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Objectives: In Poland, there are numerous cases of injuries caused by sharp instruments annually, still significantly more than in other European Union countries. The aim of this study was to analyze work-related injuries among healthcare workers in a selected hospital before and after the implementation of safety-engineered devices (SED)., Material and Methods: Retrospective analysis of medical documentation regarding occupational needlestick and sharps injuries (NSSI) in a tertiary referral surgical hospital in 1998-2018. The study group consisted of nurses and doctors who had been injured and reported the incident. The frequency of injury reports, injury rate, and characterization of circumstances surrounding NSSI are presented., Results: Over the period of 20 years, a total of 257 NSSI incidents were reported. The average injury rate was statistically significant for nurses (p = 0.004) and was higher before the introduction of SED. Moreover, the number of injuries among nurses showed a downward trend during the study period. However, for doctors, there was no statistically significant difference in the median puncture rate (p = 0.099), and the number of injuries showed an increasing trend., Conclusions: In this study, the authors' have demonstrated not only the occurrence of injuries and punctures in the daily work of medical personnel but also the potential for their reduction through the use of safety equipment at every workstation where healthcare services are provided using sharp medical instruments. Int J Occup Med Environ Health. 2024;37(2):234-43., (This work is available in Open Access model and licensed under a CC BY-NC 3.0 PL license.)

Background: Intra-hospital falls have become an important public health problem globally. The use of movement sensors with alarms has been studied as elements with predictive capacity for falls at hospital level. However, in spite of their use in some hospitals throughout the world, evidence is lacking about their effectiveness in reducing intra-hospital falls. Therefore, this study aims to develop a systematic review and meta-analysis of existing scientific literature exploring the impact of using sensors for fall prevention in hospitalized adults and the elderly population., Methods: We explored literature based on clinical trials in Spanish, English, and Portuguese, assessing the impact of devices used for hospital fall prevention in adult and elderly populations. The search included databases such as IEEE Xplore, the Cochrane Library, Scopus, PubMed, MEDLINE, and Science Direct databases. The critical appraisal was performed independently by two researchers. Methodological quality was assessed based on the ratings of individual biases. We performed the sum of the results, generating an estimation of the grouped effect (Relative Risk, 95% CI) for the outcome first fall for each patient. We assessed heterogeneity and publication bias. The study followed PRISMA guidelines., Results: Results were assessed in three randomized controlled clinical trials, including 29,691 patients. A total of 351 (3%) patients fell among 11,769 patients assigned to the intervention group, compared with 426 (2.4%) patients who fell among 17,922 patients assigned to the control group (general estimation RR 1.20, 95% CI 1.04, 1.37, P = .02, I2 = 0%; Moderate GRADE)., Conclusion: Our results show an increase of 19% in falls among elderly patients who are users of sensors located in their bed, bed-chair, or chair among their hospitalizations. Other types of sensors such as wearable sensors can be explored as coadjutants for fall prevention care in hospitals., Competing Interests: The authors have no conflicts of interest to disclose., (Copyright © 2021 the Author(s). Published by Wolters Kluwer Health, Inc.)

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.

The COVID-19 pandemic of 2020 in Italy had its first epidemic manifestations on January 31, 2020. The socio-sanitary rules imposed by the government concerned the social distance and management of intimate relationships, the sense of individual responsibility toward public health. Physical distancing and housing isolation have produced new representations of intrafamily, generational, neighborhood, community responsibility, bringing out a new "medicalized dimension" of society. In light of this contextual framework, the research aims are to analyze how: the perception of individual responsibility for public and familial health and physical distancing has redrawn the relation between subjects-family-community; the State's technical-health intervention has reformulated the idea of social closeness, but also how the pandemic fear and social confinement has re-evaluated a desire for community, neighborhood, proximity; during the lockdown families, friends, neighbors have reconstructed feelings of closeness and forms of belonging. The methodology used is quanti-qualitative and involved 300 women through an online questionnaire. The data collected highlight how the house during the lockdown is perceived as a safe place and how women implement both the recommendations and the behaviors aimed at preventing contagion, but also ways that allow coping with the situation from a perspective of well-being. Furthermore, the data show how the dimension of distancing has loosened the relational dimension outside the family unit, with a greater distancing compared to pre-pandemic data. However, the majority of women report that they have joined solidarity initiatives, demonstrating that they want to maintain ties and participate actively in community life., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Parisi, Lagomarsino, Rania and Coppola.)

Life preservers often play a vital role in ensuring passenger safety in water-related accidents, while the difficulty of donning life preservers has been repeatedly proved even in a donning test. To evaluate the influencing factors for life preserver donning tests, 109 college students and 42 villagers were chosen as subjects. A total of fourteen variables with seven categorical variables and seven continuous variables were considered as potential influencing factors. T-test and one-way analysis of variance (ANOVA, for three or more categories) were used to judge whether grouping in categorical variables had a significant effect on the donning performance. Then all variables were offered into the stepwise linear regression (SLR) to evaluate the influential factors for life preserver donning tests. Results showed that four of fourteen variables, including gender, instruction condition, age group, and tool test time (representing the subject's flexibility), had a significant effect on the donning performance. To evaluate the relationship between the donning performance and influencing factors, models of the retrieving time, the opening time, and the donning time were built based on the SLR analysis. The paper also highlights recommendations for modification of the donning test procedure, which helps to improve the validation and reliability of life preserver donning tests., Competing Interests: The authors have declared that no competing interests exist.

Purpose: This study addressed the potential effect of higher seat stiffness with ABTS (All-Belt-to-Seat) compared to conventional seats in rear impacts. It analyzed field accidents and sled tests over a wide range in delta V and estimated the change in number of injured occupants if front-seats were replaced with stiffer ABTS., Methods: The rear-impact exposures and serious-to-fatal injury rates were determined for 15+ year old non-ejected drivers and right-front passengers in 1994+ model year vehicles using 1994-2015 NASS-CDS. More than 50 rear sled tests were analyzed using conventional and ABTS seats. An injury risk was calculated for selected ATD biomechanical responses. The results obtained with the ABTS and conventional seats were compared for matched tests based on head restraint position, ATD size and initial position and delta V. The change in risk was used to estimate the change in injury in the field by adjusting the injury rate by delta V., Results: On average, front seat occupants were 39 years old, weighed 78 kg and were 171 cm tall. About 29.3% of serious-to-fatally injured (MAIS 3 + F) front seat occupants were involved in delta Vs less than 24 km/h and about 28.4% in a delta V of 48 km/h or greater. The average biomechanical response and injury risk in sled tests were higher with an ABTS seat than with a conventional seat. The average maximum injury risk was assessed by delta V groups for conventional and ABTS seats. The relative risk of ABTS to conventional seats was 1.34 in less than 16 km/h, 1.69 in 16-24 km/h, 1.65 in 24-32 km/h, 1.33 in 32-40 km/h, 5.77 in 40-48 km/h and 48.24 in the 56-64 km/h delta V category. The estimated relative risk was 11.90 in 48-56 km/h and 34.11 in 64+ km/h. The number of serious-to-fatally injured occupants was estimated to increase by up to 6.88-times if stiffer ABTS seats replaced conventional seats., Conclusions: The field data indicate that the 50 th percentile male Hybrid III size is representative of an average occupant involved in rear crashes. ABTS seats used in this study are stiffer than conventional seats and increase ATD responses and injury risks over a wide range of crash severities.

