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BACKGROUND/OBJECTIVE: Headgear designed to protect girls lacrosse athletes is widely available and permitted for voluntary use; however, it remains unknown how policies mandating headgear use may change the sport and, particularly regarding impacts during game-play. Therefore, this study compares the impact rates and game play characteristics of girls high school lacrosse in Florida which mandates headgear use (HM), with states having no headgear mandate (NHM). MATERIALS AND METHODS: Video from 189 randomly-selected games (HM: 64, NHM: 125) were analyzed. Descriptive statistics, Impact Rates (IR), Impact Rate Ratios (IRR), Impact Proportion Ratios (IPR), and 95% Confidence Intervals (CI) were calculated. IRRs and IPRs with corresponding CIs that excluded 1.00 were deemed statistically significant. RESULTS: 16,340 impacts (HM:5,821 NHM: 10,519; 86.6 impacts/game, CI: 88.6-93.3) were identified using the Lacrosse Incident Analysis Instrument (LIAI). Most impacts directly struck the body (n = 16,010, 98%). A minority of impacts directly struck a players head (n = 330, 2%). The rate of head impacts was significantly higher in the HM cohort than NHM cohort (IRR = 2.1; 95% CI = 1.7-2.6). Most head impacts (n = 271, 82%) were caused by stick contact in both groups. There was no difference in the proportion of penalties administered for head impacts caused by stick contact between the HM and NHM cohorts (IPR IRRHM/NHM = 0.98; CI = 0.79-1.16). However, there was a significantly greater proportion of head impacts caused by player contact that resulted in a penalty administered in the HM cohort (IPR = 1.44 CI = 1.17-1.54). CONCLUSION: These findings demonstrate that mandating headgear use was associated with a two-fold greater likelihood of sustaining a head impact during game play compared to NHM states. A majority of head impacts in both HM and NHM states were caused by illegal stick contact that did not result in penalty.

Purpose: This study explores the protective capabilities of bicycle helmets on serious head injury among bicyclists hospitalized in a Norwegian level 1 trauma centre. Method: Information on helmet use, demographic variables, Abbreviated Injury Scale (AIS) and surgical procedure codes was retrieved from the Oslo University Hospital Trauma Registry for patients with bicycle-related injuries from 2005 through 2016. Outcomes were serious head injury defined as maximum AIS severity score ≥ 3 in the AIS region Head, any cranial neurosurgical procedure, and 30-day mortality. Results: A total of 1256 hospitalized bicyclists were included. The median age was 41 years (quartiles 26–53), 73% were male, 5.3% had severe pre-injury comorbidities, and 54% wore a helmet at the time of injury. Serious head injury occurred in 30%, 9% underwent a cranial neurosurgical procedure, and 30-day mortality was 2%. Compared to non-helmeted bicyclists, helmeted bicyclists were older (43 years, quartiles 27–54, vs. 38 years, quartiles 23–53, p = 0.05), less often crashed during night-time (21% vs. 38%, p < 0.001), less frequently had serious head injury (22% vs. 38%, OR 0.29, 95% CI 0.22–0.39), and less often underwent cranial neurosurgery (6% vs. 14%, OR 0.36, 95% CI 0.24–0.54). No statistically significant difference in 30-day mortality between the two groups was found (1.5% vs. 2.9%, OR 0.50, 95% CI 0.22–1.11). Conclusion: Helmet use was associated with fewer and less severe head injuries and fewer neurosurgical procedures. This adds evidence to the protective capabilities of bicycle helmets. [ABSTRACT FROM AUTHOR]

This multicenter study evaluated the efficacy and safety of a novel cranial remolding helmet (baby band2), which is completely custom-made based on the shape of an infant's cranium. The study included 224 full-term infants from moderate to very severe positional plagiocephaly in Japan. Cranial geometry was assessed before and after helmet therapy using a three-dimensional scanner, and changes in the cranial vault asymmetry index (CVAI) were analyzed. The CVAI improved significantly in all patients, with the most significant improvement observed in the most severely affected group [very severe group: −9.1, severe group: −6.6, moderate group: −4.4 (mean values), p < 0.001]. The group that started therapy before the age of 7 months showed greater improvement compared to those who started therapy at the age of 7 months or older; however, both groups demonstrated significant improvement (<7 months group: −6.6, ≥7 months group: −4.4 (mean values), p < 0.001). No significant differences were observed in therapy efficacy between the centers (p = 0.402) and sex (p = 0.131). During the study period, helmet therapy did not lead to head circumference stunting, and the incidence of redness with baby band2 was five patients (2.2%). This study demonstrated that baby band2 is effective and safe for the therapy of positional plagiocephaly. [ABSTRACT FROM AUTHOR]

It was the aim of the study to analyze the distribution and pattern of facial fractures following e-scooter trauma. Prospective audit data of facial fractures were retrospectively collected to investigate the impact of e-scooter hire, specifically in the form of facial fractures associated with their use. Data collected included patient demographics, mode of injury, date of injury, facial bones involved, presence of soft tissue injury, and factors associated with injury, including intoxication and helmet use. A total of 849 patients were treated for facial fractures during the study period, of which 34 were attributed to e-scooter use. One-half of those injured riding e-scooters were intoxicated, and one-quarter were wearing helmets. There have been an increasing number of facial fractures associated with e-scooter use following the start of the shared e-scooter trial. Zygomaticomaxillary complex fractures were the most common pattern of facial fracture seen. Most patients required surgical management of their injuries. Policymakers should consider how to improve the enforcement of current regulations, given the healthcare cost associated with the management of these preventable injuries. [ABSTRACT FROM AUTHOR]

Enhancing road safety globally is imperative, especially given the significant portion of traffic-related fatalities attributed to motorcycle accidents resulting from non-compliance with helmet regulations. Acknowledging the critical role of helmets in rider protection, this paper presents an innovative approach to helmet violation detection using deep learning methodologies. The primary innovation involves the adaptation of the PerspectiveNet architecture, transitioning from the original Res2Net to the more efficient EfficientNet v2 backbone, aimed at bolstering detection capabilities. Through rigorous optimization techniques and extensive experimentation utilizing the India driving dataset (IDD) for training and validation, the system demonstrates exceptional performance, achieving an impressive detection accuracy of 95.2%, surpassing existing benchmarks. Furthermore, the optimized PerspectiveNet model showcases reduced computational complexity, marking a significant stride in real-time helmet violation detection for enhanced traffic management and road safety measures. [ABSTRACT FROM AUTHOR]

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]

