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Hip fractures in older adults, which often lead to lasting impairments and an increased risk of mortality, are a major public health concern. Hip fracture risk is multi-factorial, affected by the risk of falling, the load acting on the femur, and the load the femur can withstand. This study investigates the influence of impact direction on hip fracture risk and hip protector efficacy. We simulated falls for 4 subjects, in 7 different impact directions (15° and 30° anterior, lateral, and 15°, 30°, 60°, and 90° posterior) at two different impact velocities (2.1 and 3.1 m/s), all with and without hip protector, using previously validated biofidelic finite element models. We found the highest number of fractures and highest fragility ratios in lateral and 15° posterior impacts. The hip protector attenuated femur forces by 23-49 % for slim subjects under impact directions that resulted in fractures (30° anterior to 30° posterior). The hip protector prevented all fractures (6/6) for 2.1 m/s impacts, but only 10% of fractures for 3.1 m/s impacts. Our results provide evidence that, regarding hip fracture risk, posterior-lateral impacts are as dangerous as lateral impacts, and they support the efficacy of soft-shell hip protectors for anterior- and posterior-lateral impacts., (© 2022. The Author(s).)

Background: In 2013, the American Thyroid Association (ATA) issued a "Policy Statement on Thyroid Shielding During Diagnostic Medical and Dental Radiology." The recently updated National Council on Radiation Protection and Measurement Radiation Protection in Dentistry and Oral and Maxillofacial Imaging (NCRP Report No. 177) prompts this review of progress related to patient thyroid shielding since the ATA statement was published. Summary: Relevant publications appearing since the ATA statement were identified by querying PubMed for "thyroid and dental and (collar or shielding)" and substituting specific dental radiographic procedures in the search. The search was expanded by reviewing the cited papers in the PubMed-retrieved papers and by use of the Web of Science to retrieve papers citing the PubMed retrieved publications. Although many quantitative studies have appeared reflective of current dental radiographic instrumentation and practice, much more can be done to foster minimizing radiation to the thyroid. Conclusions: We list seven areas that should be pursued. Among them are harmonizing guidelines for the use of thyroid collars based on the recent studies and a comprehensive survey of current dental radiological practice patterns.

Advanced Driver Assistance Systems (ADAS) are being developed and installed in increasing numbers. Some of the most popular ADAS include blind spot monitoring and cruise control which are fitted in the majority of new vehicles sold in high-income countries. With more drivers having access to these technologies, it is imperative to develop policy and strategies to guarantee the safe uptake of ADAS. One key issue is that ADAS education has been primarily centred on the user manual which are not widely utilised. Moreover, it is unclear if user manuals are an adequate source of education in terms of content and readability. To address this research gap, a content analysis was used to assess the differences in ADAS-related content and readability among the manuals of the highest selling vehicles in Australia. The qualitative findings showed that there are seven themes in the user manuals: differences between driving with and without ADAS, familiarisation requirements, operational limits of the ADAS, potential ADAS errors, behaviour adaptation warnings, confusion warnings, and malfunction warnings. The quantitative analysis found that some of the manuals require several years of education above the recommended for a universal audience (>8 years) to be understood. Additionally, there is a notable number of text diversions and infographics which could make comprehension of the user manual difficult. This investigation shows that there is a lack of standardisation of ADAS user manuals (in both content and delivery of information) which requires regulatory oversight. Driver ADAS education needs to be prioritised by policymakers and practitioners as smart technology continues to increase across the transport system. It seems that current strategies based on user manuals are insufficient to achieve successful adoption and safe use of these technologies., Competing Interests: The authors have declared that no competing interests exist.

Objectives: Drugs can come in concentrated solutions that require dilution before intravenous bolus administration. Upon dilution, the syringe can contain more than the required amount of drug. The user may mistakenly administer the full contents of the syringe, resulting in an overdose. In this cross-sectional study, we evaluated user experience and perception of Syringe Brake, a dosage flow restrictor device, as part of the intravenous morphine bolus administration workflow., Methods: From December 2018 to January 2019, doctors and nurses working in the emergency department of 3 public tertiary hospitals in Singapore were invited to complete a paper-based 11-item 5-point Likert scale survey questionnaire after 3 months of Syringe Brake implementation., Results: Overall, 77.5% (290/374; 4.11 ± 0.83) of participants were satisfied with the use of Syringe Brake to prevent medication error. Our survey results showed that the top features of Syringe Brake were ease of setting the desired volume to be administered (86.1%; 4.21 ± 0.72), allowing the drug to be titrated safely (84.8%; 4.26 ± 0.77), and giving users the confidence to avoid overdosing the patient (82.1%; 4.21 ± 0.78). Those with hands-on experience with Syringe Brake rated significantly higher for all survey statements except on the perceived ability to prevent error arising from miscommunication (adjusted odds ratio, 1.58 [0.98-2.57]; P = 0.062)., Conclusions: Syringe Brake shows promising potential for adoption to prevent medication errors. The device serves as a constraint to prevent accidental overdose, caused by user unfamiliarity or autopilot administration., Competing Interests: This work was supported by Changi General Hospital FY2018 Innovation Grant (COCHFINN1801). The funding source was not involved in the study design, manuscript preparation, data management, or writing of the report. A full regular patent application has been filed for Syringe Brake, and the intellectual property is managed by Changi General Hospital. Y.Y.Y.N. is one of the coinventors of Syringe Brake and will receive net royalties outside the submitted manuscript. However, she will not hold any patent rights to Syringe Brake. The remaining authors disclose no conflict of interest., (Copyright © 2020 The Author(s). Published by Wolters Kluwer Health, Inc.)

Injuries are a leading cause of death and disability among children. Numerous injury prevention strategies have been successful in high-income countries, but the majority of unintentional injuries happen to children living in low- and middle-income countries (LMICs). This project aims to delineate the childhood injury prevention initiatives in LMICs. For inclusion, peer-reviewed articles needed to address unintentional injury, include children <18, assess a prevention-related intervention, contain a control group, and be published after 1988. Two pairs of reviewers evaluated articles independently to determine study eligibility. 74 articles were included. 30 studies addressed road traffic injuries, 11 drowning, 8 burns, 3 falls, 8 poisonings, and 21 an unspecified injury type. The findings show positive effects on injury outcome measures following educational interventions, the need for longer follow-up periods after the intervention, the need for effectiveness trials for behavior change, and the need for an increase in injury prevention services in LMICs. This is the first systematic review to summarize the prevention initiatives for all types of childhood unintentional injuries in LMICs. Increased attention and funding are required to go beyond educational initiatives with self-reported measures and little follow-up time to robust interventions that will reduce the global burden of unintentional injuries among children., Competing Interests: The authors have declared that no competing interests exist.