Objective: The aim of this study was to explore a suitable method for analyzing road transport accidents that involve hazardous materials and to explore the main factors that influence the occurrence of accidents of varying severity., Methods: The 2015-2019 reported crash data from the Ministry of Transport of the People's Republic of China were obtained, and road transport crashes involving hazardous materials were extracted as the analysis data. The dataset was classified into three injury severity categories: property damage only (PDO), injured (INJ), and fatal (FAT). A statistical model and three machine learning-based models were developed: a random parameters logit model (RPLM), multilayer perceptron (MLP), decision tree C5.0 (C5.0) and support vector machine (SVM). The four models were trained/estimated using the training/estimation dataset, and the best model was used to model accidents of the three different severity levels. The main factors that influence the occurrence of accidents at each crash severity level were obtained., Results: C5.0 had the best modeling performance. The direct accident form (DAF), indirect accident form (IAF) and road segment (RS) were determined to be the critical determinants of PDO accidents. The DAF, IAF, road type, RS and time had a substantial effect on INJ accidents. The DAF, IAF, hazardous material type (HMT) and road surface condition were important factors in the occurrence of FAT accidents., Conclusions: Different data have unique characteristics, and the best modeling and analysis method should be chosen accordingly. The safety of road transport of hazardous materials in China is poor, and the losses caused by accidents are substantial. Strengthening the monitoring of travel speed and travel time; improving driver safety awareness, driving skills and the ability to mitigate emergencies; improving the configuration of vehicle safety equipment and the linkage with the control center and rescue center; improving the environmental differences between inside a tunnel and outside a tunnel; reducing the design of long downhill and steep slope sections; reducing the transport plan in unsafe environments; and improving the ability of road management to mitigate bad environments can be effective measures to reduce the severity of road transport accidents involving hazardous materials.

Objective: Forward collision warning (FCW) and automatic emergency braking (AEB) have the potential to prevent or mitigate many large truck crashes. While these systems are known to be effective in passenger vehicles, less is known about their effectiveness in large trucks. The objective of this study was to estimate the effectiveness of these systems in reducing real-world crash rates of large trucks. Methods: Data on Class 8 trucks operating on limited-access highways during 2017-2019 were obtained from SmartDrive Systems. Detailed data on exposure measures and crash circumstances were extracted from video footage by both automated means and manual coding. Crash rates were compared by front crash prevention technology (FCW, AEB, neither), both for all police-reportable crashes overall and for relevant crash types. Results: FCW was associated with a statistically significant 22% reduction in the rate of police-reportable crashes per vehicle miles traveled, and a significant 44% reduction in the rear-end crash rate of large trucks. AEB also was associated with significant reductions-12% overall and 41% for rear-end crashes. Warnings were issued in 31% of rear-end crashes for FCW-equipped trucks. AEB intervened in 43% of rear-end crashes; about two thirds of these interventions involved autobrake activations. On average, speed was reduced by over half between the time of the intervention and impact for both systems. Observed reductions in same-direction sideswipe and roadway departure crashes per mile traveled were smaller in magnitude than those of rear-end crashes; these were consistent with other crash avoidance technologies suspected to be bundled with FCW/AEB in some cases, and very few front crash prevention interventions occurred in these types of crashes. Conclusions: FCW and AEB are effective countermeasures for crashes in which large trucks rear-end other vehicles. Large truck safety is expected to improve as new trucks are increasingly equipped with these systems. FCW has the advantage that some of these systems can be retrofitted to existing trucks, so benefits can be realized sooner and with less investment.

Objective: The objective of this study is to estimate the potential safety benefits of Emergency Lane Keeping (ELK) and Autonomous Emergency Steering (AES) systems with precise and reliable lateral positioning., Methods: The material comprised in-depth studies of fatal road crashes in Sweden in 2017. Crashes resulting in passenger car occupant fatality ( n  = 114) were included; single vehicle ( n  = 60) and head-on ( n  = 31), intersection ( n  = 9), rear-end ( n  = 5), overtaking ( n  = 5), animal ( n  = 1), other ( n  = 1, U-turn), and train ( n  = 2). Additionally, fatal collisions between motor vehicles and vulnerable road users (VRUs) were included; pedestrians ( n  = 36), cyclists/moped users ( n  = 15), and motorcyclists ( n  = 17). A case-by-case analysis was conducted to identify crashes potentially prevented by ELK and AES with precise (within 0.1 m accuracy) and reliable lateral positioning. The identified crashes potentially avoided by ELK systems involved unintentional drift-out-of-lane on roads with posted speed limits of ≥70 km/h (43 mph). For comparison, the same material was used to identify the potential safety benefits of the more traditional lane departure warning (LDW) and Lane Keeping Assist (LKA) systems without enhanced lateral positioning. Crashes potentially avoided by LDW/LKA occurred on roads with visible lane markings and without rumble strips on the departure side while ELK with enhanced lateral positioning is not reliant on lane markings. Collisions potentially avoided by AES occurred on roads with sufficient escape zones and road friction., Results: The study shows that ELK systems with enhanced lateral positioning could potentially avoid 33 - 45 (36 - 49%) out of 91 head-on and single car crashes resulting in passenger car occupant fatality, which corresponds to a further 18% (5/28) compared to traditional lane support (LDW/LKA) without enhanced lateral positioning. The improved lane keeping addresses crashes involving absent or nonvisible lane markings that are covered by snow. Furthermore, the study shows that the evasive steering features of AES systems with enhanced lateral positioning could potentially prevent 28 (54%) out of 52 collisions resulting in passenger car occupant fatalities (i.e., head-on, intersection, rear-end, overtaking, and animal collision). Additionally, AES with enhanced lateral positioning could potentially prevent 16 (31%) out of 51 collisions between motor vehicles and vulnerable road users resulting in fatally injured pedestrians, cyclists or moped users. The total potential safety benefits of AES include both lane keeping and evasive steering features including lane escaping. The study identified that the total number of crashes potentially avoided by AES corresponds to 42% out of all crashes resulting in passenger car occupant fatalities ( n  = 48/114)., Conclusions: This is a first attempt to identify and quantify the increase in potential safety benefits, based on the assumption that robust lateral vehicle positioning has been applied to lane keeping as well as lane escaping. In addition to the potentially increased number of prevented crashes compared to traditional lane support, a robust lateral positioning system may have the potential to improve the redundancy in positioning systems. Previous research suggests several techniques to improve lateral vehicle positioning. However, further research is required, including testing for implementation of adequately improved lateral vehicle awareness to establish which techniques are appropriate.

Objective: Autonomous Emergency Braking (AEB) is a promising technology for crash avoidance or pre-crash impact speed reduction through the automatic application of braking force. Implementation of AEB technology on motorcycles (MAEB) is still problematic as its interaction with the rider may compromise the safety. In previous studies, MAEB interventions at low decelerations were shown to be easily manageable by common riders in straight line condition, but they were not previously tested in lateral maneuvers such as lane change and swerving, which are common in pre-crash situations. The objective of this paper is to assess the applicability of MAEB activation during lateral avoidance maneuver and to estimate its benefits in this scenario., Methods: Field tests were carried out involving common riders as participants, using a test protocol developed on the experience of previous studies. The test vehicle was a sport-touring motorcycle equipped with an automatic braking system that could be activated remotely by researchers to simulate MAEB intervention. The motorcycle was equipped with outriggers to prevent capsizing. The Automatic Braking (AB) interventions using a nominal deceleration of 0.3 g were deployed at pseudo-random times in conditions of straight-line travel and a sharp lane-change maneuver emulating a pre-crash avoidance action. The straight-line trials were used as the reference condition for analysis., Results: Thirty-one participants experienced AB interventions in straight-line and lane-change at an average speed of 44.5 km/h. The automatic braking was deployed in all the key phases of the avoidance maneuver. The system reached a deceleration of 0.3 g for a time of intervention of approximately 1 s. The participants were consistently able to control the vehicle during the automatic braking interventions and were always able to complete the lane-change maneuver. The speed reductions obtained with the AB interventions during lane change were very similar to those obtained in the straight-line conditions., Conclusions: MAEB interventions with decelerations up to 0.3 g can be easily managed by motorcycle riders not only in straight-line conditions but also during an avoidance maneuver. Further investigations using higher deceleration values are now possible.