Purpose: Short-track speed skating results in high-energy crashes with an elevated risk of head injury. The goal of this study was to evaluate the resulting kinematics of an anti-rotation helmet technology for speed skating. Methods: Two traditional rigid foam speed-skating helmets (BT and ST) were compared with one anti-rotation speed skating helmet (MIPS). Each helmet was impacted with a pneumatic device across three locations. The resulting linear or rotational accelerations (PLA or PRA) and rotational velocities (PRV) were measured with accelerometers placed on a Hybrid III head form. Additionally, the head impact criterion (HIC) was calculated from accelerations and the brain injury criterion (BrIC) was obtained from rotational velocities. Results: MIPS showed significantly higher values of accelerations (PLA = 111.24 ± 9.21 g and PRA = 8759.11 ± 2601.81 rad/s2) compared with the other helmets at all three impact locations (p < 0.01, ES = 3.00 to 4.11). However, velocities were lowest, but not significantly different, for the MIPS helmet (25.77 ± 1.43 rad/s). Furthermore, all resulting kinematics except peak linear accelerations were significantly different across impact locations. Conclusion: Helmet designs specific to the collision characteristics of speed skating may still be lacking, but would decrease the risk of sport-related concussions. [ABSTRACT FROM AUTHOR]

Objectives: This study aimed to determine the impact of standing electric scooters on maxillofacial on the Italian territory. Methods: The authors analyzed the epidemiology of the injuries to define electric mobility's impact on maxillofacial surgery practice. For this retrospective cohort study, data were collected by unifying the standing e-scooter-related fractures database from 10 Italian maxillofacial surgery departments. The reference period considered was from January 2020 to December 2023. The main data considered included age, gender, type of access, time slot of admission, type of admission, alcohol level, helmet use, dynamics of the accident, and area of the fracture. Results: A total of 79 patients were enrolled. The average age of the participants was approximately 31 years. The blood alcohol level was found to be above the Italian norm in 15 cases (19%). Only one patient wore a helmet. The most affected facial third was the middle one with 36 cases (45.5%), followed by the lower one (31, 39.3%). The most recurrent patterns were fractures of the orbito-malar-zygomatic complex (15, 19%), followed by multifocal (bifocal, trifocal) fractures of the mandible (14, 17.5%). Conclusions: This study demonstrated how maxillofacial fractures related to the use of electric scooters are associated with complex patterns, associated with a high rate of post-surgical aftermaths. [ABSTRACT FROM AUTHOR]

To compare traumatic spinal injury patterns between motorcyclists and occupants of other nonheavy motor vehicles using data from the National Spinal Cord and Column Injury Registry of Iran. All drivers/riders and passengers of motorcycles, cars, pick-up trucks, and vans registered between January 2017 to July 2023, met the inclusion criteria for the present study. The logistic regression models were used to compare the patterns of vertebral fracture between the 2 groups. One thousand seven hundred twenty-six spinal fracture patients were identified, 385 (22.3%) motorcyclists and 1341 (77.7%) car occupants with mean ages 33.2 ± 14.3 and 36.1 ± 13.6 years, respectively (P < 0.001). Only 45 (11.7%) motorcyclists used helmets, whereas 856 (63.8%) car occupants used seat belts (P < 0.001). The average numbers of fractured vertebrae were 3.9 ± 1.4 and 3.7 ± 1.1 among car occupants and motorcyclists, respectively (P = 0.004). The proportions of motorcyclists and car occupants with injuries in each spinal region are as follows: lumbar (50.5% of motorcyclists vs. 40.4% of car occupants; P = 0.003), thoracic (39.2% vs. 30.9%; P = 0.01), cervical (24.3% vs. 37.0%; P < 0.001), and sacral (1.3% vs. 7.5%; P < 0.001). The AO Spine type C injuries were present in 6.1% of motorcyclists and 10.1% of car occupants (P = 0.03). Motorcyclists were younger, less educated, had a higher proportion of males, and less commonly used safety devices than car occupants. The most commonly fractured spine region among both groups was the lumbar region. The cervical and sacral vertebrae fractures were significantly more common in car occupants, whereas the thoracic and lumbar vertebrae fractures were significantly more common in motorcyclists. [ABSTRACT FROM AUTHOR]

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Due to the material properties of current ski face masks for adolescents, moisture in exhaled air can become trapped within the material fibers and freeze, leading to potential issues such as breathing difficulties and increased risk of facial frostbite after prolonged skiing. This paper proposes a research approach combining computational fluid dynamics (CFD) and ergonomics to address these issues and enhance the comfort of adolescent skiers. We developed head and face mask models based on the head dimensions of 15–17-year-old males. For enclosed cavities, ensuring the smooth expulsion of exhaled air to prevent re-inhalation is the primary challenge. Through fluid simulation of airflow characteristics within the cavity, we evaluated three different inlet configurations. The results indicate that the location of the air inlets significantly affects the airflow characteristics within the cavity. The side inlet design (type II) showed an average face temperature of 35.35 °C, a 38.5% reduction in average CO2 concentration within the cavity, and a smaller vortex area compared to the other two inlet configurations. Although the difference in airflow velocity within the cavity among the three configurations was minimal, the average exit velocity differed by up to 0.11 m/s. Thus, we conclude that the side inlet configuration offers minimal obstruction to airflow circulation and better thermal insulation when used in the design of fully enclosed helmets. This enhances the safety and comfort of adolescent wearers during physical activities in cold environments. Through this study, we aim to further promote the development of skiing education, enhance the overall quality of adolescents' skiing, and thus provide them with more opportunities for the future. [ABSTRACT FROM AUTHOR]

Electric vehicle accidents on the road occur frequently, and head injuries are often the cause of serious casualties. However, most electric vehicle riders seldom wear helmets. Therefore, combining target detection algorithms with road cameras to intelligently monitor helmet-wearing has extremely important research significance. Therefore, a helmet-wearing detection algorithm based on the improved YOLOv8n model, PRE-YOLO, is proposed. First, we add small target detection layers and prune large target detection layers. The sophisticated algorithm considerably boosts the effectiveness of data manipulation while significantly reducing model parameters and size. Secondly, we introduce a convolutional module that integrates receptive field attention convolution and CA mechanisms into the backbone network, enhancing feature extraction capabilities by enhancing attention weights within both channel and spatial aspects. Lastly, we incorporate an EMA mechanism into the C2f module, which strengthens feature perception and captures more characteristic information while maintaining the same model parameter size. The experimental outcomes indicate that in comparison to the original model, the proposed PRE-YOLO model in this paper has improved by 1.3%, 1.7%, 2.2%, and 2.6% in terms of precision P, recall R, mAP@0.5, and mAP@0.5:0.95, respectively. At the same time, the number of model parameters has been reduced by 33.3%, and the model size has been reduced by 1.8 MB. Generalization experiments are conducted on the TWHD and EBHD datasets to further verify the versatility of the model. The research findings provide solutions for further improving the accuracy and efficiency of helmet-wearing detection on complex traffic roads, offering references for enhancing safety and intelligence in traffic. [ABSTRACT FROM AUTHOR]