This study examined the effects of plastic antipecking devices (PAD) on the production performance, upper beak length, behavior, and plumage condition of a local Chinese chicken breed. Three hundred sixty 63-d-old Wannan chickens with intact beaks were randomly allocated into 3 groups. Birds were fitted with the PAD at 63 d (PAD63d) and at 77 d of age (PAD77d). Control birds were not fitted with PAD. The results showed that there were no significant effects of PAD on the BW, carcass traits, and meat quality (P > 0.05). The mortality in the PAD63d and PAD77d groups was lower than that in the control group. Compared with those in the PAD77d and control groups, the feed conversion ratio (FCR) from 63 to 112 d of age was lower in the PAD63d group. The ADFI of birds from 63 to 112 d of age was lowest in birds in the PAD63d group, intermediate in birds in the PAD77d group, and highest in control birds (P < 0.05). Birds in the PAD63d and PAD77d groups showed a lower frequency of walking and running, a higher frequency of sleeping, and higher plumage scores of the back and tail than those of control birds (P < 0.05). Birds' daily walking steps in the PAD77d group decreased compared with that of birds in the control group (P < 0.05). The upper beak length at 91 d and 112 d of age was longest in birds in the PAD63d group and shortest in control birds (P < 0.05). Overall, PAD appeared to be effective at reducing mortality, FCR, overall activity, and plumage damage and increasing the upper beak length., (Copyright © 2020. Published by Elsevier Inc.)

Safety-engineered devices (SEDs) have been developed to protect healthcare personnel (HCP) from needlestick and sharps injuries (NSIs). The aim of this study was to analyze NSIs associated with SEDs and non-SEDs among HCP in hospitals, medical offices and care facilities. Records from online questionnaires on NSIs were used. Causes of NSIs were compared for SED use and healthcare setting. A sample of 835 files was included. Injuries with SEDs accounted for 35.0% of all NSIs, whereas the proportions were higher in medical offices and lower in care facilities. NSIs in nurses were more often associated with SEDs than NSIs in physicians. NSIs from intravenous needles were associated with SEDs in more than 60% of cases in hospitals and medical offices and in about 30.0% of cases in care facilities. In contrast, suturing was associated with every fourth NSI in hospitals, of which fewer than 10.0% were associated with SEDs. In care facilities, SEDs were involved in 36.1% of NSIs during subcutaneous injections. NSIs during disposal accounted for 29.2% of total NSIs, of which 36.1% were associated with SEDs. Frequent reasons for SED-associated NSIs were technical problems, unexpected patient movement and problems during disposal. Our analysis shows that many NSIs are associated with SEDs. Continuous training is necessary in the handling and disposal of SEDs.

Background: A continuing complication, pressure injuries are due to sustained mechanical loading and tissue deformations, which can then be exacerbated by additional intrinsic and extrinsic risk factors. Although support surfaces are designed to mitigate risk factors for pressure injuries, the presence of a turn and position device (TPD) between the patient and support surface may interfere with how support surfaces affect these risk factors., Objective: Report the use of the NPIAP's S3I standard test methods to characterize the performance of a support surface when used in conjunction with three different TPDs., Design: Laboratory testing compared three TPDs for Immersion, Envelopment, and Horizontal Stiffness in each of five surface combinations., Main Outcome Measure: Immersion test measures how far mannequin indenter immerses into surface. Envelopment test measures immersion and pressure distribution with hemispherical-indenter with mounted sensor rings. Horizontal Stiffness test measures the shear modulus of the support surface with epicondyle indenter., Main Results: For the specific TPDs tested here, the one with an adjustable integrated air bladder improved rather than compromised both the envelopment and the immersion of the support surface alone. Additionally, this TPD provided potential protection against sliding and the associated frictional shear forces., Conclusions: This paper describes how TPDs should perform in order to help establish which features are needed in a new medical device of this type. Laboratory testing demonstrates it is possible to improve performance of a support surface by applying a TPD as an add-on, thus relieving tissue deformation exposure through more effective pressure redistribution.

Adoption of interventional endoscopic procedures is increasing with increasing prevalence of diseases. However, medical radiation exposure is concerning; therefore, radiation protection for medical staff is important. However, there is limited information on the usefulness of an additional lead shielding device during interventional endoscopic procedures. Therefore, we aimed to determine whether an additional lead shielding device protects medical staff from radiation.An X-ray unit (CUREVISTA; Hitachi Medical Systems, Tokyo, Japan) with an over-couch X-ray system was used. Fluoroscopy-associated scattered radiation was measured using a water phantom placed at the locations of the endoscopist, assistant, nurse, and clinical engineer. For each location, measurements were performed at the gonad and thyroid gland/eye levels. Comparisons were performed between with and without the additional lead shielding device and with and without a gap in the shielding device. Additionally, a clinical study was performed with 27 endoscopic retrograde cholangiopancreatography procedures.The scattered radiation dose was lower with than without additional lead shielding at all medical staff locations and decreased by 84.7%, 82.8%, 78.2%, and 83.7%, respectively, at the gonad level and by 89.2%, 86.4%, 91.2%, and 87.0%, respectively, at the thyroid gland/eye level. Additionally, the scattered radiation dose was lower without than with a gap in the shielding device at all locations.An additional lead shielding device could protect medical staff from radiation during interventional endoscopic procedures. However, gaps in protective equipment reduce effectiveness and should be eliminated.

The coronavirus infection, also known as SARS-COV2, has proven to be potentially fatal, representing a major global health problem. Its spread after its origin in the city of Wuhan, China has resulted in a pandemic with the collapse of the health system in several countries, some with enormous social impact and expressive number of deaths as seen in Italy and Spain. Extreme intra and extra-hospital measures have been implemented to decrease the transmission and dissemination of the COVID-19. Regarding the surgical practice, a huge number of procedures considered non-essential or elective were cancelled and postponed until the pandemic is resolved. However, urgent and oncological procedures have been carried out. In this publication, we highlight and teach adaptations to be made with commonly used materials in laparoscopy to help prevent the spread and contamination of the healthcare team assisting surgical patients.

Background: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus responsible for Coronavirus disease 2019 (COVID-19) has a predilection for infecting the mucosa of the upper and lower airways. Otolaryngologists and supporting health care workers (HCWs) are particularly at high risk of becoming infected while treating patients as many in-office procedures and surgeries are Aerosol Generating Medical Procedures (AGMP). Based on a review of the literature and various guidelines, recommendations are made to mitigate the risk to health care workers of becoming infected with SARS-CoV-2 while providing clinical care., Recommendations: During the COVID-19 pandemic all elective and non-time sensitive Otolaryngology procedures should be deferred to mitigate the risk of transmission of infection to HCWs. For non-AGMPs in all patients, even COVID-19 positive patients Level 1 PPE (surgical mask, gown, gloves and face shield or goggles) is sufficient. If local prevalence is favourable and patients are asymptomatic and test negative for SARS-CoV-2, Level 1 PPE can be used during short duration AGMPs, with limited risk of infected aerosol spread. For AGMPs in patients who test positive for SARS-CoV-2 a minimum of Level 2 PPE, with adequate protection of mucosal surfaces, is recommended (N95/FFP2 respirator, gown, double gloves, goggles or face shield and head cover). For long duration AGMPs that are deemed high-risk in COVID-19 positive patients, Level 3 PPE can provide a higher level of protection and be more comfortable during long duration surgeries if surgical hoods or PAPRs are used. It is recommended that these procedures are performed in negative pressure rooms, if available. It is essential to follow strict donning and doffing protocols to minimize the risk of contamination., Conclusions: By following strict infection prevention recommendations, the risk of HCWs becoming infected with SARS-CoV-2 while treating patients can be minimized. As the COVID-19 pandemic evolves rapidly, these recommendations should serve as guidance and need to be interpreted based on local factors and availability of healthcare resources.

