature points detection task. In order to prove the effectiveness of our method, we conduct control experiment and ablation study on two mainstream safety helmet wearing datasets. The experiment results show that our method significantly improves the accuracy of helmet wearing detection compared with other outstanding detection models in this field and our model can realize real-time detection under complex background. At the same time, we further intuitively illustrate the effectiveness of our method by means of feature map visualization. [ABSTRACT FROM AUTHOR]

To purpose was to assess and compare the health-related quality of life (HRQoL) and risk of depression two years after trauma, between patients with and without traumatic brain injury (TBI) in a mixed Swedish trauma cohort. In this prospective cohort study, TBI and non-TBI trauma patients included in the Swedish Trauma registry 2019 at a level II trauma center in Stockholm, Sweden, were contacted two years after admission. HRQoL was assessed with RAND-36 and EQ-5D-3L, and depression with Montgomery Åsberg depression Rating Scale self-report (MADRS-S). Abbreviated Injury Score (AIS) head was used to grade TBI severity, and American Society of Anesthesiologists (ASA) score was used to assess comorbidities. Data were compared using Chi-squared test, Mann Whitney U test and ordered logistic regression, and Bonferroni correction was applied. A total of 170 of 737 eligible patients were included. TBI was associated with higher scores in 5/8 domains of RAND-36 and 3/5 domains of EQ-5D (p < 0.05). No significant difference in MADRS-S. An AIS (head) of three or higher was associated with lower scores in five domains of RAND-36 and two domains of EQ-5D but not for MADRS-S. An ASA-score of three was associated with lower scores in all domains of both RAND-36 (p < 0.05, except mental health) and EQ-5D (p < 0.001, except anxiety/depression), but not for MADRS-S. In conclusion, patients without TBI reported a lower HRQoL than TBI patients two years after trauma. TBI severity assessed according to AIS (head) was associated with HRQoL, and ASA-score was found to be a predictor of HRQoL, emphasizing the importance of considering pre-injury health status when assessing outcomes in TBI patients. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to investigate if one level of corrective femoral osteotomy (subtrochanteric or supracondylar) bears an increased risk of unintentional implications on frontal and sagittal plane alignment in a simulated clinical setting. Methods: Out of 100 cadaveric femora, 23 three-dimensional (3-D) surface models with femoral antetorsion (femAT) deformities (> 22° or < 2°) were investigated, and femAT normalized to 12° with single plane rotational osteotomies, perpendicular to the mechanical axis of the femur. Change of the frontal and sagittal plane alignment was expressed by the mechanical lateral distal femoral angle (mLDFA) and the posterior distal femoral angle (PDFA), respectively. The influence of morphologic factors of the femur [centrum–collum–diaphyseal (CCD) angle and antecurvatum radius (ACR)] were assessed. Furthermore, position changes of the lesser (LT) and greater trochanters (GT) in the frontal and sagittal plane compared to the hip centre were investigated. Results: Mean femoral derotation of the high-antetorsion group (n = 6) was 12.3° (range 10–17°). In the frontal plane, mLDFA changed a mean of 0.1° (− 0.06 to 0.3°) (n.s.) and − 0.3° (− 0.5 to − 0.1) (p = 0.03) after subtrochanteric and supracondylar osteotomy, respectively. In the sagittal plane, PDFA changed a mean of 1° (0.7 to 1.1) (p = 0.03) and 0.3° (0.1 to 0.7) (p = 0.03), respectively. The low-antetorsion group (n = 17) was rotated by a mean of 13.8° (10°–23°). mLDFA changed a mean of − 0.2° (− 0.5° to 0.2°) (p < 0.006) and 0.2° (0–0.5°) (p < 0.001) after subtrochanteric and supracondylar osteotomy, respectively. PDFA changed a mean of 1° (− 2.3 to 1.3) (p < 0.01) and 0.5° (− 1.9 to 0.3) (p < 0.01), respectively. The amount of femAT correction was associated with increased postoperative deviation of the mechanical leg axis (p < 0.01). Using multiple regression analysis, no other morphological factors were found to influence mLDFA or PDFA. Internal rotational osteotomies decreased the ischial-lesser trochanteric space by < 5 mm in both the frontal and sagittal plane (p < 0.001). Conclusions: In case of femAT correction of ≤ 20°, neither subtrochanteric nor supracondylar femoral derotational or rotational osteotomies have a clinically relevant impact on frontal or sagittal leg alignment. A relevant deviation in the sagittal (but not frontal plane) might occur in case of a > 25° subtrochanteric femAT correction. Level of evidence: IV. [ABSTRACT FROM AUTHOR]