It is crucial to ensure workers wear safety helmets when working at a workplace with a high risk of safety accidents, such as construction sites and mine tunnels. Although existing methods can achieve helmet detection in images, their accuracy and speed still need improvements since complex, cluttered, and large-scale scenes of real workplaces cause server occlusion, illumination change, scale variation, and perspective distortion. So, a new safety helmet-wearing detection method based on deep learning is proposed. Firstly, a new multi-scale contextual aggregation module is proposed to aggregate multi-scale feature information globally and highlight the details of concerned objects in the backbone part of the deep neural network. Secondly, a new detection block combining the dilate convolution and attention mechanism is proposed and introduced into the prediction part. This block can effectively extract deep features while retaining information on fine-grained details, such as edges and small objects. Moreover, some newly emerged modules are incorporated into the proposed network to improve safety helmet-wearing detection performance further. Extensive experiments on open dataset validate the proposed method. It reaches better performance on helmet-wearing detection and even outperforms the state-of-the-art method. To be more specific, the mAP increases by 3.4%, and the speed increases from 17 to 33 fps in comparison with the baseline, You Only Look Once (YOLO) version 5X, and the mean average precision increases by 1.0% and the speed increases by 7 fps in comparison with the YOLO version 7. The generalization ability and portability experiment results show that the proposed improvements could serve as a springboard for deep neural network design to improve object detection performance in complex scenarios. [ABSTRACT FROM AUTHOR]

Objectives: Plagiocephaly is a flattening or asymmetry of the skull in infants that –while benign– can be distressing to parents. There are no standardized treatment recommendations, but helmeting therapy (HT) can be pursued. However, there is no strong evidence for the effectiveness of HT, leading to ambiguity for who should be offered this intervention. In this study, we aim to evaluate any differences in the proportion of patients being offered HT based on race/ethnicity, sex, or insurance type. Methods: A retrospective review from January 12th, 2017, to April 30th, 2022, of all patients with a plagiocephaly diagnosis under 18 months of age was conducted. A one-way analysis of variance was used to assess significance with differences <0.05 considered significant. Results: Of the 1667 patients identified with plagiocephaly, 807 (48.4%) patients were offered HT, and 501 (30.1%) subsequently received a helmet. Patients with public insurance represented a significantly lower proportion of patients offered HT compared to their respective proportion within all patients diagnosed with plagiocephaly (26.9% vs 31.8%, P =.01). Additionally, patients who identified as Black or African American represented a significantly lower proportion of patients offered HT compared to their respective proportion within all patients diagnosed with plagiocephaly (8.1% vs 10.6%, P =.04). Conclusion: Our study demonstrates that the proportions of patients with plagiocephaly who were offered HT compared to their overall proportion within all patients diagnosed with plagiocephaly were different for patients with public insurance and patients who identified as Black or African American. This highlights the need for standardized recommendations for HT. [ABSTRACT FROM AUTHOR]

ABSTRACT:Motorized two-wheeler users account for 45% of road fatalities in 2021 in India. Correct helmet use decreases the risk of fatalities, but information about the prevalence of correct helmet use is limited in the Indian context. This study aims to assess the prevalence of helmet use and factors associated with correct helmet use among motorized two-wheeler users in Bengaluru city, India. This observational cross-sectional assessment was conducted in a random-representative sample of 98021 motorized two-wheelers sampled from 15 intersections. Helmet use and other information were collected by trained Field Data Collectors via hand-held tablet devices and the KoBo collect application, following a globally used checklist. The prevalence of helmet use (all types) was 88% among riders and pillion together and 92.4% among riders. However, the prevalence of correct helmet use is 38% among riders, and non-standard helmet use is 27%. This study reveals a correct helmet use gap in Bengaluru city. The study recommends the need to shift enforcement, messaging, and intervention focus towards correct helmet use and the implementation of routine population-based surveillance for helmet use in the city. [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]

Horseback riding can cause severe brain and spinal injuries. This study aimed to identify the spectrum of neurosurgical injuries related to recreational horseback riding. A retrospective study was performed utilizing the University of Puerto Rico neurosurgery database to identify patients who were consulted to the neurosurgery service between 2018 and 2023 after a horse fall during recreational activities. The outcome upon discharge using the modified Rankin scale (mRS) was documented. Descriptive statistics were used to report frequency and median values. The neurosurgery service evaluated and managed 112 patients with a horseback riding fall-related injury during 6 years. Ninety-eight (87.5%) patients were male. The patients' median age was 31.5 (IQR 22–40). There were 89 head injuries (79.5%), 19 spinal injuries (17%), and 4 combined head/spine injuries (3.5%). Forty percent of the patients were admitted to inpatient care with a median length of stay of 7 days (IQR 3–17). Twenty-four patients (21%) required surgery. Upon discharge, 86.6% of the patients had an mRS grade of 0–2, 3.6% had a grade of 3, 1.8% had a grade of 4, and 1.8% had a grade of 5. Seven patients (6%) died (mRS grade 6). Most neurologic injuries involve isolated trauma to the head. Fifteen percent of the riders' falls were caused after the horse was impacted by a motor vehicle. Forty percent of the patients require admission and 21% undergo surgery. Ten percent of the patients had a poor mRS grade of 4– to 6 when discharged. [ABSTRACT FROM AUTHOR]

Traumatic injury is responsible for eight million childhood deaths annually. In Uganda, there is a paucity of comprehensive data describing the burden of pediatric trauma, which is essential for resource allocation and surgical workforce planning. This study aimed to ascertain the burden of non-adolescent pediatric trauma across four Ugandan hospitals. We performed a descriptive review of four independent and prospective pediatric surgical databases in Uganda: Mulago National Referral Hospital (2012-2019), Mbarara Regional Referral Hospital (2015-2019), Soroti Regional Referral Hospital (SRRH) (2016-2019), and St Mary's Hospital Lacor (SMHL) (2016-2019). We sub-selected all clinical encounters that involved trauma. The primary outcome was the distribution of injury mechanisms. Secondary outcomes included operative intervention and clinical outcomes. There was a total of 693 pediatric trauma patients, across four hospital sites: Mulago National Referral Hospital (n = 245), Mbarara Regional Referral Hospital (n = 29), SRRH (n = 292), and SMHL (n = 127). The majority of patients were male (63%), with a median age of 5 [interquartile range = 2, 8]. Chiefly, patients suffered blunt injury mechanisms, including falls (16.2%) and road traffic crashes (14.7%) resulting in abdominal trauma (29.4%) and contusions (11.8%). At SRRH and SMHL, from which orthopedic data were available, 27% of patients suffered long-bone fractures. Overall, 55% of patients underwent surgery and 95% recovered to discharge. In Uganda, non-adolescent pediatric trauma patients most commonly suffer injuries due to falls and road traffic crashes, resulting in high rates of abdominal trauma. Amid surgical workforce deficits and resource-variability, these data support interventions aimed at training adult general surgeons to provide emergency pediatric surgical care and procedures. [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]