Objective: Motorcycle helmets are the most common and effective protective device to reduce head injuries and mortality in crashes among powered two-wheeler riders. Even if they are globally recognized as effective, there are still concerns regarding their correct use, which is necessary to achieve maximum head protection. The goal of this systematic review is to assess which characteristics of helmet design and use showed a positive influence on rider safety, in order to provide insights to improve end-user helmet usage., Methods: A literature search was carried out combining two sets of keywords, one related with either motorcycle or rider and the other referring to either protective equipment or injuries. After the exclusion of duplicates, 977 papers were screened by reviewers, thus identifying 32 papers that were analyzed in group discussions., Results: Among the papers included in this study, no strong conflicting conclusions emerged in their results. The studies focusing on the use of different types of helmets highlighted that full-face helmets, compared with other standard helmets, have a positive influence on head injuries and facial injuries. Correct fastening was clearly beneficial for head and facial injuries, induced injuries, and helmet ejection., Conclusions: This systematic review provides important insights to improve the usage of helmets by end-users. Correct fastening is a crucial factor to avoid helmet roll-off during a crash. Most studies agreed that full-face helmets provide higher protection in comparison with other standard helmets, especially for facial injuries, and no negative influence with respect to neck and spinal injuries.

Background: An essential concept that all radiographers are required to implement is the use of techniques and the provision of protective devices to minimize radiation to patients and staff. Methods to achieve this could include good communication, immobilization, beam limitation, justification for radiation exposure, shielding, appropriate distances and optimum radiographic exposures factors., Purpose: The aim of this study was to assess the availability and utilization of radiation protection and safety measures by medical imaging technologists (MITs) in Rwandan hospitals., Methods: A quantitative, non-experimental descriptive design was used and data collected by means of a self-designed questionnaire. One hundred and sixteen MITs (n = 116) representing 96.67% of the total population participated in the study., Results: The study found radiation safety measures were not adequately implemented in government hospitals. Only 58.62% of MITs had radiation-measuring devices, with 29% receiving dose readings inconsistently. Lead rubber aprons were available at 99.13% of the hospitals; however, 59% of the participants had never checked the integrity of the aprons. Lead rubber aprons and lead equivalent barriers were most prevalent in the facilities., Conclusion: The study found there was a lack of adequate radiation safety equipment. Exposure charts and immobilization devices were not adequately implemented in the hospitals. The level of education and experience of the MITs did not appear to influence the radiation safety practice significantly. There is a need for concerted efforts between the Rwanda Utilities Regulatory Authority (RURA), Ministry of Health, University of Rwanda and hospital management to improve the radiation safety culture, especially in view of the law governing radiation protection that was recently promulgated., (Copyright © 2020. Published by Elsevier Inc.)

This study introduces a method that allows the generation and safety evaluation of a scenario catalog derived from potential car-pedestrian conflict situations. It is based on open-source software components and uses the road layout standard OpenDRIVE to derive participants' motion profiles with the support of available accident data. The method was implemented upon the open-source framework openPASS and can simulate results for different active safety system setups and facilitates the prediction of system capabilities to decrease the relative impact velocities and collision configurations such as the point of impact. A demonstration case was performed where the scenario catalog was derived and used to evaluate pedestrian collisions with and without a generic autonomous emergency braking (AEB) system. The AEB system aims to intervene in the event of an impending collision and might affect the outcome of a baseline scenario. The study indicated a change in the collision configuration and identified conflict situations less affected by the system. A particularly interesting finding was that some scenarios even led to a higher number of collisions (at lower impact) for the AEB intervention in comparison to the baseline cases., (Copyright © 2020 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

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.

Objective: This study aims to evaluate a car passenger's experience and actions in a rotated seat in terms of interaction with an adjacent passenger., Methods: A static user study was conducted, using a stationary test vehicle with two front row seats facing rearwards. The seats were mounted on a swivel plate which allowed inboard rotation. Thirty-two participants in 16 test pairs were grouped based on stature; short or tall. The participants within each pair knew each other. Three seating configurations were evaluated; 0° and 10° and 20° inboard rotated position of both seats. The participants were seated in each seating configuration for 10 min; 5 min they engaged in a conversation with each other and 5 min they were watching media on an Ipad mounted in front of them. Subjective data from each participant on their experiences and preferences were collected through questionnaires, and objective data on sitting postures and eye gaze were collected through video recording., Results: Ninety-two percent of the short participants preferred to sit in the 20° rotated seating configuration when watching media and 75% preferred the 20° seating configuration when engaged in conversation. Compared to short participants, the tall participants showed a relative larger spread in seating configuration preference; 15% and 30% of them preferred the reference position for media and conversation, respectively. Leg interference was common for tall participants when 20° inboard rotated. They perceived it uncomfortable and used various strategies to avoid contact, including crossing legs or feet. Time spent with mutual eye contact did not vary by seating configuration., Conclusions: This static user study shows that rotated seats could be a desired seating configuration in future autonomous vehicles for individuals who know each other. It reveals the reasons behind the preferences and the extent of desired seat rotation, showing differences between tall and short individuals. By understanding how occupant position and posture can be influenced by offering various seating configurations, the occupant can choose a comfortable position that is also safe. The leg and feet positions are raised as the body region with most variations and for which an increased understanding of influence in a crash is encouraged.

Objective: The study quantifies the kinematics of children in booster child restraint systems (CRSs) in various naturalistic seating postures exposed to frontal impacts in a full-vehicle environment, with and without the application of pre-crash automatic emergency braking., Methods: The PIPER 6YO and 10YO pediatric human body models were positioned in CRSs. The 6YO was restrained on a lowback (LBB) and highback (HBB) booster, while the 10YO was positioned on an LBB and in a NoCRS condition. All simulations used the 3-point seatbelt. The child models were pre-positioned (gravity settled, seatbelt tensioned) in four naturalistic seating postures: leaning-forward, leaning-forward-inward, leaning-forward-outward, and a pre-submarining position, along with a baseline reference seating position. A 2012 Toyota Camry finite element (FE) model was used as the vehicle environment. A standard 3-point lap-shoulder belt system was modeled to restrain the child and CRS in the left-rear vehicle seat. Two vehicle impact cases were considered: with and without a pre-crash AEB. For with-AEB cases, a pre-crash phase was run to incorporate postural changes due to the application of AEB. All seating positions were ultimately subjected to a full-frontal rigid-barrier impact at 35 MPH. A total of 40 conditions were simulated in LS-DYNA., Results: Injury metrics varied widely for both occupants. Shoulder belt slippage was observed for the 6YO leaning-forward-inward on HBB. No head contact was observed for any simulated cases. Forward-leaning and forward-inward-leaning postures generally had greater head excursion across all seating postures. The lap belt rode over the pelvis for pre-submarining postures. Injury metrics for cases with pre-crash AEB were lower compared to their corresponding without-AEB cases. HIC15, head acceleration, upper neck tension force, and upper neck flexion moment were similar or lower for with-AEB scenarios., Conclusions: Pre-crash AEB reduces the effect of the impact despite the same collision speed as cases without-AEB. This is primarily due to the limited travel distance of the occupant, thus, starting an earlier ride-down during the crash. Moreover, different initial seating postures lead to a wide range of injury exposures. Vehicle and child restraint design should incorporate these seating postures to ensure robust protection of the occupant in a crash.