Since the introduction of widely available e-scooter rentals in Hamburg, Germany in June of 2019, our emergency department has seen a sharp increase in the amount of e-scooter related injuries. Despite a rising number of studies certain aspects of e-scooter mobility remain unclear. This study examines the various aspects of e-scooter associated injuries with one of the largest cohorts to date. Electronic patient records of emergency department admissions were screened for e-scooter associated injuries between June 2019 and December 2021. Patient demographic data, mechanism of injury, alcohol consumption, helmet usage, sustained injuries and utilized medical resources were recorded. Overall, 268 patients (57% male) with a median age of 30.3 years (IQR 23.3; 40.0) were included. 252 (94%) were e-scooter riders themselves, while 16 (6%) were involved in crashes associated with an e-scooter. Patients in non-rider e-scooter crashes were either cyclists who collided with e-scooter riders or older pedestrians (median age 61.2 years) who tripped over parked e-scooters. While e-scooter riders involved in a crash sustained an impact to the head or face in 58% of cases, those under the influence of alcohol fell on their head or face in 84% of cases. This resulted in a large amount of maxillofacial soft tissue lacerations and fractures. Extremity fractures and dislocations were more often recorded for the upper extremities. This study comprises one of the largest cohorts of e-scooter associated injuries to date. Older pedestrians are at risk to stumble over parked e-scooters. E-scooter crashes with riders who consumed alcohol were associated with more severe injuries, especially to the head and face. Restricted e-scooter parking, enforcement of drunk driving laws for e-scooters, and helmet usage should be recommended. [ABSTRACT FROM AUTHOR]

2 Cover Bull riding fracture Case series We conducted a retrospective review at Children's Hospital of Orange County (CHOC) in California, of pediatric patients treated for injuries associated with mechanical bull riding. We reviewed a series of pediatric patients who suffered head injuries/skull fractures caused by mechanical bull riding, many of which required surgical intervention. Pediatric patients suffering a skull fracture may also be at risk of growing skull fractures and traumatic encephaloceles [[4]]. [Extracted from the article]

Background: Certified training courses in all-terrain vehicle (ATV) operation are recommended, but little has been published regarding how they affect riding behaviors. Our objectives were to determine adolescents' ATV riding exposures, crashes and injuries, and the association of completing certified ATV training on riding behaviors. Methods: Respondents completed an anonymous paper survey at 30 school districts approximately one year after participating in the Safety Tips for ATV Riders (STARs) program. Survey data were compiled using Qualtrics™. Frequency, chi-square, Fisher's exact test, and logistic regression analyses were performed using SAS, V.9.4. Results: 4,891 students completed the survey from Fall 2012–Fall 2019. Respondents were 10–18 years old, and similar numbers of participants were male and female. Fifty-nine percent lived in town, 18% on a farm, and 22% in the country but not on farm. Forty-two percent reported their families owned an ATV. Seventy-seven percent had ridden an ATV, 40% of whom reported riding at least weekly. The vast majority (94%) used ATVs for recreation and 49% used them for work purposes. In the previous year, 22% of riders reported having been in a crash, with 7% of crash victims requiring medical attention for injuries. Greater crash likelihood was seen in males, recreational riders, more frequent riders, competitive racers and those who had ridden with passengers or on roads. Only 8% of riders had completed certified ATV safety training (note, STARs is not a certification program). Those whose families owned ATVs, more frequent riders, and public park users had greater likelihoods of course completion. Relative to their peers, respondents who completed a certification course had higher proportions that always/almost always wore helmets (39% vs. 20%, p < 0.0001) and lower proportions that never/almost never wore helmets (29% vs 58%, p < 0.0001), had ridden with passengers (63% vs. 96%, p < 0.0001), and had driven on public roads (41% vs 50%, p = 0.0065). Conclusions: ATV safety training certification among Iowa adolescents in the study was infrequent but those that received training reported higher helmet use, less riding with passengers, and less driving on public roads. These data suggest completing safety training certification may promote safer riding behaviors among youth. [ABSTRACT FROM AUTHOR]