Sarcopenia is a disease in which a decline in muscle mass with age is associated with a decline in physical performance. In the field of otorhinolaryngology, head and neck surgery, sarcopenia is gaining attention as a cause of swallowing disorders and as a problem in the treatment of head and neck cancer. Head and neck cancer occurs in anatomical sites related to swallowing, so patients with head and neck cancer are prone to swallowing disorders and "nutrition-related sarcopenia." Since it is a cancer, it also becomes a "disease-related sarcopenia," making it easy for patients to develop secondary sarcopenia. Medical intervention against sarcopenia is important in order to decrease the number of adverse events related to treatments for cases with sarcopenia, with reports stating that proactive exercise and nutritional therapy prior to treatment for cases with sarcopenia contributes to a decrease in serious complications as well as improving the survival rate. It is the same for head and neck cancer patients with sarcopenia, so intervention prior to treatment of head and neck cancer is an area that is expected to see reports in the future. However, if the disease is malignant, it is highly likely that sarcopenia cannot be sufficiently improved due to the short period of time from diagnosis to the beginning of treatment. In this case, choosing a treatment that takes sarcopenia into consideration is another way to handle it. Assessing sarcopenia prior to treatment may help avoid post-treatment pneumonia related to sarcopenia, postoperative complications including fistula, radiation-induced toxicity including swallowing disorders, and chemotherapy-related toxicity, and it is believed to greatly contribute to the prognosis of the overall survival (OS), disease-free survival (DFS), and disease-specific survival (DSS). [ABSTRACT FROM AUTHOR]

Employ a novel testing method to assess Multi Directional Impact Protection System (MIPS) helmet technology on rotational velocity and acceleration during head impact. An optimization study was completed utilizing a 50th percentile male Hybrid III anthropomorphic test device (ATD). Helmets included expanded polystyrene foam (EPS) and two different MIPS helmets (MIPS 1, MIPS 2). A 24.38-m-long elevated track with rails and a motorized sled was utilized to replicate a fall from approximately 2.13 m. The sled was set to a speed of 20.92 kph, where a tripping mechanism induced rotation in the ATD from the sled and onto a sand surface. During impact of the ATD with the sand surface, head kinematics were measured using resultant acceleration (peak G's), duration of impact (ms), and rotational velocity (rad/s). A total of three trials for each helmet did not demonstrate a significant difference between the EPS vs. MIPS 1 group with, peak (G's) for resultant acceleration (p = 0.100), duration (ms) for resultant acceleration, (p = 0.100), peak (G's) for rotational velocity, (p = 0.700), and duration (ms) for rotational velocity (p = 0.700). Similarly, the EPS vs. MIPS 2 testing demonstrated no significant differences between the MIPS 2 helmet compared to the EPS helmet, with resultant acceleration (p = 0.400), duration acceleration (p = 0.200), rotational velocity (p = 0.400) and duration velocity (p = 0.400). However, when the MIPS helmet data were pooled, and the EPS helmet data were compared, a statistically significant difference in the duration of acceleration was found (p = 0.048). Current testing uses a helmeted head form which is dropped or rolled from a prescribed height. These methods discount the loading placed on the neck and head through the angular momentum of the body. Our novel testing method did not find significant differences between the helmet types in diminishing peak rotational forces to the brain; however, our data suggests that MIPS helmet liners may reduce duration of impact. The reduction of acceleration duration could indicate less rotation of the neck, due to the dampening of these forces by the MIPS liners. [ABSTRACT FROM AUTHOR]

One has to wonder where all the armour from the Middle Ages and the Renaissance that is no longer preserved might have gone. The article presents some forms of repurposing discarded pieces of armour. The focus is on two helms of the fourteenth century, which were secondarily used in a fire hood. The new finds not only tell an interesting story, they are also rare representatives of a once widespread type. [ABSTRACT FROM AUTHOR]

Concussion screening among collegiate lacrosse athletes is a major safety priority. Although attention has been directed at concussion management following injury, less is known about the association between cognition and balance during preseason screening. The purpose of the study was to assess the relationship between balance and neurocognition among collegiate male lacrosse players and to examine predictive determinants of postural stability. Participants included a convenience sample of 49 male collegiate Division 3 lacrosse players who completed a demographic survey and performed the immediate postconcussion test (ImPACT) and instrumented Sensory Organization Test (SOT). There was a significant association between balance SOT performance and both verbal memory (r = .59, p < .01) and visual motor speed scores (r = .43, p < .05). Significant correlations between verbal memory and SOT Conditions 2, 5, and 6 were also noted (all p < .05). Verbal memory predicted 33% of the variance in the SOT composite balance score (p < .001). Our results indicate a significant relationship exists between postural stability and both verbal memory and visual processing speed among collegiate male lacrosse players and supports vestibulocortical associations. Findings warrant ongoing performance and executive function tracking and can serve as a conduit for integrated sensorimotor and dual-task training. [ABSTRACT FROM AUTHOR]

Background: The percentage of elderly trauma patients under anticoagulation and antiplatelet agents has been rising lately. As newer agents are introduced, each comes with its own advantages and precautions. Our study covered elderly patients admitted to the ED with maxillofacial trauma while on anticoagulation (AC) or antiplatelet therapy (APT). We aimed to investigate the demographic characteristics, causes, and types of maxillofacial trauma, along with concomitant injuries, duration of hospitalisation, haemorrhagic complications, and the overall costs of care in the emergency department (ED). Methods: Data were gathered from the ED of Bern University Hospital. In this retrospective analysis, patients over 65 of age were included, who presented at our ED with maxillofacial trauma between 2013 and 2019 while undergoing treatment with therapeutic AC/APT. Results: The study involved 188 patients with a median age of 81 years (IQR: 81 [74; 87]), of whom 55.3% (n=104) were male. More than half (54.8%, n=103) were aged 80 years or older. Cardiovascular diseases were present in 69.7% (n=131) of the patients, with the most common indications for AC/APT use being previous thromboembolic events (41.5%, n=78) and atrial fibrillation (25.5%, n=48). The predominant cause of facial injury was falls, accounting for 83.5% (n=157) of cases, followed by bicycle accidents (6.9%, n=13) and road-traffic accidents (5.3%, n=10). The most common primary injuries were fractures of the orbital floor and/or medial/lateral wall (60.1%, n=113), zygomatic bone (30.3%, n=57), followed by isolated orbital floor fractures (23.4%, n=44) and nasal bone fractures (19.1%, n=36). Fractures of the mandible occurred in 14.9% (n=28). Facial hematomas occurred in 68.6% of patients (129 cases), primarily in the midface area. Relevant facial bleeding complications were intracerebral haemorrhage being the most frequent (28.2%, n=53), followed by epistaxis (12.2%, n=23) and retrobulbar/intraorbital hematoma (9%, n=17). Sixteen patients (8.5%) experienced heavy bleeding that required emergency treatment. The in-hospital mortality rate was 2.1% (4 cases). Conclusions: This study indicates that falls are the leading cause of maxillofacial trauma in the elderly, with the most common diagnoses being orbital, zygomatic, and nasal fractures. Haemorrhagic complications primarily involve facial hematomas, especially in the middle third of the face, with intracerebral haemorrhage being the second most frequent. Surgical intervention for bleeding was required in 8.5% of cases. Given the aging population, it is essential to improve prevention strategies and update safety protocols, particularly for patients on anticoagulant/antiplatelet therapy (AC/APT). This can ensure rapid diagnostic imaging and prompt treatment in emergencies. [ABSTRACT FROM AUTHOR]