Background: Administration of doxorubicin via bolus injection may result in environmental contamination and a risk of nurses becoming exposed. Small spills are frequently observed by nurses when syringes are connected to, and disconnected from, infusion lines., Aims: The effect of a closed-system drug transfer device (CSTD) on the release of doxorubicin was studied during administration via bolus injections., Methods: 10 administrations with the currently used technique and 10 administrations using the CSTD were compared by analysis of doxorubicin contamination on gauze pads, tissues and gloves., Findings: Using the current technique, contamination was found during nine administrations, which was mainly on the gauze pads and, to a lesser extent, on the tissues and gloves, indicating release of doxorubicin during administration. With use of the CSTD, contamination was found only on one pair of gloves., Conclusion: Use of a CSTD significantly decreased the number of spills and level of contamination compared with the currently used technique and, consequently, the use of such devices offers a safer working environment for nurses.

Purpose: Health care professionals can be exposed to hazardous drugs such as cytostatics during preparation of drugs for administration. Closed sytem transfer devices (CSTDs) were introduced to provide protection for healthcare professional against unintended exposure to hazardous drugs. The interest in CSTDs has significantly increased after USP <800> monograph was issued. The majority of the studies published so far on CSTDs have focused on their "containment" function. However, other important attributes for CSTDs with potential importance for product quality impact are not yet fully evaluated., Methods: In the current study, we evaluated four sytems from different suppliers, in combination with different container closure systems (CCS), using solutions of different viscosity and surface tension. The different CSTD / CCS combinations were tested for (a) containment (integrity) using a highly sensitive helium leak test, (b) the force required for mounting the vial adaptor, (c) contribution to visible and subvisible particles as well as (d) the hold-up volume., Results: Results show that the majority of CSTDs may have leaks varying in size, and that some of them generated visible particles due to stopper coring and subvisible particles, both due to silicon oil and particulate contaminations of the Devices. Finally, the holdup volume was up to 1 mL depending on the CSTD type, vial size and solution viscosity., Conclusion: These results show that there is a need to evaluate the compatibility of CSTD systems to select the best system for the intended use and that CSTDs may adversely impact product quality and delivered dose.

The purpose of this study was to analyze car-to-cyclist accidents to determine the challenges for an active safety system on car to avoid accidents. Based on 2261 car-to-cyclist accidents provided by in-depth accident databases, accidents are analyzed more specifically from kinematic reconstructions. The main accident scenarios are determined: crossing nearside, crossing farside, longitudinal, turning (right and left) and others. Proportion of brakes activation by the drivers before the impact was also given for those scenarios. The relative positions of the cyclists to the vehicle are analyzed from few seconds before the impact until the crash. It is observed that one second before the impact most of the cyclists were at a lateral distance smaller than 5 m to the center line of the car and less than 20 m ahead of car front. Finally, the possible detection of the cyclist by implemented sensors in the vehicle and the possible triggering of an active safety system like an Automatic Emergency Braking or a Forward Collision Warning are studied. Required detection sensors parameters, such as Field Of View (FOV) and the detection range, were analyzed relatively to the scenario's characteristics, e.g. remaining time after cyclist appearance and before the collision, differences between scenario types. Different sensor FOVs and detection ranges were analyzed to determine their possible rates of cyclist detection. The study concluded that a FOV of 60° and a range of 35 m would detect most of the cyclists in car-to-cyclist accident scenarios. It was also concluded that in about 80% of cases, the last time to trigger brake (t LTTB ), i.e. the last moment to brake in order to avoid the accident based on physical and comfort braking limitations by the car, was 1 s before the collision. It was also calculated that with a FOV of 60°, 51% of cyclists could be detected up to 4 s before t LTTB , and 72% up to 1 s before t LTTB . Values found in this paper can be useful to determine some of the specifications of an Advanced Driver Assistance System (ADAS), e.g. detection sensor coverages, available time to trigger an autonomous emergency braking or forward collision warning device. Those values are given for general ADAS sensors specification but also per scenario in the case of sensors that can adapt to a specific scenario., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

Cooperative Intelligent Transportation Systems (C-ITS) are being deployed in several cities around the world. We are preparing for the largest Field Operational Test (FOT) in Australia to evaluate C-ITS safety benefits. Two of the safety benefit hypotheses we formulated assume a dependency between lane changes and C-ITS warnings displayed on the Human Machine Interface (HMI) during safety events. Lane change detection is done by processing many predictors from several sensors at the time of the safety event. However, in our planned FOT, the participating vehicles are only equipped with the vehicle C-ITS and the IMU. Therefore, in this paper, we propose a framework to test lane change and C-ITS dependency. In this framework, we train a random forest classifier using data collected from the IMU to detect lane changes. Consequently, the random forest output probabilities of the testing data in case of C-ITS and control are used to construct a 2x2 contingency table. Then we develop a permutation test to calculate the null hypothesis needed to test the independence of the lane change during safety events and the C-ITS., Competing Interests: The authors have declared that no competing interests exist.

This study was to evaluate dose reduction and resulting image quality of a new synthetic thyroid shield based on silicon rubber (SR)-lead (Pb) composites and compare to tungsten paper (WP) and a Radibabarrier thyroid shields in CT examination of the neck. The synthetic SR-Pb thyroid shield had a Pb percentage from 0 to 5 wt% and a thickness of 0.6 cm. Scanning on the neck of an anthropomorphic phantom was performed with and without the SR-Pb, WP, and Radibarrier thyroid shields. The thyroid shields were placed directly on the neck surface. The thyroid dose was measured using radiophoto-luminescence (RPL) detectors. Image quality was characterized by consistency of the Hounsfield unit (HU) on the areas of anterior, posterior and lateral of the neck phantom. Detailed evaluation of the image quality was employed by image subtraction. It was found that the thyroid dose at the surface decreased with an increase of Pb percentage in the SR-Pb shield. The thyroid dose reduction was 34% for a Pb percentage of 5 wt%. The reduction of the dose using WP and Radibarrier were 36% and 67%, respectively. The dose reduction when using the WP and Radibarrier was higher than when using the SR-Pb 5 wt% thyroid shield. However the existence of artifact in the WP and the Radibarrier reduced the image quality, indicated by a significant change of HU, i.e. the increases of HU in the posterior area were 77% for the WP and 553% for the Radibarrier. The SR-Pb shield produced only a very small artifact, resulting in an increase of HU in the posterior area of only 9%. The SR-Pb shield is suitable in the daily clinical setting for thyroid dose reduction in CT examinations while maintaining image quality.