Objective: To understand which users' characteristics influence their preferences in the selection of vehicle seating configurations and positions across different traveling scenarios involving a fully automated vehicle (FAV)., Methods: Participants ( n  = 730) completed an online survey in which they were asked to imagine traveling in a FAV across three hypothetical scenarios. Participants were asked to select between five different seating configurations and four positions for each scenario and about their anthropometry and their driving/riding experience. Multinomial regression analyses were conducted to identify the factors that influenced users' preferences., Results: FAV Configuration #3 (traditional light vehicle seating configuration) was the preferred seating configuration for 74% of the participants, followed by FAV #2 (in which the two seating rows face each other, 13%) in Scenario 1 (riding by oneself). Similar numbers were observed in Scenario 3 (riding with an unknown person). In Scenario 2 (riding with their partner), participants preferred FAV #2 (12.5%) and FAV #5 (in which the front seat passengers point toward a common point in the front, conventional rear seat configuration, 17.5%). Having close family was significant to choose the traditional vehicle configuration over other vehicle configurations, but only when the participants were driving by themselves. Having previously experienced motion sickness was significant to prefer a forward seating configuration when the trip was shared with partners. Belonging to a particular height or weight group was significantly associated with the preferred seat within the preferred FAV configuration (the driver's position in FAV #3; a rear-facing seat in FAV #2), although there was not a clear trend between increasing weight and/or height and preferring one seating position over the others., Conclusions: Previous work had shown differences in participants' preferences for seating configurations and positions depending on age, sex and country. While increasing the sample size, the current study analyses other factors that were associated with choosing one vehicle configuration and seating position over others. As these factors are directly related to the likelihood of sustaining injuries in the event of a crash, the current study provides important insights regarding the potential risk factors for FAV occupants.

Background: To identify if e-cigarette usage is an on-campus problem for secondary schools and evaluate initial school survey responses. More specifically, this survey can aid in identifying where students are seen using e-cigarettes, if smoke alarms have been newly inserted on school property, if smoke alarms have been tampered with to allow for vaping without detection; and, if any e-cigarette fires or explosions have occurred on school property., Methods: This survey, disseminated to New Jersey secondary school teachers across seven sessions January-July 2019, resulted in 104 complete responses of 109 respondents. The survey was conducted after fire prevention, exit/egress, and life safety portions of "OSHA 10 Plus for General Industry" courses. Survey questions included number of times teachers observed students vaping and location where vaping in last 12 months, fire alarm installation and tampering, and fires or explosions and injuries from vaping/e-cigarette devices., Results: Many (63%) respondents reported very or moderately common rates of vaping within their schools; however, three of four questions regarding school fire and smoke alarm use specifically to detect vaping had a majority of unsure/I don't know responses., Conclusion: Results suggested concerns regarding student vaping and e-cigarette use inside and outside secondary schools. Improved school detection and response are warranted., Trial Registration: Not applicable.

3DHZETRN-v2 includes a detailed three dimensional (3D) treatment of neutron/light-ion transport based on a quasi-elastic/multiple production assumption allowing improved agreement of the neutron/light-ion fluence compared with results of three Monte Carlo (MC) codes in the sense that the variance with respect to the individual MC results is less than the variance among the MC code results. The current numerical methods are no longer the main limitation to HZETRN code development and further changes in the nuclear model are required. In a prior study, an improved quasi-elastic spectrum based on a solution of the transport approximation to nuclear media effects showed promise, but the remaining multiple-production spectrum was based on a database derived from the Ranft model that used Bertini multiplicities. In the present paper, we will implement a more complete Serber first step into the 3DHZETRN-v2 code, but we retain the Bertini-Ranft branching ratios and evaporation multiplicities. It is shown that the new Serber model in the 3HZETRN-v2 code reduces the variance with individual MC codes, which are largely due to nuclear cross section model differences. The code will be available through the software system, OLTARIS, for shield design and validation and provides a basis for personal computer software capable of space shield analysis and optimization., Competing Interests: Declaration of Competing Interest None., (Published by Elsevier Ltd.)

Geant4 Monte Carlo simulations were carried out to investigate the possible shielding materials of aluminum, polyethylene, hydrides, complex hydrides and composite materials for radiation protection in spacecraft by considering two physical parameters, stopping power and fragmentation cross section. The dose reduction with shielding materials was investigated for Fe ions with energies of 500 MeV/n, 1 GeV/n and 2 GeV/n which are around the peak of the GCR energy spectrum. Fe ions easily stop in materials such as polyethylene and hydrides as opposed to materials such as aluminum and complex hydrides including high Z metals with contain little or no hydrogen. Attenuation of the primary particles in the shielding and fragmentation into more lightly charged and therefore more penetrating secondary particles are competing factors: attenuation acts to reduce the dose behind shielding while fragmentation increases it. Among hydrogenous materials, 6 Li 10 BH 4 was one of the more effective shielding materials as a function of mass providing a 20% greater dose reduction compared to polyethylene. Composite materials such as carbon fiber reinforced plastic and SiC composite plastic offer 1.9 times the dose reduction compared to aluminum as well as high mechanical strength. Composite materials have been found to be promising for spacecraft shielding, where both mass and volume are constrained., Competing Interests: Declaration of Competing Interest The authors declare that there are no potential conflicts of interest., (Copyright © 2020 The Committee on Space Research (COSPAR). Published by Elsevier Ltd. All rights reserved.)

Trauma patients with a serious injury to the head or neck can remain immobilised with a cervical collar (C-collar) device in situ and are subsequently exposed to device-related skin integrity threats. This study aimed to determine the incidence and risk factors associated with the development of C-collar-related pressure injures (CRPIs) in an intensive care unit. This retrospective longitudinal cohort study was conducted in an Australian metropolitan intensive care unit. Following ethical approval, data from patients over 18 years, who received a C-collar were retrieved over a 9-year period. Chi square and t-tests were used to identify variables associated with CRPI development. A logistic regression model was employed to analyse the risk factors. Data from 906 patients were analysed. Nine-year pressure injury incidence was 16.9% (n = 154/906). Pressure injury development directly associated with a C-collar increased by 33% with each repositioning episode (odds ratio 1.328, 95% confidence interval 1.024-1.723, P = .033). Time in the C-collar (10.4 to 2.5 days, P = .002) and length of stay in intensive care unit (ICU) (20.1 to 16.1 days, P < .001) were associated with pressure injury development. Patients with C-collar devices are a vulnerable group at risk for pressure injury development because of their immobility and length of ICU stay., (© 2020 Medicalhelplines.com Inc and John Wiley & Sons Ltd.)

Background: This study describes a novel approach in reducing SARS-CoV-2 transmission during tracheostomy., Methods: Five patients underwent tracheostomy between April 1, 2020 and April 17, 2020. A clear and sterile plastic drape was used as an additional physical barrier against droplets and aerosols. Operative diagnosis; droplet count and distribution on plastic sheet and face shields were documented., Results: Tracheostomy was performed for patients with carcinoma of tonsil (n = 2) and nasopharynx (n = 1), and aspiration pneumonia (n = 2). Droplet contamination was noted on all plastic sheets (n = 5). Droplet contamination was most severe over the central surface at 91.5% (86.7%-100.0%) followed by the left and right lateral surfaces at 5.2% (6.7%-10.0%) and 3.3% (6.7%-10.0%), respectively. No droplet contamination was noted on all face shields., Conclusion: Plastic drapes can help reduce viral transmission to health care providers during tracheostomy. Face shields may be spared which in turn helps to conserve resources during the novel coronavirus disease 2019 pandemic., (© 2020 Wiley Periodicals, Inc.)

As an aerosol and droplets generating procedure, tracheostomy increases contamination risks for health workers in the coronavirus disease context. To preserve the health care system capacity and to limit virus cross-transmission, protecting caregivers against coronavirus infection is of critical importance. We report the use of external fixator equipment to set up a physical interface between the patient's neck and the caregiver performing a tracheostomy in COVID-19 patients. Once the metal frame set in place, it is wrapped with a single-use clear and sterile cover for surgical C-arm. This installation is simple, easy, and fast to achieve and can be carried out with inexpensive material available in every hospital. This physical interface is an additional safety measure that prevents the direct projection of secretions or droplets. It should, of course, only be considered as a complement to strict compliance with barrier precautions and personal protective equipment., (© 2020 Wiley Periodicals, Inc.)