Autonomous outdoor moving objects like cars, motorcycles, bicycles, and pedestrians present different risks to the safety of Visually Impaired People (VIPs). Consequently, many camera-based VIP mobility assistive solutions have resulted. However, they fail to guarantee VIP safety in practice, i.e., they cannot effectively prevent collisions with more dangerous threats moving at higher speeds, namely, Critical Moving Objects (CMOs). This paper presents the first practical camera-based VIP mobility assistant scheme, ARAware, that effectively identifies CMOs in real-time to give the VIP more time to avoid danger through simultaneously addressing CMO identification, CMO risk level evaluation and classification, and prioritised CMO warning notification. Experimental results based on our real-world prototype demonstrate that ARAware accurately identifies CMOs (with 97.26% mAR and 88.20% mAP) in real-time (with a 32 fps processing speed for 30 fps incoming video). It precisely classifies CMOs according to their risk levels (with 100% mAR and 91.69% mAP), and warns in a timely manner about high-risk CMOs while effectively reducing false alarms by postponing the warning of low-risk CMOs. Compared to the closest state-of-the-art approach, DEEP-SEE, ARAware achieves significantly higher CMO identification accuracy (by 42.62% in mAR and 10.88% in mAP), with a 93% faster end-to-end processing speed. [ABSTRACT FROM AUTHOR]

BACKGROUND: Wearing protective helmets is an important prevention strategy to reduce work-related traumatic brain injuries. The existing standardized testing systems are used for quality control and do not provide a quantitative measure of the helmet performance. OBJECTIVE: To analyze the failure characterizations of Type I industrial helmets and develop a generalized approach to quantify the shock absorption performance of Type I industrial helmets based on the existing standardized setups. METHODS: A representative basic Type I construction helmet model was selected for the study. Top impact tests were performed on the helmets at different drop heights using two different impactor masses (3.6 and 5.0 kg). RESULTS: When the helmets were impacted with potential impact energies smaller than the critical potential impact energy values, there was a consistent relationship between the peak impact force and the potential impact energy. When the helmets were impacted under potential impact energies greater than the critical potential impact energy values, the peak impact forces increased steeply with increasing potential impact energy. CONCLUSION: A concept of safety margin for construction helmets based on potential impact energy was introduced to quantify the helmets' shock absorption performance. The proposed method will help helmet manufacturers improve their product quality. [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]

Positional plagiocephaly is a deformational cranial flattening frequently treated in pediatric neurosurgical practice. Positional maneuvers and orthotic helmet therapy are preferred therapeutic options for moderate-to-severe forms. Treatment response seems to be age-dependent. Nevertheless, predictive data are vague, and cost-efficiency might be a limiting factor for treatment. The purpose of this study was to investigate the early predictive value of sonographic parameters on the efficacy of orthotic helmet therapy through the assessment of changes in skull shape and correlation of the parameters with caliper cephalometry values and with age. A consecutive cohort of 49 patients < 10 months of age, undergoing orthotic helmet therapy for positional plagiocephaly, was recruited prospectively. The authors routinely assessed the patency of the lambdoid sutures by ultrasound and the following additional skull parameters were measured: suture width, adjacent full bone thickness, adjacent cortical bone thickness and occipital angle. Caliper cephalometric values, as well as demographic and clinical data were collected. Retrospective data analysis showed an inverse relation between both cortical and full skull bone thickness and early treatment efficacy, defined by a reduction in the occipital angle. The improvement of sonographic parameters correlated with the development of cranial caliper cephalometry values. In conclusion, the sonographic assessment of skull bone thickness is a safe and cost-effective tool to predict the early efficacy of orthotic helmet therapy in positional plagiocephaly and might, therefore, help the clinician to foresee the potential evolution of the deformity. [ABSTRACT FROM AUTHOR]

Head injuries resulting from e-scooter use have led to calls for helmet use to be promoted or mandatory. Helmet use is mandatory for e-scooters in Australia but observational studies have reported significant levels of nonuse, particularly by riders of shared e-scooters. The aim of this study is to understand whether nonuse in the mandatory context is a consistent behavior for an individual or is situationally-influenced, and what are the factors associated with nonuse. An online survey was completed between 2022 and 2023 by 360 adult e-scooter riders in Canberra, Australia. Riders were asked whether they had worn a helmet on their last ride and how often they had not worn a helmet when riding in the last 30 days. The survey also asked about rider characteristics (demographics, frequency of e-scooter and bicycle use, perceived risk of e-scooter use, e-scooter ownership, and risky behaviors while riding), trip duration and perceptions of the helmet requirement (knowledge of and support for the law). Respondents were mostly male, young, highly educated, and full-time workers. Of the 29.1% of riders who reported riding without a helmet in the last 30 days, 24.4% had worn a helmet at least once during that period and 4.8% had consistently not worn a helmet. Younger age, shared e-scooter use and more frequent riding frequency (shared e-scooters only) were associated with helmet nonuse in the bivariate analyses but not in the logistic regression. Logistic regression showed that the independent predictors of helmet nonuse were the number of risky riding behaviors, lack of knowledge, and lack of support for the law. Most nonuse of helmets in a mandatory context seems to be situational, rather than consistent. Many of the factors associated with nonuse of helmets for e-scooters are similar to those reported for bicycles. Nonuse of helmets appears to be one of a number of risky behaviors performed by riders, rather than being primarily an outcome that is specific to factors associated with helmets (e.g., concerns about hygiene, discomfort or availability). [ABSTRACT FROM AUTHOR]

Electric power operation, as one of the key fields in the world, faces particularly prominent safety issues. Ensuring the safety of operators has become the most fundamental requirement in power operation. However, there are some safety hazards in power construction. These hazards are mainly due to weak safety awareness among staff and the failure to standardize the wearing of safety helmets. In order to effectively address this situation, technical means such as video surveillance technology and computer vision technology can be utilized to monitor whether staff are wearing helmets and provide timely feedback. Such measures will greatly enhance the safety level of power operation. This paper proposes an improved lightweight helmet detection algorithm named YOLO-M3C. The algorithm first replaces the YOLOv5s backbone network with MobileNetV3, successfully reducing the model size from 13.7 MB to 10.2 MB, thereby increasing the model's detection speed from 42.0 frames per second to 55.6 frames per second. Then, the CA attention mechanism is introduced into the backbone network to enhance the feature extraction capability of the model. Finally, in order to further improve the detection recall rate and accuracy of the model, a knowledge distillation of the model was carried out. The experimental results show that, compared with the original YOLOv5s algorithm, the average accuracy of the improved YOLO-M3C algorithm is improved by 0.123, and the recall rate is the same. These results verify that the algorithm YOLO-M3C has excellent performance in target detection and recognition, which can improve accuracy and confidence, while reducing false detection and missing detection, and effectively meet the needs of helmet-wearing detection. [ABSTRACT FROM AUTHOR]