Hazardous drug is a common term used by the National Institute of Occupational Health and Safety (NIOSH) to classify medications that may induce adverse mutagenic and reproductive responses in health care personnel. NIOSH publishes a list of drugs it defines as hazardous where it may be appropriate for health care workers to take protective measures to reduce the potential for occupational exposure. Recent updates and proposed updates to this list have included large molecule biological products with oncology indications. Both NIOSH and USP <800> recommend the use of closed system transfer devices (CSTDs) during compounding. CSTDs are required for administration of prepared solution in NIOSH. However, USP has suggested that the principles of <800> are broadly applicable to hazardous drug handling activities across all facility types. USP encourages the widespread adoption and use of <800> across all health care settings, which many health care workers have interpreted beyond compounding to include administration and preparation of conventionally manufactured sterile products per approved labeling. Although the use of CSTDs may reduce exposure of health care personnel to chemotherapy agents in health care setting, the impact of CSTDs on quality of biologic drug products, including monoclonal antibodies and other proteins, is not fully understood. To complicate this issue further, there are several commercially available CSTDs in the market which have different fluid paths and material of construction that comes in contact with the drug. Testing every combination of CSTD and drug product for potential incompatibilities can be a labor intensive and impractical approach and cause delay in getting essential drugs to patients. A panel discussion was held at a recent American Association of Pharmaceutical Scientists 2018 PharmSci 360 conference to discuss the impact of CSTDs on biologics. Impact on subvisible and visible particulates and impact to other product quality attributes such as high molecular weight species formation upon contact with CSTDs were reported in American Association of Pharmaceutical Scientists meeting. Impact to deliverable dose, holdup volumes of various CSTDs, and stopper coring were also reported that has significant impact to patient safety. Given the fact that USP chapter <800> will be implemented in December 2019, feedback from health authorities regarding the use of CSTDs for biological drug products is needed to provide an appropriate risk/benefit balance to ensure patient safety and quality of the biologic drug product while also protecting the health care worker and the environment. The purpose of this commentary is to provide an industry perspective on the challenges during the use of CSTDs for biologic drug products and is intended to raise caution and awareness on the benefits and shortcomings of these devices., (Copyright © 2020 American Pharmacists Association®. Published by Elsevier Inc. All rights reserved.)

Objectives: To investigate the effect of wearing hard hats on the lower cervical and upper thoracic region using surface electromyography (sEMG) and possible link to work-related musculoskeletal disorder (WRMSD)., Methods: Twenty study subjects wore sEMG sensors placed on the upper trapezius muscle on their dominant side to assess muscle activity while wearing different hard hats. Study subjects were asked to don six different hard hats and assume varied neck postures. A repeated-measures design was used to analyze the results for difference and similarities in muscle activity., Results: There was a small, significant effect of wearing a hard hat on muscle loading in the upper trapezius (p = 0.038). Post-hoc analyses revealed the only statistically significant difference was between wearing no hard hat at all and wearing head protection (without accessories) in the flexed posture (p = 0.006)., Conclusion: The results demonstrated that there was little difference in lower cervical and upper thoracic muscle activity while donning hard hat and assuming various neck postures. Wearing a sample of commonly used hard hats in this study does not appear to substantially increase muscle activity that would cause fatigue in the lower cervical and upper thoracic region among young, healthy volunteer subjects.

Objectives: The Insurance Institute for Highway Safety (IIHS) rates automotive seats as good, acceptable, marginal, and poor on their abilities to prevent whiplash injuries during rear-end collisions. The goal of this study was to compare the performance of some good- and poor-rated seats at speed changes below 16 km/h where some whiplash injuries occur. Methods: A BioRID II anthropometric test device (ATD) underwent rear-end collisions from 2 to 14 km/h while seated on one of two Volvo Whiplash Prevention seats (WHIPS), a Saab Active Head Restraint seat (SAHR), or a General Motors High Retention seat (GMHR). The WHIPS and SAHR seats were rated good whereas the GMHR seat was rated poor by the IIHS. The ATD's kinematics, kinetics and three neck injury criteria were evaluated across the range of collision severities. Results: Most of the head and torso kinematics, kinetics and injury criteria exhibited graded responses with increasing collision severities. Only head extension angle remained relatively similar across all speed changes. Differences between the good- and poor-rated seats were most apparent in the upper neck loads and moments, and head retraction for speed changes greater than 6 km/h. Conclusions: The relatively similar occupant responses across all seats could explain the marginal reductions in whiplash injury risk between good- and poor-rated seats in field studies. Further research into the design of anti-whiplash devices is required to better understand the link between occupant response and injury, and to better mitigate the risk of whiplash injuries during rear-end collisions.

A two-phased retrospective cross-sectional study analysed the occupational dose and radiation protection practice among medical workers in two hospitals in the UAE. Phase 1 evaluated radiation protection practice using a questionnaire, whereas phase 2 assessed the occupational dose. Readings of 952 thermoluminescence dosimeters were analyzed. The result showed 52% of medical workers have a good level of radiation protection practice. Readings of 952 thermoluminescence dosimeters were analyzedAverage annual effective dose per worker ranged from 0.39 to 0.83 mSv. Cardiologists and nurses displayed a higher average of occupational radiation dose compared to other workers. There were no significant correlations between radiation protection practice and hospital, occupation or department. Finally, the occupational dose was within the international and national limits, but the reduction of radiation dose to cardiologist and nurses is essential. Moreover, training is essential to promote radiation safe practice among medical workers., (© The Author(s) 2019. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.)

The objective of this study was to assess the radiation doses received by anaesthetists from prostatic artery embolization (PAE) procedures. Ten PAE procedures conducted in a reference hospital in the city of Recife, Brazil were investigated. Occupational dosimetry was performed using thermoluminescent dosemeters which were located next to the eyes, close to the thyroid (over the shielding), on the thorax (under the apron), on the wrist and on the feet of the physician's body. The results showed that the anaesthetist's feet received the highest doses followed by the eyes and the hands. In some complex PAE procedures the doses received by anaesthetists on the lens of the eyes and the effective dose were higher than those received by the main operator due to the anaesthetist's close position to the patient's table and the use of oblique projections. The personal dose equivalent Hp(3) per procedure for the anaesthetist's right eyebrow ranged from 20.2 μSv to 568.3 μSv. This result shows that anaesthetists assisting PAE procedures can exceeds the annual eye lens dose limit of 20 mSv recommended by the ICRP with only one procedure per week if radiation protection measures are not implemented during procedures., (© The Author(s) 2019. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.)