Purpose: Abusive head trauma (AHT) is a major cause of morbidity and mortality in children. Studies on pediatric head injury observe that AHT patients often have a higher incidence of malignant cerebral oedema and, overall, worse prognosis. There are limited studies with a focus on the outcome of decompressive surgery in children with AHT. This is a study undertaken to review our institutional experience on the role of decompressive surgery in AHT patients and objectively assess its outcomes, in corroboration with current literature. Methods: This is an ethics-approved, retrospective study. Inclusion criteria consist of all children with a diagnosis of AHT managed by the Neurosurgical Service, KK Women's and Children's Hospital. Demographical and clinical variables are incorporated in the statistical analyses. Results: From 2011 to 2021, a total of 7 patients required decompressive surgery for AHT. Mean age of the cohort was 17.1 months (with the majority of patients being male (n = 5, 71.4%). During the follow-up period, there was 1 mortality (14.3%), 3 patients developed cerebral palsy (42.9%), and 3 patients had post-traumatic epilepsy (42.9%). With regards to functional outcome, 4 patients (57.1%) had a favorable KOSCHI score at 6 months follow-up. Conclusion: Decompressive surgery in children with AHT presents with its own unique challenges. We therein present our neurosurgical experience in decompressive surgery for this extremely vulnerable group of patients. Given the potential role of decompressive surgery in AHT, the development of an objective marker to select such patients who may benefit most from intervention should be the way forward. [ABSTRACT FROM AUTHOR]

Purpose: Abusive head trauma (AHT) is a serious problem in children. The aims of this study are to identify risk factors that correlate with outcomes for those requiring neurosurgical intervention for very young children with AHT, assessment of variables associated with outcomes, and corroboration of our results with literature. Methods: This is an ethics-approved, retrospective study. Inclusion criteria consisted of patients aged 2 years old or less with a diagnosis of AHT managed by the Neurosurgical Service, KK Women's and Children's Hospital. Demographical and clinical variables are incorporated in the statistical analyses. Logistic regression was applied to statistically significant variables for the risk prediction model. Results: From 2000 to 2020, 24 patients required surgery for AHT. Timepoint was set at 12 months post-diagnosis. Univariate analyses demonstrated that patients with mild TBI were likely to have a favourable GOS-E Peds (p = 0.01), whereas radiological presence of cerebral oedema (p <.001), development of scar epilepsy (p = 0.021), and progression to cerebral palsy (p = 0.001) were associated with unfavourable GOS-E Peds. Conclusion: This is the first study focused on neurosurgical outcomes for very young children with AHT in Singapore. We advocate multidisciplinary efforts to improve outcomes for this devastating condition. [ABSTRACT FROM AUTHOR]