The nesting habits of Baya Weaver Ploceus philippinus with nesting site (e.g., power and television cables), source of nest materials, various developmental stages of nests, abnormal nests, number of individuals and their association with other bird species, and threats to their nests were studied between March and September 2021 in the agrarian landscapes of 42 villages in Kallakurichi District, Tamil Nadu. A total of 155 nest colonies containing 1,725 nests of various developmental stages and 1,993 adult birds were counted on power/television cables. The number of nests per colony found varied from one to 57. The average number of nests per colony was eleven. Baya Weaver had preferred power/television cables as nesting sites in the study area in spite of availability of potential nest-supporting trees, such as Cocos nucifera and Borassus flabellifer within 500 m radii from cables bearing nests. Birds used fibres of sugarcane leaves (Saccharum officinarum) for the construction of nests. Out of 778 helmet stage nests observed, 90% (n = 716) helmet stage nests had clay deposits on their inner walls and no clay deposits were found in the remaining 10% (n = 62) helmet stage nests. Eleven types of abnormal nests constituted 17% (n = 286) of the total nests. Sixteen other bird species (e.g., birds of order: Passeriformes, Coraciiformes, Piciformes, Cuculiformes and Columbiformes) were found associated with the individuals of Baya Weaver. These bird species strictly shared similar roosting and foraging grounds. The avian predators such as House Crow Corvus splendens, Large-billed Crow Corvus macrorhynchos, Black Drongo Dicrurus macrocercus, Rufous Treepie Dendrocitta vagabunda, Coucal Centropus senegalensis, and Shikra Accipiter badius had damaged the nests, eggs and chicks. The study revealed that about 1.1% nests (n = 197) were probably damaged by these avian predators. Power cables in the study sites had provided suitable nesting sites for Baya Weavers. The causes for utilization of power cables as nesting sites in larger geographical areas require further studies. [ABSTRACT FROM AUTHOR]

Introduction: Wearing a helmet reduces the risk of head injuries substantially in the event of a motorcycle crash. Countries around the world are committed to promoting helmet use, but the progress has been slow and uneven. There is an urgent need for large-scale data collection for situation assessment and intervention evaluation. Methods: This study proposes a scalable, low-cost algorithm to estimate helmet-wearing rates. Applying the state-of-the-art deep learning technique for object detection to images acquired from Google Street View, the algorithm has the potential to provide accurate estimates at the global level. Results: Trained on a sample of 3995 images, the algorithm achieved high accuracy. The out-of-sample prediction results for all three object classes (helmets, drivers, and passengers) reveal a precision of 0.927, a recall value of 0.922, and a mean average precision at 50 (mAP50) of 0.956. Discussion: The remarkable model performance suggests the algorithm's capacity to generate accurate estimates of helmet-wearing rates from an image source with global coverage. The significant enhancement in the availability of helmet usage data resulting from this approach could bolster progress tracking and facilitate evidence-based policymaking for helmet wearing globally. [ABSTRACT FROM AUTHOR]

Background: Treatment for post-traumatic greater occipital neuralgia (GON) includes serial injections of steroid/anesthetic. While these injections can alleviate pain, effects can be transient, frequently lasting only 1 month. As a potential alternative, platelet-rich plasma (PRP) injections are an emerging biological treatment with beneficial effects in peripheral nerve disorders. We investigated the feasibility, safety, and effectiveness of a single PRP injection for post-traumatic GON in comparison to saline or steroid/anesthetic injection. Methods: In this pilot randomized, double-blinded, placebo-controlled trial, 32 adults with post-traumatic GON were allocated 1:1:1 to receive a single ultrasound-guided injection of (1) autologous PRP (2) steroid/anesthetic or (3) normal saline. Our primary outcome was feasibility (recruitment, attendance, retention) and safety (adverse events). Exploratory measures included headache intensity and frequency (daily headache diaries) and additional questionnaires (headache impact, and quality of life) assessed at pre-injection, 1 week, 1 month, and 3 months post-injection. Results: We screened 67 individuals, 55% were eligible and 95% of those participated. Over 80% of daily headache diaries were completed with 91% of participants completing the 3-month outcome questionnaires. No serious adverse events were reported. There were no significant differences between groups for headache intensity or frequency. Headache impact on function test-6 scores improved at 3 month in the PRP (β = -9.7, 95% CI [-15.6, -3.74], p = 0.002) and saline (β = -6.7 [-12.7, -0.57], p = 0.033) groups but not steroid/ anesthetic group (p = 0.135). Conclusion: PRP is a feasible and safe method for treating post-traumatic GON with comparable results to saline and steroid/anaesthetic. Further trials with larger sample sizes are required. [ABSTRACT FROM AUTHOR]

A new algorithm, Yolov8n-FADS, has been proposed with the aim of improving the accuracy of miners' helmet detection algorithms in complex underground environments. By replacing the head part with Attentional Sequence Fusion (ASF) and introducing the P2 detection layer, the ASF-P2 structure is able to comprehensively extract the global and local feature information of the image, and the improvement in the backbone part is able to capture the spatially sparsely distributed features more efficiently, which improves the model's ability to perceive complex patterns. The improved detection head, SEAMHead by the SEAM module, can handle occlusion more effectively. The Focal Loss module can improve the model's ability to detect rare target categories by adjusting the weights of positive and negative samples. This study shows that compared with the original model, the improved model has 29% memory compression, a 36.7% reduction in the amount of parameters, and a 4.9% improvement in the detection accuracy, which can effectively improve the detection accuracy of underground helmet wearers, reduce the workload of underground video surveillance personnel, and improve the monitoring efficiency. [ABSTRACT FROM AUTHOR]

This study aims to enhance the performance of aircrew helmet liners made of 3D woven honeycomb composites through structural improvements. To achieve this, an optimization of the honeycomb design was carried out using a statistical tool by varying its geometrical parameters. A Box Behnken design was employed, using three independent factors: cell height, cell size, and cell wall thickness to assess its impact and their interactions on responses. The performance was evaluated using a multiobjective response to maximize impact energy absorption, achieve the target cushion factor, and balance relative density for lightweight design. Since the liner materials were subjected to flatwise compression and dynamic impact tests to assess the performance. Their behavior. The results revealed that the honeycomb core with a cell height of 15 mm, a cell size of 10 mm, and a cell wall thickness of 0.6 mm exhibited good behavior. The response surface analysis and contour plots were used to analyze the interactions and combined effects of variables on each response. It was observed that lesser cell size shows significant improvement in impact energy with higher wall thickness. However, the cushion factor implies inadequate energy mitigation. The analysis comparing desirability and confirmatory experiments highlighted the potential for the aircrew helmet liner to achieve its maximum performance. This study provides valuable insights into the structural design of 3D woven honeycomb composite liners for aircrew helmets and its findings signify the potential for applications in the aerospace and defense industries. [ABSTRACT FROM AUTHOR]