Researchers involved in community-based participatory research often face challenges due to numerous dynamic factors, including the physical location of the study population, willingness to participate, language barriers, cultural norms, social stigmas, and unpredictable weather and other disasters. Investigators who work with commercial fishermen are all too familiar with these potential obstacles and barriers to performing occupational safety and health research. Such has been the case along the Texas and Louisiana gulf coasts, where the burden of occupational fatalities in the shrimp fishery remains high. Moreover, the need for strategic community, regulatory agency, and research partnerships in order to explore solutions that can help to reduce this burden is ongoing. The IFISH 5 conference and the panel session described in this brief report offered a venue to acknowledge and create awareness of these barriers and opportunities for developing sustainable solutions that can have an impact on this loss of life. The approach taken was to explore the perspectives of a panel of regional collaborators including two researchers, an outreach community liaison, and a marine safety and health official from the U. S. Coast Guard. Key barriers emerging from the panel fell into four themes, each emphasized by one of the four panel members, allowing for discussion of potential solutions. The themes included: (1) language gap; (2) cultural influences and use of personal flotation devices; (3) relationships with the community; and (4) enforcement agency role as a trusted opinion leader. This panel session can readily serve as a model to promote similar exploration of barriers and solutions in commercial fishing across other regions of the US and internationally as well.

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

Automated vehicles (AV) testing on the public roads is ongoing in several states in the US as well as in Europe and Asia. As long as the automated vehicle technology has not achieved full automation (Level 5), human drivers are still expected to take over the steering wheel and throttles when there is an automated vehicle disengagement. However, contributing factors and the mechanism about automated vehicle-initiated disengagement has not been quantitatively and comprehensively explored and investigated due to the lack of field test data. Besides, understanding human drivers' perception and promptness of reaction to the AV disengagement is essential to ensure safety transition between automated and manual driving. By harnessing California's Autonomous Vehicle Disengagement Report Database, which includes the AV disengagement data from field tests in 2016-2017, this paper quantitatively investigated the AV disengagement using multiple statistical modeling approaches that involve statistical modeling and classification tree. Specifically, the paper identifies the contributing factors impacting human drivers' promptness to AV disengagements, and quantitatively investigates the underlying causes to AV disengagements. Results indicate that current AV disengagement on public roads is dominated by causes due to a planning issue. The cause of an AV disengagement is significantly induced by lacking certain numbers of radar and LiDAR sensors installed on the automated vehicles. These thresholds of these sensors needed are revealed. Cause of disengagement and roadway characteristics significantly impact drivers' take-over time when facing an AV disengagement. AV perception or control issue-based disengagement can significantly extend drivers' perception-reaction time to take over the driving. The quantitative knowledge obtained ultimately facilitates revealing the mechanisms of the automated vehicle disengagements to ensure safe AV operations on public roads., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

A variety of hip protectors are available, but it is not clear which is the most effective and there is no standard test to evaluate their performance. This is the first study that uses a standard mechanical test on hip protectors. Some protectors perform well but others are almost ineffective, providing little to no protection to the wearer during a fall., Introduction: Each year, over 70,000 patients are admitted to hospital in the UK with hip fractures. There are a variety of commercial hip protectors currently available. However, it is not explicitly clear which is the most effective with regard to maximum force attenuation, whilst still being both comfortable for the user and providing reasonable force reduction if misplaced from the intended position. The numerous test methods reported in the literature have given conflicting results, making objective comparison difficult for users, researchers, and manufacturers alike. The Canadian Standards Association (CSA) has therefore published an express document (EXP-08-17) with a draft standard test method. This paper presents initial results for a range of hip protectors., Methods: Eighteen commercially available hip protectors were tested according to EXP-08-17. Each hip protector was impacted five times in correct anatomical alignment over the greater trochanter and once at 50 mm displacements in the anterior, posterior, and lateral directions., Results: Considerable differences were identified between individual hip protectors in their ability to reduce impact forces on the femur (between 3% and 36% reduction in peak force). The performance was reduced when misplaced in many cases (maximum reduction only 20%)., Conclusions: This is the first study that uses a standard mechanical test on hip protectors. Previous studies have used a variety of methods, making it difficult to interpret results. We hope that these results using a standard test method will facilitate the effective comparison of results, as well as providing useful data for clinicians, users, and purchasers.

The construction industry involves many hazardous activities that may expose workers to a wide variety of health hazards. Selection of construction safety equipment is crucial in ensuring workers' safety. This article aims to examine key factors influencing management decisions concerning safety equipment selection, utilizing exploratory factor analysis (EFA) and the analytic hierarchy process (AHP). A questionnaire survey is conducted in the construction companies in Bangkok, Thailand. The factor analysis extracts 103 sets of data into six key factors - namely supplier agreements, supplier support, personal, equipment design, safety-related policies and cost value factors - with a total of 20 associated items. The AHP results conclude that the safety-related policies, equipment design and personal factors are the most important factors when selecting construction safety equipment. A construction company can use the study results as a checklist to help assess different safety equipment, and to select the best equipment.

One focus of the U.S. Federal Motor Carrier Safety Administration (FMCSA) is to provide leadership in the testing and evaluation of promising safety technologies developed for use in commercial motor vehicles (CMVs). To this end, a program was developed by FMCSA to conduct independent, short-turnaround evaluations of promising safety technologies. Vendors who had promising safety technologies, focused in the commercial vehicle domain, were solicited to participate and submit an application. One technology was selected by FMCSA for each evaluation cycle (lasting approximately 18 months). The technology was tested in both static and dynamic conditions, after which a trucking fleet, and its drivers, were brought in to test the technology in a field operational test (FOT) lasting approximately 6 weeks. During the FOT, 15-20 trucks were instrumented with the technology and other data collection equipment, including sensors and video cameras. A study was then conducted during which drivers used the technology in their revenue-producing operations. Initially, often for the first 2 months, the technology collected data but did but not actively present alerts to the driver. Following this baseline period, a four-month intervention period was conducted. Each evaluation has resulted in more than 1,000,000 km of driving data including continuous video data. Data analyses focused on understanding the efficacy of the technology in terms of (i) safety improvements, (ii) challenges to implementation (e.g., unintended consequences), and (iii) user acceptance (including driver, fleet manager, and other fleet personnel as appropriate). The technology vendors who applied for the first three evaluations can be classified into the following general categories: fatigue/drowsiness, fleet management, visibility safety systems, cell phone policy/enforcement, and other systems. Three technology evaluations were completed in the first 5 years of (i) a blind spot detection and warning system, (ii) an onboard monitoring system, and (iii) a novel mirror technology. High-level results of each of these three evaluations are highlighted in the paper., (Copyright © 2018 Elsevier Ltd. All rights reserved.)