Indiscriminatory in its spread, COVID-19 has engulfed communities from all social backgrounds throughout the world. While healthcare professionals work tirelessly testing for the virus and caring for patients, they too have become casualties of the pandemic. Currently the best way to attempt to curb the spread of the virus, echoed by almost all nation leaders, is to distance ourselves from one another socially or physically. However ideal this may seem, social distancing is not always practical in densely populated lower-income countries with many citizens below the breadline. With the majority of South Africans living in poverty, communities in overcrowded households are unable to distance themselves from one another appropriately. In addition, as a nation we struggle with high HIV and tuberculosis rates, malnutrition and an already overburdened healthcare system, emphasising the extreme vulnerability of our people. These factors, coupled with the fact that many of our healthcare professionals lack the necessary personal protective equipment to prevent them from contracting the virus themselves, highlight the gravity of the damaging repercussions that we may face in the coming months, after the complete national lockdown in force at the time of writing is lifted and we move towards a partial lockdown state. Nationally, there needs to be a shift in mindset towards exploring alternative technology-based preventive measures that may empower the healthcare sector in the long term and enhance social distancing.

Background: The Sustainable Development Goals (SDGs), which aim to halve global traffic deaths by 2020, will not be met by most low-income and middle-income countries (LMICs). In Latin America and the Caribbean (LAC) region, traffic deaths have remained stable at a high-level despite strong progress in other health domains. We evaluated the effects of road safety interventions in LAC and estimated the benefits that vehicle design improvements would have in this region., Methods: In our study done in October, 2018, we used a counterfactual analysis to assess the reduction in deaths and disability-adjusted life years (DALYs) lost if eight proven vehicle safety technologies were made more widely available in LAC countries. We estimated: (1) country-level incidence of traffic injuries, (2) the effectiveness of technologies through a systematic literature review, (3) the prevalence of car safety technologies, and (4) the lives saved and DALYs averted if all cars had these technologies. We characterised uncertainty in estimates by reporting the sensitivity of the results to alternative modelling assumptions., Findings: Increasing availability of electronic stability control, which includes antilock-brake systems, would have the largest benefits in the LAC region, estimated at 19·4% (sensitivity analysis range 8·6-31·1) fewer deaths and 17·0% (5·7-29·2) fewer DALYs. Increasing use of seatbelts would reduce deaths by 12·1% (9·1-15·5) and DALYs by 12·6% (9·4-16·3). Optimisation for side-impacts would result in 6·3% (3·1-6·5) fewer deaths, and improvements to vehicle front-end design would result in 6·0% (2·2-10·4) fewer deaths. The overall effect of improved vehicle design in the region would be 28·1% (12·8-39·2) fewer deaths, and 29·1% (13·5-39·8) fewer DALYs. Other safety technologies modelled, including airbag (front and side), side door beam, and side structure and padding, have smaller benefits., Interpretation: Regulating and encouraging the use of proven vehicle safety technologies in LMICs would have large gains and needs to be prioritised in the SDG agenda for 2030., Funding: Inter-American Development Bank., (Copyright © 2020 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 license. Published by Elsevier Ltd.. All rights reserved.)

Introduction: Automobiles carrying an autonomous emergency braking system (AEBS) are currently prevailing. While the reduction of traffic accidents is expected because of the widespread use of the system, concerns as regards many drivers using the system without proper understanding of the trigger conditions (TCs) have arisen. This research aims to grasp the degree of recognition of the AEBS TCs by a driver with a vehicle equipped with the system., Method: Using a web research company, we sent a survey sheet for screening to 9999 monitors randomly selected by gender and age group and confirmed own vehicle with an autonomous braking system ownership status. The number of answer targets was 200 for each of the four groups divided by age and gender. In this research, we developed a multivariate analysis model with the degree of understanding the AEBS TCs as the objective variable. The explanatory variables of this model were "Driver characteristics" and "Contact opportunities of information on the AEBS.", Results: Using PCA's main component scores as the objective variable, two types of multiple regression models were constructed according to the AEBS TCs (do not work properly and work accidentally). The model analysis showed that gender, age, confidence in driving skill, and experience of the AEBS before purchasing are significant variables in both models. The recognition of the conditions of the "AEBS does not work properly" was influenced by the information-gathering ability and the degree of reference to various information. In contrast, the recognition of the conditions of the "AEBS work accidentally" was influenced by the interest of automobiles, such as the importance of automobile for self-expression and explanation taken up in a car magazine., Conclusions: This study clarified the driver characteristics and contact opportunities of information that have problems in recognizing the AEBS TCs. Practical Applications: Considering measures, such as public relations, utilizing this result will be meaningful in terms of road safety in the current stage, which is the transitional period of the AEBS., (Copyright © 2020 National Safety Council and Elsevier Ltd. All rights reserved.)

Objective: We studied which current fatal at-fault crashes would occur despite the most advanced current active safety devices (up to SAE level 2 of driving automation) and how frequent these crashes would be., Methods: We carried out a cross-sectional study of passenger cars that were first registered during the period 1st January 2010 to 31st December 2017 in Finland. To gain the true exposure for these cars, we accessed the national Vehicular and Driver Data Register to obtain the mileage information and the registration count for the study period of 2010-17. Similarly, we accessed the registry of Finnish road accident investigation teams and included all fatal at-fault crashes among the cars in our study for the same period. We used a real world reference technology for each active safety system in our analysis and chose one car brand as an example. This gave us exact system specifications and enabled testing the operation of the systems on the road. We performed field tests to gain further information on the precise operation of the safety systems in different operating conditions. Finally, we gathered all information on the studied active safety systems and analyzed the investigated at-fault fatal crashes case-by-case using our four level method., Results: Cars in our study were the primary party in 113 investigated fatal accidents during the years 2010-17. In 87 of the accidents, the leading cause of death was the injuries due to the crash, and these cases were classified as "unavoidable" (n = 58, 67 %), "avoidable" (n = 26, 30 %) or unsolved (n = 3, 3 %). Of the 58 "unavoidable" crashes 21 (36 %) were suicides, 21 (36%) involved active driver input which would have prevented the safety system operation, 15 (17 %) featured circumstances beyond the safety system performance and in one loss-of-control crash the driver had disabled the relevant safety system (electronic stability control). The registration years of the cars in our study (2010-17) totaled 3,772,864 and during this period, the cars travelled 75.9 billion kilometers. The crash incidence of the "unavoidable" at-fault fatal crashes was 0.76-0.80 fatal crashes per billion kilometers and 15-16 fatal crashes per million registration years., Conclusions: We calculated a crash incidence for the "unavoidable" crashes which was 20-27% smaller than the observed crash rate of ESC-fitted passenger cars in our previous study. We concluded that suicides, active driver input until the crash, and challenging weather and road conditions are the most difficult factors for current active safety systems. Our analysis did not account for issues such as system usability or driver acceptance and therefore our results should be regarded as something that is currently theoretically achievable. However, the observed incidence is a good reference for automated driving development and the crash rate of automated cars., (Copyright © 2019 Elsevier Ltd. 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.