Automatic detection of safety helmet wearing is significant in ensuring safe production. However, the accuracy of safety helmet detection can be challenged by various factors, such as complex environments, poor lighting conditions and small-sized targets. This paper presents a novel and efficient deep learning framework named High-Resolution You Only Look Once (HR-YOLO) for safety helmet wearing detection. The proposed framework synthesizes safety helmet wearing information from the features of helmet objects and human pose. HR-YOLO can use features from two branches to make the bounding box of suppression predictions more accurate for small targets. Then, to further improve the iterative efficiency and accuracy of the model, we design an optimized residual network structure by using Optimized Powered Stochastic Gradient Descent (OP-SGD). Moreover, a Laplace-Aware Attention Model (LAAM) is designed to make the YOLOv5 decoder pay more attention to the feature information from human pose and suppress interference from irrelevant features, which enhances network representation. Finally, non-maximum suppression voting (PA-NMS voting) is proposed to improve detection accuracy for occluded targets, using pose information to constrain the confidence of bounding boxes and select optimal bounding boxes through a modified voting process. Experimental results demonstrate that the presented safety helmet detection network outperforms other approaches and has practical value in application scenarios. Compared with the other algorithms, the proposed algorithm improves the precision, recall and mAP by 7.27%, 5.46% and 7.3%, on average, respectively. [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]

Concussion is a common injury in the adolescent and young adult populations. Although branched chain amino acid (BCAA) supplementation has shown improvements in neurocognitive and sleep function in pre-clinical animal models of mild-to-moderate traumatic brain injury (TBI), to date, no studies have been performed evaluating the efficacy of BCAAs in concussed adolescents and young adults. The goal of this pilot trial was to determine the efficacy, tolerability, and safety of varied doses of oral BCAA supplementation in a group of concussed adolescents and young adults. The study was conducted as a pilot, double-blind, randomized controlled trial of participants ages 11–34 presenting with concussion to outpatient clinics (sports medicine and primary care), urgent care, and emergency departments of a tertiary care pediatric children's hospital and an urban tertiary care adult hospital, between June 24, 2014 and December 5, 2020. Participants were randomized to one of five study arms (placebo and 15 g, 30 g, 45 g, and 54 g BCAA treatment daily) and followed for 21 days after enrollment. Outcome measures included daily computerized neurocognitive tests (processing speed, the a priori primary outcome; and attention, visual learning, and working memory), symptom score, physical and cognitive activity, sleep/wake alterations, treatment compliance, and adverse events. In total, 42 participants were randomized, 38 of whom provided analyzable data. We found no difference in our primary outcome of processing speed between the arms; however, there was a significant reduction in total symptom score (decrease of 4.4 points on a 0–54 scale for every 500 g of study drug consumed, p value for trend = 0.0036, [uncorrected]) and return to physical activity (increase of 0.503 points on a 0–5 scale for every 500 g of study drug consumed, p value for trend = 0.005 [uncorrected]). There were no serious adverse events. Eight of 38 participants reported a mild (not interfering with daily activity) or moderate (limitation of daily activity) adverse event; there were no differences in adverse events by arm, with only two reported mild adverse events (both gastrointestinal) in the highest (45 g and 54 g) BCAA arms. Although limited by slow enrollment, small sample size, and missing data, this study provides the first demonstration of efficacy, as well as safety and tolerability, of BCAAs in concussed adolescents and young adults; specifically, a dose-response effect in reducing concussion symptoms and a return to baseline physical activity in those treated with higher total doses of BCAAs. These findings provide important preliminary data to inform a larger trial of BCAA therapy to expedite concussion recovery. [ABSTRACT FROM AUTHOR]

As an important part of head protection equipment, research on the material and structural application of helmet liners has always been one of the hotspots in the field of helmets. This paper first discusses common helmet liner materials, including traditional polystyrene, polyethylene, polypropylene, etc., as well as newly emerging anisotropic materials, polymer nanocomposites, etc. Secondly, the design concept of the helmet liner structure is discussed, including the use of a multi-layer structure, the addition of geometric irregular bubbles to enhance the energy absorption effect, and the introduction of new manufacturing processes, such as additive manufacturing technology, to realize the preparation of complex structures. Then, the application of biomimetic structures to helmet liner design is analyzed, such as the design of helmet liner structures with more energy absorption properties based on biological tissue structures. On this basis, we propose extending the concept of bionic structural design to the fusion of plant stalks and animal skeletal structures, and combining additive manufacturing technology to significantly reduce energy loss during elastic yield energy absorption, thus developing a reusable helmet that provides a research direction for future helmet liner materials and structural applications. [ABSTRACT FROM AUTHOR]

Representing neither the glory of World War II, nor the anguish of the Vietnam War, the Korean War continues to occupy an obscure place in American history and culture. Similarly, those who fought in this conflict – including African Americans – have been overshadowed by the combatants who served before and after. Yet the Korean War was enormously significant, not least because it was the first conflict fought by a racially integrated American fighting force. For the first time, black and white soldiers ate, slept, and fought side by side. Films about the Korean War made during the 1950s explored this new racial dynamic. Focusing on the representation of African Americans in The Steel Helmet (1951) and Pork Chop Hill (1959), this article examines the ways in which screen representations both reflected and challenged popular attitudes regarding African American military service during the Korean War. [ABSTRACT FROM AUTHOR]

There is a paucity of large-scale data on the factors that suggest an impending or underlying extremity pediatric acute compartment syndrome (ACS). In addition, literature regarding the timing of operative fixation and the risk of ACS is mixed. We aimed to describe the factors associated with pediatric ACS. Analysis of 2017-2019 Trauma Quality Improvement Program. We included patients aged <18 y diagnosed with upper extremity (UE) and lower extremity (LE) fractures. Burns and insect bites/stings were excluded. Multivariable regression analyses were performed to identify the predictors of ACS. 61,537 had LE fractures, of which 0.5% developed ACS. 76,216 had UE fractures, of which 0.16% developed ACS. Multivariable regression analyses identified increasing age, male gender, motorcycle collision, and pedestrian struck mechanisms of injury, comminuted and open fractures, tibial and concurrent tibial and fibular fractures, forearm fractures, and operative fixation as predictors of ACS (P value <0.05). Among LE fractures, 34% underwent open reduction internal fixation (time to operation = 14 [8-20] hours), and 2.1% underwent ExFix (time to operation = 9 [4-17] hours). Among UE fractures, 54% underwent open reduction internal fixation (time to operation = 11 [6-16] hours), and 1.9% underwent ExFix (time to operation = 9 [4-14] hours). Every hour delay in operative fixation of UE and LE fractures was associated with a 0.4% increase in the adjusted odds of ACS (P value <0.05). Our results may aid clinicians in recognizing children who are "at risk" for ACS. Future studies are warranted to explore the optimal timing for the operative fixation of long bone fractures to minimize the risk of pediatric ACS. [ABSTRACT FROM AUTHOR]