Objectives: To test maternal voice alarm effectiveness under residential conditions and determine whether personalizing the maternal voice alarm message with the child's first name improves effectiveness., Study Design: Using a randomized, nonblinded, repeated measures design, we compared 3 maternal voice smoke alarms with respect to their ability to awaken 176 children 5-12 years old from stage 4 slow-wave sleep and prompt their performance of an escape procedure. A conventional residential high-frequency tone smoke alarm was used as a comparative reference. Children's sleep stage was monitored in a residence-like research setting., Results: Maternal voice alarms awakened 86%-91% of children and prompted 84%-86% to escape compared with 53% awakened and 51% escaped for the tone alarm. A sleeping child was 2.9-3.4 times more likely to be awakened by each of the 3 voice alarms than the tone alarm. The median time to awaken was 156 seconds for the tone alarm and 2 seconds for each voice alarm. The proportions of children who awakened and escaped differed significantly between the tone alarm and each voice alarm, but no significant differences were found between each pair of the voice alarms, regardless of whether the child's first name was included in the alarm message., Conclusions: The maternal voice alarms significantly outperformed the tone alarm under residential conditions. Personalizing the alarm message with the child's first name did not increase alarm effectiveness. These findings have important implications for development of an effective and practical smoke alarm for children., Trial Registration: ClinicalTrials.gov: NCT01169155., (Copyright © 2018 Elsevier Inc. All rights reserved.)

The main requirement established for the development of European Union product safety directives is to ensure a high level of safety for users. This research aims to analyze whether Europe needs a product safety directive for scaffolding and identify the main factors to be defined in public policies on the use of standardized scaffolding in the absence of such a directive. The principal types of scaffolding were reviewed, along with European regulations, and their risk levels. Finally, a qualitative study using a panel of experts was conducted to determine the differences between types of scaffolding and whether the enactment of such a directive would be justified. Key results were that the risk level associated with scaffolding positioned it third or fourth between material agents more hazardous in relation to falls from height. There is no existing product safety directive for scaffolding, despite the fact that there are directives for other products less dangerous than or as dangerous as scaffolding. However, there are noncompulsory standards EN 12810-1-2 and EN 12811-1-2-3-4 for scaffolding, which would form the basis of the essential requirements contained in a directive if it were created. The experts highlighted significant differences between "standardized" and "nonstandardized" scaffolding, with higher safety levels and productivity, and better maintenance, inspection, assembly, and dismantling associated with the former, and lower costs with the latter. Thus, they found that the enacting of an EU product safety directive for scaffolding would be justifiable, and in its absence supported the promotion of the use of standardized scaffolding.

Purpose: A survey of guidelines and current practices was conducted to examine the safe handling procedures for antineoplastic and other hazardous drugs that are used in 24 countries including the Americas, Europe, the Mideast, Far East, and Australia., Methods: Subject experts were asked to complete a brief survey regarding safe handling guidelines and practices for hazardous drugs in their countries. Questions addressed practices for handling monoclonal antibodies, the use of closed-system transfer devices, medical surveillance practices, and measurements of compliance with existing guidelines., Results: Responses from 37 subject experts representing 24 countries revealed considerable variation in the content and scope of safe handling guidelines and pharmacy practices among the participating countries. Guidelines in the majority of countries used the term "cytotoxics," while others referred to "hazardous" or "antineoplastic" drugs. The International Society of Oncology Pharmacy Practice standard was cited by six countries, and five cited the National Institute for Occupational Safety and Health Alert. Others cited international guidelines other than International Society of Oncology Pharmacy Practice, or they have created their own guidelines. Approximately half reported that their guidelines were mandatory under federal, state, or provincial legislation. Only 11 countries reported that monoclonal antibodies were covered in their guidelines. Closed-system drug-transfer devices are widely used, but were not specifically recommended in four countries, while one country required their use. Medical surveillance programs are in place in 20 countries, but only in The Netherlands is surveillance mandatory. Nine countries reported that they have completed recent updates or revisions of guidelines, and the measures for their adoption have been initiated., Conclusions: Although the overall goals in the participating countries were similar, the approaches taken to assure safe handling of hazardous drugs varied considerably in some cases.

Competing Interests: DisclosuresThe authors have declared no potential conflicts of interest.

Background and Purpose: Carotid artery stenting is an alternative to endarterectomy for the treatment of symptomatic carotid stenosis but was associated with a higher risk of procedural stroke or death in randomized controlled trials (RCTs). Technical aspects of treatment may partly explain these results. The purpose of this analysis was to investigate the influence of technical aspects such as stent design or the use of protection devices, as well as clinical variables, on procedural risk., Methods: We pooled data of 1557 individual patients receiving stent treatment in three large RCTs comparing stenting versus endarterectomy for symptomatic carotid stenosis. The primary outcome event was any procedural stroke or death occurring within 30 days after stenting., Results: Procedural stroke or death occurred significantly more often with the use of open-cell stents (61/595 patients, 10.3%) than with closed-cell stents (58/962 patients, 6.0%; RR 1.76; 95% CI 1.23 to 2.52; P=0.002). Procedural stroke or death occurred in 76/950 patients (8.0%) treated with protection devices (predominantly distal filters) and in 43/607 (7.1%) treated without protection devices (RR 1.10; 95% CI 0.71 to 1.70; P=0.67). Clinical variables predicting the primary outcome event were age, severity of the qualifying event, history of prior stroke, and level of disability at baseline. The effect of stent design remained similar after adjustment for these variables., Conclusions: In symptomatic carotid stenosis, the use of stents with a closed-cell design is independently associated with a lower risk of procedural stroke or death compared with open-cell stents. Filter-type protection devices do not appear to reduce procedural risk., Competing Interests: Competing interests: None declared., (© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.)

Objective: To identify the practice differences among chemotherapy units and the opinions of pharmacists on safety precautions for handling antineoplastic drugs in hospitals., Method: The survey was administered to hospital pharmacists in Turkey. The pharmacists who work in chemotherapeutic drug preparation units were asked to participate if they are volunteered. The participating pharmacists were asked questions about the type of chemotherapy units, order and verification process of chemotherapy protocols and potential shortcomings of chemotherapy preparation. The questions were initially assessed in a small sample of pharmacists and subsequently revised and refined. The filled and returned questionnaires were accepted as given consent., Results: A total of 97 questionnaires were delivered and 40 (41%) were returned by pharmacists. The median age and practicing years in hospitals of the pharmacists were 38.0 and 6.25 years, respectively. Fully automated chemotherapy units were used by 42.5% of respondents, whereas 30% prepare chemotherapeutics manually; furthermore, 87.5% provide chemotherapeutic drug preparations (admixtures) less than 120 per day. With regard to the drug preparation process, more than half of the respondents 'always' use protective equipment without foot covers (32.3%). Almost 90% of respondents 'always' use a coat, mask and biological safety cabinets; however, 20% of respondents 'often' use closed-system drug transfer sets. More than 50% of pharmacists expressed that they have sufficient knowledge on cytotoxics and the risk of exposure, protective precautions, selection and usage of personal protective equipment and correct storage of cytotoxics., Conclusion: Pharmacists acknowledge sufficient understanding of safe preparation and handling of chemotherapeutics, but reported practices by pharmacists in hospitals are not consistent with published recommendations. Providing theoretical and practical educations for pharmacists and developing standard procedures for preparing chemotherapy may be beneficial in improving the preparation and use of antineoplastics in Turkey.