Objective: Intersection collision is the most common type of vehicle accidents, and it is more complicated and has more variables compared to straight road collisions. Intersection collisions are also a major obstacle to practical application of self-driving technology. This calls for more studies and development of Intersection-Advanced Driver Assistance System (I-ADAS) which can be applied to various scenarios of intersection collisions. Method: In this study, NHTSA FARS and NASS-CDS DB from the period of 2013-2015 were used to analyze the circumstances and severity of damage in intersection collisions. With these analysis results, 17 possible vehicle collision scenarios were established based on the travel directions and relative positions of the two vehicles. The 17 accident scenarios were categorized into nine groups based on the travel direction and relative positions, and accident characteristics of each group, such as the severity of injuries, were analyzed. Results: Based on these characteristics, a method of qualitatively predicting and avoiding an intersection collision accident using a black box camera mounted on vehicles is introduced. Conclusion: When classifying the collision types, it was done with the consideration of making car-mounted camera-based intersection accident prediction and prevention possible. The intersection accident scenarios deduced for the purpose of the development of I-ADAS and self-driving system were analyzed regarding the severity of injuries and other factors. Based on these factors, possible methods to predict and prevent intersection accidents by using video footages and other data from the black box installed on cars were simply suggested.

Around 372 000 people drown every year globally. In countries, such as the UK, a large proportion of these deaths are due to recreational boating accidents, and a dominant factor influencing the outcome is whether the person was wearing a personal flotation device (PFD). The rate of PFD wear is low around the world, with reported rates ranging from 5% to 40%. In an effort to combat this, the UK has been running an education campaign since 2009 to try and increase PFD wear. In this contribution, 9 years of observational data show that the educational efforts have had little impact on the rate of wear over time. Activity type and age both influenced wear rates, with kayakers and children significantly more likely to wear PFDs. This study shows that education has been ineffective and there needs to be some consideration of regulatory approaches in order to reduce drowning., Competing Interests: Competing interests: SP was previously employed by the RNLI., (© Author(s) (or their employer(s)) 2019. No commercial re-use. See rights and permissions. Published by BMJ.)

In recent years, the popularity of all-terrain vehicles (ATVs) in the United States (US) has increased, and the number of ATV driver and passenger deaths have also increased substantially in the last few decades. Riders or occupants of ATVs as well as golf carts are particularly vulnerable to injury, not only due to the lack of protection and safety equipment offered by their vehicles, but also the propensity for ejection in the event of a crash. Given the vulnerability of these road users, it's critical to understand factors which may affect injury severity to plan effective countermeasures aimed at reducing these injuries and fatalities. To better understand factors affecting the injury severity of ATV and golf cart riders or occupants involved in police-reported crashes, this study presents an analysis using six years of crash data from the US state of Arizona. Over the analysis period, there were 1769 drivers/passengers of these vehicle types involved in police-reported crashes. Of these occupants/riders, 67.7% were injured or killed as a result of the crash; a proportion significantly higher than police-reported crashes involving most other vehicle types, exhibiting the need to examine factors leading to these injuries and fatalities. In order to analyse factors affecting the injury severity of ATV and golf cart occupants/riders, a random parameters (RP) ordered logit statistical model was developed, which was most appropriate given the ordered nature of injury-severity data. Several person- vehicle- roadway- and environmental-related variables were found to significantly affect the injury severity of riders or occupants of ATVs and golf carts. Given the vulnerability of these road users, it's important for transportation agencies to explore effective countermeasures aimed at reducing the severity of crashes involving these vehicle types. The results of this study provide important insights which can assist in developing effective engineering-, enforcement-, education, or policy-related countermeasures., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

Objective: To generate evidence of the effectiveness of hip protectors to minimize risk of hip fracture at the time of falling among residents of long-term care (LTC) by contrasting rates of hip fractures between falls with and without hip protectors., Design: A 12-month, retrospective cohort study. We retrospectively reviewed fall incident reports recorded during the 12 months prior to baseline in participating homes., Setting and Participants: A population-based sample comprising all residents from 14 LTC homes owned and operated by a single regional health authority, who experienced at least 1 recorded fall during the 12-month study., Results: At baseline, the pooled mean (standard deviation) age of residents in participating homes was 82.7 (11.3) years and 68% were female. Hip protectors were worn in 2108 of 3520 (60%) recorded falls. Propensity to wear hip protectors was associated with male sex, cognitive impairment, wandering behavior, cardiac dysrhythmia, use of a cane or walker, use of anti-anxiety medication, and presence of urinary and bowel incontinence. The incidence of hip fracture was 0.33 per 100 falls in falls with hip protectors compared with 0.92 per 100 falls in falls without hip protectors, representing an unadjusted relative risk (RR) of hip fracture of 0.36 (95% confidence interval 0.14-0.90, P = .029) between protected and unprotected falls. After adjusting for propensity to wear hip protectors, the RR of hip fracture was 0.38 (95% confidence interval 0.14-0.99, P = .048) during protected vs unprotected falls., Conclusions and Implications: Hip protectors were worn in 60% of falls, and the risk of hip fracture was reduced by nearly 3-fold by wearing a hip protector at the time of falling. Given that most clinical trials have failed to attain a similar level of adherence, our findings support the need for future research on the benefits of dissemination and implementation strategies to maximize adherence with hip protectors in LTC., (Copyright © 2019 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.)

Background: Falls overboard are the most common cause of fatalities in commercial fishing. As a result, interventions aimed at increasing and measuring the use of personal flotation devices (PFDs) are a high priority. The focus of this study was to explore the use of accelerometers as a means for objectively measuring PFD use on lobster fishing vessels., Methods: For participating vessels, researchers attached an accelerometer to a PFD worn by a crewmember and another to the vessel's wheelhouse. GoPro videos were also employed to record crewmember activities so these could be synchronized with accelerometer outputs. Accelerometer outputs included two distinct measures, the proportional integration mode (PIM) and zero crossing mode (ZCM). Data were fitted to various equations to identify the best method for predicting PFD use., Results: Seven lobster fishing vessels participated in the trial. Data indicated that accelerometers could predict PFD use with a fairly high degree of accuracy. In particular, a logistic equation incorporating PIM values from the PFD and the absolute value of the difference between the PFD PIM readings and the PIM readings from the stationary accelerometer demonstrated the highest degree of accuracy, with correct classifications for 73.3% to 77.6% of the 10-second data intervals. Accuracy was highest when crew members were moving versus stationary. The predictive value of ZCM was comparatively limited., Conclusions: PIM accelerometer readings can be used to measure PFD use with a considerably high degree of accuracy, especially for sternmen who are moving regularly and have the highest risk for falling overboard., (© 2019 Wiley Periodicals, Inc.)

Kerala, a maritime state on the west coast of peninsular India, constitutes approximately 10% of India's total coastline and claims a 20% share in national marine fish production. The registered fishing fleet consists of about 29,969 motorized, 4248 mechanized, and 2515 non-motorized crafts. This study was done to assess occupational hazards faced by fishers as well as the usage of sea safety devices (SSDs) in Kerala. Information was collected from 180 mechanized, motorized, and traditional boat owners. The study revealed that capsizing, sinking, grounding, burning, collision, mishaps, man overboard, and injuries were common occupational hazards. SSDs used were life buoy, life jacket, first aid kit, emergency rations, fire extinguisher, fire bucket, global positioning system, magnetic compass, emergency position indicating radio beacon (EPIRB), sonar, echo sounder, oil lamp, signaling torch, and batteries. Fishers with mechanized boats had high knowledge and used most SSDs. Fishers with motorized boats had adequate knowledge but less SSD usage. Traditional and small-scale fishers did not use most SSDs. Non-parametric Kruskal-Wallis statistical test revealed a significant difference in regards to usage between mechanized, motorized, and traditional fishers, indicating there are gaps in usage of SSDs between the three groups of fishers. It is necessary to educate and motivate fishers with motorized and traditional boats to use SSDs.