Background: In Benin, some riders of two-wheeled vehicles still do not wear helmets, the main protection against head injuries in road accidents. The objective of this study is to describe the characteristics of two-wheeled users, and to determine the factors influencing helmet use among this group. Methods: This is a prospective cross-sectional study of 977 two-wheeled road accident victims from a cohort. Proportions or means were calculated for the different variables. Statistical comparisons were made to test the association with helmet use. Logistic regression modelling was performed to identify factors associated with helmet use. Results: Among all subjects, 81.1% [CI95% (78.5; 83.4)] wore a helmet. Factors explaining helmet use were female gender (OR = 2.8 [1.3–6.1]), purpose of trip (OR = 1.7 [1.1–2.6]), possession of health insurance (OR = 3.7 [1.3–10, 5]), having been driving for 15–20 years (OR = 2.6 [1.4–4.7]) or more than 20 years (OR = 3.4 [2.0–5.8]), good road conditions (OR = 3.1 [2.0–4.8]), and good visibility (OR = 1.9 [1.3–3.1]). Conclusion: The factors influencing helmet use are gender, reason for travel, length of time as a driver, possession of health insurance, conditions, and visibility of the road on which the subject are driving. These factors are related to experience and appropriation of the notion of risk, but also related to the environment. To increase helmet use among two-wheelers, helmet awareness should take into account the individual factors found in this study. Enforcement actions should be strengthened, and the quality of the roads improved. [ABSTRACT FROM AUTHOR]

Electric bicycles and scooters have gained popularity among riders; studies assessing these device-related injuries have not specified ocular trauma. Our study examined the types and risk factors for ocular and periocular injuries associated with electric devices compared to motorcycle accidents. The study was conducted on the National Trauma Registry database from 20 trauma centers, including patients involved in accidents with electric bicycles, scooters, and motorcycles between 2014 to 2019. Injured riders were assigned into two groups: motorcycle group (M) and electric bicycle & scooter group (E). Data such as gender, age, protective gear use, ocular injury type, injury severity score (ISS), and ocular surgery were captured. Logistic regression models were conducted for injury types and the need for surgery. 8181 M-riders and 3817 E-riders were involved in an accident and hospitalized. E-riders suffered from ocular injury more than M-riders. Males were most vulnerable and the ages of 15–29. Orbital floor fracture was the most common injury, followed by ocular contusion, eyelid laceration, and other ocular wounds. Electric bicycle and scooter riders are more likely to suffer from ocular injury than motorcycle riders. Riders without helmets are at greater risk for injuries, specifically orbital floor fractures. ISS of 16 + was associated with injury demanding ocular surgery. [ABSTRACT FROM AUTHOR]

The purpose of this study was to examine the impact attenuation properties of women's lacrosse headgear and to characterize mechanical properties of the materials of which they are composed. Impacts using a linear impactor (2.2, 2.9, and 5.0 m/s) and a projectile shooter (13.4 and 27.0 m/s) were applied to a Hybrid III 50th male head-neck assembly at six impact locations to replicate realistic women's lacrosse head impacts. Individual materials that make up the headgear were tested in compression at two quasi-static strain rates, 0.01/s and1/s, and 100/s using uniaxial test machines. For the linear impactor tests, results showed a significant decrease in peak linear and rotational acceleration (PLA and PRA), peak rotational velocity (PRV), head injury criteria and brain injury criteria in the helmeted impacts (p < 0.022). During the ball impacts PRV and PRA were significantly lower for both helmeted conditions compared with no helmet (p < 0.01). Material characterization tests indicated a range of rate effects in these materials ranging from weak to pronounced, and these effects correspondingly influenced the strain energy density graphs. The connection of the materials' rate effects to the performance of the headgear is described in general and in relation to the impact tests. [ABSTRACT FROM AUTHOR]