Objective: To identify in the literature the efficacy of needlesticks with safety devices to reduce the occurrence of occupational accidents with exposure to biological material among health workers., Method: Integrative literature review, structured in the stages: Guiding question, search, categorization of studies, evaluation, discussion and interpretation of results, and synthesis of knowledge. Search for original articles and systematic reviews on the main bases of the Health area, published from 2000 to 2016 in Portuguese, English and Spanish, with descriptors: needlesticks injuries, exposure to biological agents, needles, protective devices, occupational accidents, accident prevention and health personnel., Results: We selected eleven articles, most characterized the passive safety devices as more effective in reducing the occurrence of injuries by needlesticks., Conclusion: The use of needlesticks with safety devices reduces the occurrence of accidents, bringing greater solvency when combined with the training of workers.

Background: Falls and fractures are extremely frequent in long-term care facilities (LTCFs). Therefore, a fall and fracture prevention program was started in nearly 1000 LTCFs in Bavaria/Germany between 2007 and 2010. The components of the program were exercise classes, the documentation of falls, environmental adaptations, medication reviews, the recommendation to use hip protectors and education of staff. The present study aimed to provide a comprehensive evaluation of the implementation process of the program regarding results of the implementation phase and the follow-up of 3-9 years after start of implementation., Methods: Data from numerous sources were used, including data from published studies, statistical data, health insurance claims data and unpublished data from an online questionnaire. To incorporate different aspects, time periods and results, the RE-AIM framework was applied., Results: The program was adopted by 942 of the 1150 eligible LTCFs and reached about 62,000 residents. During the implementation phase exercise classes and recommendation about environmental adaptations were offered in nearly all LTCFs. 13.5% of the residents participated in exercise classes. Hip protectors were available for 9.2% of all residents. In the first implementation wave, femoral fracture rate was significantly reduced by 18% in the first year. At follow-up nearly 90% of all LTCFs still offered exercise classes, which were attended by about 11% of residents. However, only 10% of the exercise classes completely fulfilled the requirements of an effective strength and balance training. Individual advice about environmental adaptations was provided in 74.3% of the LTCFs and nearly all LTCFs claimed to offer hip protectors to their residents. A long-term effect of the program on femoral fractures could not be detected., Conclusions: The program did not affect the femoral fracture rate in the long run. Possible reasons could be a high turn-over of the staff, a reduced fidelity of training components or a shift in daily priorities among the staff.

Lane Change Warning system (LCW) is exploited to alleviate driver workload and improve the safety performance of lane changes. Depending on the secure threshold, the lane change warning system could transmit caution to drivers. Although the system possesses substantial benefits, it may perturb the conventional operating of the driver and affect driver judgment if the warning threshold does not conform to the driver perception of safety. Therefore, it is essential to establish an appropriate warning threshold to enhance the accuracy rate and acceptability of the lane change warning system. This research aims to identify the threshold that conforms to the driver perception of the ability to safely change lanes with a rear vehicle fast approaching. We propose a theoretical warning model of lane change based on a safe minimum distance and deceleration of the rear vehicle. For the purpose of acquiring the different safety levels of lane changes, 30 licensed drivers are recruited and we obtain the extreme moments represented by driver perception characteristics from a Front Extremity Test and a Rear Extremity Test implemented on the freeway. The required deceleration of the rear vehicle corresponding to the extreme time is calculated according to the proposed model. In light of discrepancies in the deceleration in these extremity experiments, we determine two levels of a hierarchical warning system. The purpose of the primary warning is to remind drivers of the existence of potentially dangerous vehicles and the second warning is used to warn the driver to stop changing lanes immediately. We use the signal detection theory to analyze the data. Ultimately, we confirm that the first deceleration threshold is 1.5 m/s 2 and the second deceleration threshold is 2.7 m/s 2 . The findings provide the basis for the algorithm design of LCW and enhance the acceptability of the intelligent system., (Copyright © 2018 Elsevier Ltd. All rights reserved.)

Soft tissue neck injuries, also referred to as whiplash injuries, which can lead to long term suffering accounts for more than 60% of the cost of all injuries leading to permanent medical impairment for the insurance companies, with respect to injuries sustained in vehicle crashes. These injuries are sustained in all impact directions, however they are most common in rear impacts. Injury statistics have since the mid-1960s consistently shown that females are subject to a higher risk of sustaining this type of injury than males, on average twice the risk of injury. Furthermore, some recently developed anti-whiplash systems have revealed they provide less protection for females than males. The protection of both males and females should be addresses equally when designing and evaluating vehicle safety systems to ensure maximum safety for everyone. This is currently not the case. The norm for crash test dummies representing humans in crash test laboratories is an average male. The female part of the population is not represented in tests performed by consumer information organisations such as NCAP or in regulatory tests due to the absence of a physical dummy representing an average female. Recently, the world first virtual model of an average female crash test dummy was developed. In this study, simulations were run with both this model and an average male dummy model, seated in a simplified model of a vehicle seat. The results of the simulations were compared to earlier published results from simulations run in the same test set-up with a vehicle concepts seat. The three crash pulse severities of the Euro NCAP low severity rear impact test were applied. The motion of the neck, head and upper torso were analysed in addition to the accelerations and the Neck Injury Criterion (NIC). Furthermore, the response of the virtual models was compared to the response of volunteers as well as the average male model, to that of the response of a physical dummy model. Simulations with the virtual male and female dummy models revealed differences in dynamic response related to the crash severity, as well as between the two dummies in the two different seat models. For the comparison of the response of the virtual models to the response of the volunteers and the physical dummy model, the peak angular motion of the first thoracic vertebra as found in the volunteer tests and mimicked by the physical dummy were not of the same magnitude in the virtual models. The results of the study highlight the need for an extended test matrix that includes an average female dummy model to evaluate the level of occupant protection different seats provide in vehicle crashes. This would provide developers with an additional tool to ensure that both male and female occupants receive satisfactory protection and promote seat concepts that provide the best possible protection for the whole adult population. This study shows that using the mathematical models available today can provide insights suitable for future testing., (Copyright © 2017 Elsevier Ltd. All rights reserved.)