• From 2010 to 2018, over 7 million visits to Emergency Departments (EDs) were due to concussion. • The vast majority of concussions diagnosed in EDs were not sport-related. • Most concussions were diagnosed in the South, followed by West, Midwest, and Northeast. • The Midwest and Northeast regions of the US had lower odds of concussion diagnoses in EDs. • Geographic region and mechanism of injury patterns inform future concussion efforts. Background : Concussion is a type of traumatic brain injury (TBI) that can be sustained through sport-related and non-sport-related (e.g., motor vehicle accidents, falls, assaults) mechanisms of injury (MOI). Variations in concussion incidence and MOI may be present throughout the four geographic regions (Midwest, Northeast, South, West) of the United States. However, there is limited evidence exploring concussion cause and diagnosis patterns based on geographic region and MOI. These factors have implications for better understanding the burden of concussion and necessary efforts that can translate to the mitigation of safety concerns. Purpose: The purpose of this study was to identify patterns of sport-related concussion (SRC) and non-sport-related concussion (NSRC) across the four geographic regions of the United States. Methods: A descriptive epidemiology study of patient visits to the emergency department (ED) for concussion between 2010 and 2018, using publicly available data from the National Hospital Ambulatory Medical Care Survey (NHAMCS) was conducted. The exposure of interest was geographic region while the main outcome measures were concussion diagnosis and MOI. Descriptive statistics were calculated using population-weighted frequencies and percentages. The association between geographic region and MOI (SRC vs. NSRC) was analyzed using logistic regression models. Odds ratios (OR) presented with 95% confidence intervals (CI) were included. Univariate analyses were conducted followed by multivariable analyses adjusting for sex, age, race/ethnicity, and primary source of payment. Statistical significance was set a priori at p < 0.05 for all analyses. Results: From 2010 to 2018, 1,161 visits resulted in a concussion diagnosis, representing an estimated 7,111,856 visits nationwide. A greater proportion of concussion diagnoses occurred within EDs in the South (38.2%) followed by the West (25.8%), Midwest (21.4%), and Northeast (14.6%). Compared to the West region, patients visiting the ED in the Midwest (OR = 0.75, 95% CI = 0.57–0.98) and Northeast (OR = 0.71, 95% CI = 0.51–0.98) had a lower odds of being diagnosed with a concussion. More patients sustained a NSRC MOI (94.3%) compared to SRC MOI (5.7%). For both mechanisms, the South region had the highest population-weighted frequency of SRC (n = 219,994) and NSRC diagnoses (n = 2,495,753). Univariate and multivariable logistic regression analyses did not reveal statistically significant associations for geographic region and MOI (p > 0.05). Conclusion: Our findings showed that the Midwest and Northeast regions had a lower odds of concussion diagnoses in EDs. Overall, the vast majority of concussions were not sport-related, which has public health implications. These findings improve our understanding of how concussion injuries are being sustained geographically nationwide and help to explain care-seeking patterns for concussion in the ED setting. [ABSTRACT FROM AUTHOR]

Guardian Caps (GCs) are currently the most popular external helmet add-on designed to reduce the magnitude of head impacts experienced by American football players. Guardian Caps have been endorsed by influential professional organizations; however, few studies evaluating their efficiency are publicly available. To present preliminary on-field head kinematics data for National Collegiate Athletic Association (NCAA) Division I American football players using instrumented mouthguards through closely matched preseason workouts with and without GCs. Case series. The 2022 American football preseason. Twenty-five male NCAA Division I student-athletes participating in American football completed some portion of the 6 workouts included in this study. Of the 25 participants, 7 completed all 6 workouts using their instrumented mouthguards. Peak linear acceleration (PLA), peak angular acceleration (PAA), and total impacts were collected via instrumented mouthguards during 3 preseason workouts using traditional helmets (TRAD condition) and 3 using a TRAD and GCs (GC condition). The TRAD and GC values for PLA, PAA, and total impacts were evaluated using analyses of variance. No difference was present between the collapsed mean values for the entire sample between the TRAD and GC conditions for PLA (TRAD = 16.3g ± 2.0g, GC = 17.2g ± 3.3g, P =.20), PAA (TRAD = 992.1 ± 209.2 rad/s2, GC = 1029.4 ± 261.1 rad/s2, P =.51), or the total number of impacts (TRAD = 9.3 ± 4.7, GC = 9.7 ± 5.7, P =.72). Similarly, no difference was observed between the TRAD and GC conditions for PLA (TRAD = 16.1g ± 1.2g, GC = 17.2g ± 2.79g, P =.32), PAA (TRAD = 951.2 ± 95.4 rad/s2, GC = 1038.0 ± 166.8 rad/s2, P =.29), or total impacts (TRAD = 9.6 ± 4.2, GC = 9.7 ± 5.04, P =.32) between sessions for the 7 players who completed all 6 workouts. These data suggested no difference in head kinematics data (PLA, PAA, and total impacts) when GCs were worn. Therefore, GCs may not be effective in reducing the magnitude of head impacts experienced by NCAA Division I American football players. [ABSTRACT FROM AUTHOR]

Data in literature indicate that in patients suffering a minor head injury (MHI), biomarkers serum levels could be effective to predict the absence of intracranial injury (ICI) on head CT scan. Use of these biomarkers in case of patients taking oral anticoagulants who experience MHI is very limited. We investigated biomarkers as predictors of ICI in anticoagulated patients managed in an ED. We conducted a single-cohort, prospective, observational study in an ED. Our structured clinical pathway included a first head CT scan, 24 h observation and a second CT scan. The outcome was delayed ICI (dICI), defined as ICI on the second CT scan after a first negative CT scan. We assessed the sensitivity (SE), specificity (SP), negative predictive value (NNV) and positive predictive value (PPV) of the biomarkers S100B, NSE, GFAP, UCH-L1 and Alinity TBI in order to identify dICI. Our study population was of 234 patients with a negative first CT scan who underwent a second CT scan. The rate of dICI was 4.7 %. The NPV for the detection of dICI were respectively (IC 95 %): S100B 92.7 % (86.0–96.8 %,); ubiquitin C-terminal hydrolase-L1 (UCH-L1) 91.8 % (83.8–96.6 %); glial fibrillary protein (GFP) 100 % (83.2–100 %); TBI 100 % (66.4–100 %). The AUC for the detection of dICI was 0.407 for S100B, 0.563 for neuron-specific enolase (NSE), 0.510 for UCH-L1 and 0.720 for glial fibrillary acidic protein (GFAP), respectively. The NPV of the analyzed biomarkers were high and they potentially could limit the number of head CT scan for detecting dICI in anticoagulated patients suffering MHI. GFAP and Alinity TBI seem to be effective to rule out a dCI, but future trials are needed. [ABSTRACT FROM AUTHOR]