Although dogs routinely travel in motor vehicles, there is a lack of evidence on if, how, and why people choose to restrain their dogs when travelling. A lack of restraint is likely to be associated with an increased risk of serious injury or death in the case of an accident, and in some cases may even precipitate an accident. The aim of the present study was to determine the frequency in which dog restraints are used in the US, UK and Australia in a convenience sample, and the factors associated with whether or not a dog is restrained. Online surveys using SurveyMonkey® were distributed in the US, UK and Australia during 2017-2018. The survey consisted of questions related to owning a dog, owner and dog demographics, use of restraint when driving with the dog, reasons for restraining/not restraining the dog, and attitudes to restraint of dogs in vehicles. A logistic regression was used to determine factors associated with the use of restraint. There were 706, 692 and 637 completed surveys from the US, UK and Australia, respectively. A little over half of respondents restrained their dog in the US (55%) compared to 67% in Australia and 72% in the UK. The most common method of restraint in the US and UK was a cage/crate in the cargo area in the back of the vehicle; in Australia it was a harness and tether attached to a seat buckle. In the generalised linear model, country, dog size, owner age, dog age and vehicle type were all significant factors associated with the use of restraint for dogs in cars. Younger dog owners from the US who drove a pickup truck or utility van, had a large dog, and drove with their dogs less frequently were least likely to restrain their dogs. This research highlights the need for improved education and information regarding the use of restraints for dogs traveling in vehicles, although the limitations in the convenience sample used mean further research is needed, including use of a more representative sample., (Copyright © 2019 Elsevier B.V. All rights reserved.)

Information on occupational health and safety practices in Brazilian aquaculture is limited. This paper reports preliminary results from an online survey based on research questions to identify occupational hazards, risk assessment practices, and prevention measures adopted in Brazilian aquaculture. Data were collected through an online questionnaire, comprising 25 questions, on a voluntary and anonymous basis. Aquaculture stakeholders were invited to participate in the study through email and social media channels. The demographic data demonstrated that the majority of respondents were men (72%) and having a higher education (95%). Most respondents employed administrative controls and personal protective equipment (PPE) rather than substitution and other risk elimination measures to reduce exposure. The most commonly adopted measures were PPE use (87%), adequate handling of chemicals (86%), and imparting knowledge of risks (90%). However, only 12% of participants reported the presence of safety protocols at their workplace, and 17% had some form of immunization of workers. In this study, it was possible to identify a lack of hazard signage in the workplace and lack of occupational health and safety training. The results further indicate that risk management in aquaculture continues to be a challenge in low-income countries. Aquaculture farmers should be encouraged and supported in adopting measures and appropriate technologies to eliminate risks in Brazilian aquaculture.

Background : Falls overboard are the most frequent cause of death in the Northeast lobster fishing industry. National Institute for Occupational Safety and Health (NIOSH) surveillance indicates every victim of a fall overboard who has been found was not wearing a lifejacket. Preliminary research conducted in Maine and Massachusetts indicates lifejacket use is relatively uncommon among lobstermen due to barriers such as comfort, practicality, and social norms. Methods : This study highlights an initiative to: (1) trial various lifejacket designs with lobstermen; (2) identify the most popular designs; and (3) identify other features that could encourage use of lifejackets. In 2017, nine designs were trialed with lobstermen in Maine and Massachusetts during the winter and summer fishing seasons. Participants were recruited dockside, and lifejackets were randomly assigned. Participants completed surveys at 1 week and 4 weeks to assess positive and negative design features and to understand the importance of survival technology that can be used in conjunction with lifejackets. Results : 181 lobstermen in Maine and Massachusetts agreed to participate. Recruitment rates were 90.5%, while the survey completion rate was 88.4%. Survey results identified no clear preference for a specific lifejacket design; however, the ability to choose from many options appeared to be an important factor. Conclusion : Previous studies have indicated that lifejacket preferences are fisheries specific. In the Northeast lobster fishery, however, individual preferences varied. Our research demonstrates that a range of devices covering different buoyancies, wear type, and retrieval systems should be made more available to lobstermen.

Background and Aim: Prevalence and motives for nipple shield use are not well studied in preterm infants and recommendations of nipple shield use in preterm infants are inconsistent. The aim of this study was to determine the prevalence of nipple shield use, explore the motives for nipple shield use and elucidate the association with exclusive breastfeeding in preterm infants., Methods: The study was part of a prospective survey of a Danish national cohort of preterm infants based on questionnaires answered by the 1221 mothers of 1488 preterm infants with gestational age of 24-36 weeks. Data on nipple shield use was available for 1407 infants., Results: Nipple shields were used by 54% of the mother-infant dyads for many different motives and was more often related to breastfeeding problems associated with the infant than with the mother. The most common motive for nipple shield use was "infant slipped the nipple" (52%). The lower the gestational age, the more frequently nipple shields were used for motives related to the infant. For those using a nipple shield, only the motive "infant fell asleep at the breast" was associated with a higher risk of not breastfeeding exclusively at discharge (OR 1.90 (95% CI 1.15; 3.13), p = 0.012), and "breast too engorged" with a lower risk of not breastfeeding exclusively (OR 0.32 (0.16; 0.63), p = 0.001), but overall nipple shield use was associated with failure of exclusive breastfeeding., Conclusion: The present study does not give justifiable motives for nipple shield use, except for "breast too engorged". Nipple shields should not be recommended for infants falling asleep at the breast, instead, staff and mothers should be patient, allowing the dyad time skin-to-skin. The results indicate that the use of a nipple shield does not promote exclusive breastfeeding in preterm infants., Competing Interests: The authors have declared that no competing interests exist.

Introduction: Safe storage of guns outside the household while someone is at risk for suicide is important for suicide prevention. Some gun retailers offer temporary firearm storage as a community resource. Others may be willing if perceived barriers can be addressed., Methods: We invited all gun retailers in eight Mountain West states to respond to a questionnaire about the barriers they perceive in offering temporary, voluntary gun storage for community members., Results: Ninety-five retailers responded (25% response rate). Fifty-eight percent believed federal laws make it harder to store guns and 25% perceived state laws to be obstacles. Over 60% cited legal liability in storing and returning guns as barriers. Other important barriers included cost, space and logistical issues of drop off and pick up., Conclusions: Strategies to reduce legal and other barriers will need to be addressed to better engage gun retailers as a community resource for safe gun storage., Competing Interests: Competing interests: None declared., (© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2019. All rights reserved. No commercial use is permitted unless otherwise expressly granted.)

Motorcyclists are vulnerable road users in Uganda and 21.7% (3912/18,016) experienced crashes in 2012. This study determined the prevalence of and factors associated with compliance to selected road safety measures (helmet use, retro-reflective jackets use, riding permit and carrying one passenger) among commercial motorcyclists in Kawempe, from April to June 2014 using interviewer administered questionnaires. Total compliance was 0.9% and 24.4% to at least 3/4 measures. Compliance by measure was; 7.6% retroreflective jackets, 28.8% riding permits, 69.4% helmet use and 86.1% carrying one passenger. The associated factors were; knowing that (training before one starts to ride prevents crashes, Adjusted-odds-ratio (AOR) = 2.38 (1.36-4.19), maintaining the motorcycle in good condition prevents crashes, AOR = 0.34 (0.15-0.77) and padding reduces impact of road traffic injury, AOR = 0.37 (0.15-0.89)). Prevalence to compliance is very low. Road safety messages should highlight the importance of all road safety measures to improve compliance.