Objective: The objective of this study was to investigate whether the 5-point harness or the impact shield child restraint system (CRS) or both have the potential to cause chest injuries to children. This is determined by examining whether the loading to the chest reaches the internal organ injury threshold for children., Method: The chest injury risk to a child occupant in a CRS was investigated using Q3 dummy tests, finite element (FE) simulations (Q3 dummy and human models), and animal tests. The investigation was done for 2 types of CRSs (i.e., the impact shield CRS and 5-point harness CRS) based on the UN R44 dynamic test specifications., Results: The tests using a Q3 dummy indicated that although the chest deflection of the dummy in the impact shield CRS was large, it was less than the injury threshold (40 mm). Computational biomechanics simulations (using finite element FE analysis) showed that the Q3 dummy's chest is loaded by the shield and deforms substantially under this load. To clarify whether chest injuries due to chest compression can occur with an impact shield or with the 5-point harness CRS, 7 experiments were performed using Tibetan miniature pigs with weights ranging from 9.7 to 13 kg. Severe chest and abdominal injuries (lung contusion, coronary artery laceration, liver laceration) were found in the tests using the impact shield CRS. No chest injuries were present when using the 5-point harness CRS., Conclusion: When using the impact shield CRS, the chest deformed substantially in dummy tests and FE simulations, and chest and abdominal injuries were observed in pig tests. It is possible that these chest injuries could also occur to child occupants sitting in the impact shield CRS.

Objective: The objective of this study was to investigate vehicle factors associated with child restraint tether use and misuse in pickup trucks and evaluate 4 labeling interventions designed to educate consumers on proper tether use., Methods: Volunteer testing was performed with 24 subjects and 4 different pickup trucks. Each subject performed 8 child restraint installations among the 4 pickups using 2 forward-facing restraints: a Britax Marathon G4.1 and an Evenflo Triumph. Vehicles were selected to represent 4 different implementations of tether anchors among pickups: plastic loop routers (Chevrolet Silverado), webbing routers (Ram), back wall anchors (Nissan Frontier), and webbing routers plus metal anchors (Toyota Tundra). Interventions included a diagram label, Quick Response (QR) Code linked to video instruction, coordinating text label, and contrasting text tag., Results: Subjects used the child restraint tether in 93% of trials. However, tether use was completely correct in only 9% of trials. An installation was considered functional if the subject attached the tether to a tether anchor and had a tight installation (ignoring routing and head restraint position); 28% of subjects achieved a functional installation. The most common installation error was attaching the tether hook to the anchor/router directly behind the child restraint (near the top of the seatback) rather than placing the tether through the router and attaching it to the anchor in the adjacent seating position. The Nissan Frontier, with the anchor located on the back wall of the cab, had the highest rate of correct installations but also had the highest rate of attaching the tether to components other than the tether anchor (seat adjustor, child restraint storage hook, around head restraint). None of the labeling interventions had a significant effect on correct installation; not a single subject scanned the QR Code to access the video instruction. Subjects with the most successful installations spent extensive time reviewing the vehicle manuals., Conclusion: Current implementations of tether anchors among pickup trucks are not intuitive for child restraint installations, and alternate designs should be explored. Several different labeling interventions were ineffective at achieving correct tether use in pickup trucks.

Among the many occupational risks construction workers encounter every day falling from a height is the most dangerous. The objective of this article is to propose a simple analytical design method for horizontal lifelines (HLLs) that considers anchorage flexibility. The article presents a short review of the standards and regulations/acts/codes concerning HLLs in Canada the USA and Europe. A static analytical approach is proposed considering anchorage flexibility. The analytical results are compared with a series of 42 dynamic fall tests and a SAP2000 numerical model. The experimental results show that the analytical method is a little conservative and overestimates the line tension in most cases with a maximum of 17%. The static SAP2000 results show a maximum 2.1% difference with the analytical method. The analytical method is accurate enough to safely design HLLs and quick design abaci are provided to allow the engineer to make quick on-site verification if needed.

Objective: The objective of this study was to examine the effectiveness of blind spot monitoring systems in preventing police-reported lane-change crashes., Methods: Poisson regression was used to compare crash involvement rates per insured vehicle year in police-reported lane-change crashes in 26 U.S. states during 2009-2015 between vehicles with blind spot monitoring and the same vehicle models without the optional system, controlling for other factors that can affect crash risk., Results: Crash involvement rates in lane-change crashes were 14% lower (95% confidence limits -24% to -2%) among vehicles with blind spot monitoring than those without., Discussion: Blind spot monitoring systems are effective in preventing police-reported lane-change crashes when considering crashes of all severities. If every U.S. vehicle in 2015 were equipped with blind spot monitoring that performed like the study systems, it is estimated that about 50,000 crashes could have been prevented.

Objective: The ISO13232 standard provides guidelines and methodologies for research on the effectiveness of protective devices fitted to motorcycles. The accident database used to develop the standard was composed of 2 data sets from Hannover and Los Angeles, dating from 1996. This study aims to apply the methodology outlined in the standard to a more recent European accident database to determine whether the set of the 7 most relevant impact configurations identified in the ISO13232 are representative of the European context., Methods: The ISO13232 database was rebuilt from the data tables attached to the standard and processed according to the procedure described in ISO13232-Part 2, to ensure reproducibility of the results. The comparison data set was extracted from the Motorcycle Accidents In-Depth Study (MAIDS) database. Data were then coded, processed, and analyzed using the ISO13232 methodology. To eliminate any subjectivity in the selection process of the configurations, a new ranking criterion (configuration risk index, CRI) was implemented. The CRI combined the evaluation of an accident configuration's frequency of occurrence and its harmfulness., Results: Comparison of the frequency ranking of the impact configurations from the 2 databases revealed some notable differences. Five of the 10 most important configurations were common to both databases, although ranking order differed. CRI-based selection led to differences in ranking orders. The CRI allowed better identification of the most important configurations and it was employed to define the proposed new set of configurations., Conclusion: A new set of 7 accident configurations was defined by applying the ISO13232 procedure to the MAIDS data and ranking the results with a newly proposed method. The final set had only one configuration in common with those defined in the ISO13232, testifying to the importance of defining an updated and more representative set of configurations for the European context.

Objective: Sternal bleeding during cardiac surgery is currently controlled using bone wax or other chemical substances that may result in adverse effects and affect wound healing and recovery. The purpose of this study was to identify a safe, cost-effective, and easy-to-use technique to reduce sternal bleeding and sternal trauma during cardiac surgery., Methods: After sternotomy, a sternal protection device was placed over each hemisternal section before insertion of the retractor and remained in situ until the end of surgery. Sternal bleeding and ease of use were assessed and recorded during surgery. Sternal trauma was assessed and recorded within 5 minutes of removal of the device, and overall satisfaction (Global Impression) and any intraoperative adverse events or device malfunction were reported at surgery completion. Patients were followed up 24 hours and 4 weeks after surgery., Results: Twelve patients completed the study. Adverse events reported were not considered related to the device. No sternal trauma was identified in any patient. In 9 of 11 patients, sternal bleeding was reduced after insertion of the device. The device was generally considered easy to use, although some difficulty was encountered when used with the Internal Mammary Artery retractor., Conclusions: Our data suggest that the device is safe and able to reduce sternal bleeding during surgery using sternal retractors. We recommend further studies in a larger population of patients with a control group to evaluate the device's ability to reduce the morbidity associated with sternal bleeding and sternal trauma.