Introduction: Helmet noninvasive support may provide advantages over other noninvasive oxygenation strategies in the management of acute hypoxemic respiratory failure. In this narrative review based on a systematic search of the literature, we summarize the rationale, mechanism of action and technicalities for helmet support in hypoxemic patients. Main results: In hypoxemic patients, helmet can facilitate noninvasive application of continuous positive-airway pressure or pressure-support ventilation via a hood interface that seals at the neck and is secured by straps under the arms. Helmet use requires specific settings. Continuous positive-airway pressure is delivered through a high-flow generator or a Venturi system connected to the inspiratory port of the interface, and a positive end-expiratory pressure valve place at the expiratory port of the helmet; alternatively, pressure-support ventilation is delivered by connecting the helmet to a mechanical ventilator through a bi-tube circuit. The helmet interface allows continuous treatments with high positive end-expiratory pressure with good patient comfort. Preliminary data suggest that helmet noninvasive ventilation (NIV) may provide physiological benefits compared to other noninvasive oxygenation strategies (conventional oxygen, facemask NIV, high-flow nasal oxygen) in non-hypercapnic patients with moderate-to-severe hypoxemia (PaO2/FiO2 ≤ 200 mmHg), possibly because higher positive end-expiratory pressure (10–15 cmH2O) can be applied for prolonged periods with good tolerability. This improves oxygenation, limits ventilator inhomogeneities, and may attenuate the potential harm of lung and diaphragm injury caused by vigorous inspiratory effort. The potential superiority of helmet support for reducing the risk of intubation has been hypothesized in small, pilot randomized trials and in a network metanalysis. Conclusions: Helmet noninvasive support represents a promising tool for the initial management of patients with severe hypoxemic respiratory failure. Currently, the lack of confidence with this and technique and the absence of conclusive data regarding its efficacy render helmet use limited to specific settings, with expert and trained personnel. As per other noninvasive oxygenation strategies, careful clinical and physiological monitoring during the treatment is essential to early identify treatment failure and avoid delays in intubation. [ABSTRACT FROM AUTHOR]

The long-term cognitive consequences of mild traumatic brain injury (mTBI) are poorly understood. Studies investigating cognitive performance in the chronic stage of injury in both hospital-based and population-based samples have revealed inconsistent findings. Importantly, population-based mTBI samples remain under-studied in the literature. This study investigated cognitive performance among individuals with a history of self-reported mTBI using a battery of cognitively demanding behavioural tasks. Importantly, more than half of the mTBI participants had experienced multiple mild head injuries. Compared to control participants (n = 49), participants with a history of mTBI (n = 30) did not demonstrate deficits in working memory, multitasking ability, cognitive flexibility, visuospatial ability, response inhibition, information processing speed or social cognition. There was moderate evidence that the mTBI group performed better than control participants on the visual working memory measure. Overall, these findings suggest that even multiple instances of mTBI do not necessarily lead to long-term cognitive impairment at the group level. Thus, we provide important evidence of the impact of chronic mTBI across a number of cognitive processes in a population-based sample. Further studies are necessary to determine the impact that individual differences in injury-related variables have on cognitive performance in the chronic stage of injury. [ABSTRACT FROM AUTHOR]

Protective equipment in war plays a vital role in the safety of soldiers, the threat to soldiers from brain damage caused by deformation at the back of the helmet cannot be ignored, so research on reduce blunt post-cranial injury has great significance and value. This study first conducted gunshot experiments, used rifle bullets impact bulletproof plate and different density liner foam to record the incident process and internal response of craniocerebral model. After verifying the accuracy of finite element model through experimental data, optimization model is established based on response surface method to optimize the structure of gradient foam, analyze the cranial strain and energy absorption to select the best density and thickness distribution of each foam layer. Optimization results show that liner foam which designed to have lower density and thicker thickness for impact and brace layers, higher density and thinner thickness for middle layer can significantly improve the energy absorption efficiency. Compared to the 40.65 J of energy absorption before optimization, the optimized gradient foam can absorb 109.3 J of energy, with a 169% increase in the absorption ratio. The skull strain in the craniocerebral model was reduced from 1.260 × 10–2 to 1.034 × 10–2, with a reduction of about 22%. This study provides references for the design and development of protective equipment and plays an important role in ensuring the safety of soldiers in the battlefield environment. [ABSTRACT FROM AUTHOR]