Background: The 2013 UK sharps safety regulations require healthcare facilities to use safety-engineered devices (SEDs) to protect staff. The recent increase in UK-reported occupational exposures could indicate increased reporting or increased exposures from suboptimal SED use., Aims: To ascertain SED use through examination of sharps container contents in a sample of UK hospitals., Methods: Reusable sharps containers (RSCs) were selected from seven UK hospitals in 2013 and seven different hospitals in 2016. At licensed processing facilities, the operator, wearing protective apparel, decanted RSCs, separated hollow-bore needles (HBNs) from other sharps and enumerated HBNs into capped/uncapped non-SEDs, activated/non-activated/tampered SEDs, and blunt draw-up SEDs. Probability, risk ratios (RRs) and 95% confidence limits (95% CLs) were calculated using WinPepi v2.78., Results: In 2013 and 2016, respectively, 2545 HBNs were categorized from 22 RSCs versus 2959 HBNs from 33 RSCs; 70% of HBNs were SEDs versus 93% (P < 0.001; RR 1.33; CL 1.30-1.37); 32% of activatable HBNs were not activated versus 22% (<0.001; 0.67; 0.60-0.76); 41% of HBNs were discarded 'sharp' versus 20% (<0.001; 0.48; 0.44-0.52); 25% of HBNs were uncapped needles versus 6% (<0.001; 0.22; 0.19-0.26); 5% of HBNs were capped needles versus 1% (P > 0.05); and 1% of SEDs were tampered with in both years (P > 0.05). Hospital practices varied widely., Conclusions: SED use and activation have increased significantly since 2013. Of concern is that in 2016, 22% of SEDs were non-activated and 20% of sharps were discarded 'sharp'. Increased training in SED handling, assiduous adherence to safe sharps work practices and a higher level of individual safety-ownership are indicated., (© The Author(s) 2019. Published by Oxford University Press on behalf of the Society of Occupational Medicine. All rights reserved. For Permissions, please email: journals.permissions@oup.com.)

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.)

Airbnb helps hosts rent all or part of their home to guests as an alternative to traditional hospitality settings. Airbnb venues are not uniformly regulated across the USA. This study quantified the reported prevalence of fire safety and first-aid amenities in Airbnb venues in the USA. The sample includes 120 691 venues in 16 US cities. Proportions of host-reported smoke and carbon monoxide (CO) detectors, fire extinguishers and first-aid kits were calculated. The proportion of venues that reportedly contained amenities are as follows: smoke detectors 80% (n=96 087), CO detectors 57.5% (n=69 346), fire extinguishers 42% (n=50 884) and first-aid kits 36% (n=43 497). Among this sample of Airbnb venues, safety deficiencies were noted. While most venues had smoke alarms, approximately 1/2 had CO alarms and less than 1/2 reported having a fire extinguishers or first-aid kits. Local and state governments or Airbnb must implement regulations compliant with current National Fire Protection Association fire safety standards., Competing Interests: Competing interests: None declared., (© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2019. All rights reserved. No commercial use is permitted unless otherwise expressly granted.)

Background: Domestic fire-related injuries and deaths among the aged remain a concern of many countries including Australia. This study aimed to assess the impact of a home fire safety visit project on domestic fire emergency escape plans among the 373 aged persons using multivariate analyses., Method: The study used data from a collaborative intervention program by three emergency agencies in New South Wales. It covered 373 older people at registration and 156 at post home visit follow-up. The five fire emergency escape plan outcome measures (participants having a working smoke alarm, finding out what to do if there was a fire at their home, making a plan to escape their home in the event of a fire, finding out how to escape their home in an emergency and finding out how to maintain their installed smoke alarm) were examined by adjusting for key characteristics of participants, using a generalized estimating equation (GEE) model that adjusted for repeated measures in order to examine the association between the home visit program and fire emergency escape plans., Results: There were significant improvements in participants' likelihood of finding out what to do if there was a fire in their home [AOR; 95% CI 1.89 (1.59-2.26)], making a plan to escape their home [AOR; 95% CI 1.80 (1.50-2.17)], how to escape their home in an emergency [AOR; 95% CI 1.33 (1.07-1.66)] and how to maintain their smoke alarm [AOR; 95% CI 1.77 (1.48-2.12)]. Female participants were less likely to have a plan to escape their home in the event of a fire [AOR; 95% CI 0.86 (0.75-0.99)] and to find out how to escape their home in an emergency [AOR; 95% CI 0.71 (0.61-0.82)] compared with their male counterparts. Additionally, participants who spoke languages other than English at home were significantly less likely to have a working smoke alarm [AOR; 95% CI 0.88 (0.38-0.69)]., Conclusion: Our findings suggest that home visit programs are able to increase fire safety of vulnerable and isolated older people.

Airbnb hosts rent their homes to guests as an alternative to traditional hospitality settings. Airbnb venues are not uniformly regulated for allowing smoking or requiring fire-safety amenities. This study quantified the reported prevalence of fire-safety amenities in 413,339 Airbnb venues that allow smoking in 43 cities in 17 countries. Proportions of host-reported smoke detectors and carbon monoxide (CO) alarms, and those that allow smoking were calculated. Across the entire sample 9.3% (n = 38,525) allowed smoking. An overall evaluation of those venues shows that 46% (n = 17,569) had smoke detectors compared to 64% of the 374,814 venues that do not allow smoking, a statistically significant difference (X2 = 5277 p < 0.01). A similar difference is found between venues that allow smoking and had CO alarms (19%, n = 7176) and the 33% of venues that prohibit smoking (X2 = 3442, p < 0.01). Among this sample, most Airbnb venues that allow smoking are less likely to have safety amenities., (Copyright © 2019. Published by Elsevier Inc.)

Human exposure to man-made Electromagnetic Fields (EMFs) has increased to unprecedented levels, accompanied by increase in various health problems. A connection has been indicated by an increasing number of studies. Symptoms characterized as Electro-hyper-sensitivity (EHS) are frequently reported especially in urban environments. Lately, people are advised by private companies and individuals to protect themselves from man-made EMFs by metal shielding through various products, for which there are reasonable concerns about their protective efficacy and safety. Indeed, any metal shielding practice, even when correctly applied, attenuates not only man-made totally polarized EMFs accused for the health problems, but also the natural non-polarized EMFs responsible for the biological rhythmicity and well-being of all animals. Strong evidence on this was provided by pioneering experiments in the 1960's and 1970's, with volunteers staying in a shielded underground apartment. We analyze the physical principles of EMF-shielding, the importance of natural atmospheric EMFs, and examine available shielding methods and suggested products, relying on science-based evidence. We suggest that an avoidance strategy is safer than shielding, and provide specific protection tips. We do not reject shielding in general, but describe ways to keep it at a minimum by intermittent use, as this is theoretically safer than extensive permanent shielding. We explain why metallic patches or "chips" or minerals claimed by sellers to be protective, do not seem to make sense and might even be risky. We finally suggest urgent research on the safety and efficacy of shielding methods combined with use of generators emitting weak pulses of similar frequency, intensity, and waveform with the natural atmospheric resonances., (Copyright © 2019 Elsevier B.V. All rights reserved.)

Objectives: To assess current adherence to international guidelines for practitioners of bronchoscopy in the Kingdom of Saudi Arabia. Methods: A cross-sectional survey was conducted in Saudi Arabia between December 2016 and March 2017. Pulmonologists, thoracic surgeons, and intensivists were invited to answer an emailed self-administered questionnaire survey seeking information on how they performed flexible bronchoscopy in adults. The data collected were compared between the 3 specialties. Results: Eighty-two (18%) of 456 invited practitioners completed the survey. Fifty-eight (72%) of the 82 respondents were pulmonologists. Forty (53%) of 76 respondents (93%) who had received bronchoscopy training received it abroad. Twenty-seven respondents (33%) had also received training in endobronchial ultrasound, electrocautery, brachytherapy, stent insertion, and laser procedures. Fifty-eight respondents (70%) preferred patients to undergo fasting for at least 4 hours before the procedure. Lidocaine was used for topical anesthesia, mainly by aerosol spray or nebulization. Midazolam was used by 62%, fentanyl by 50%, and propofol by 12% of respondents. Ninety percent of pulmonologists reported requesting a chest radiograph after transbronchial lung biopsy. Safety procedures for bronchoscopists, for example, wearing masks and eye protection, and for patients, for example, availability of anesthetic reversal agents, were not universally applied. Conclusion: Bronchoscopy is not standardized in Saudi Arabia. National guidelines for the indications and practice of bronchoscopy are required.