Increased bicycle helmet use in the absence of mandatory bicycle helmet legislation: Prevalence and trends from longitudinal observational studies on the use of bicycle helmets among cyclists in Denmark 2004-2022

INTRODUCTION

Using a bicycle helmet reduces the risk of serious head injuries among cyclists substantially. This makes it highly relevant to increase the use of helmets and to measure the prevalence of bicycle helmet use over time and across different groups.

METHOD

Since 2004, the use of bicycle helmets in Denmark has been measured observationally in two nationwide time series: one among cyclists in city traffic across all age groups, and one among cycling school children (aged 6-16) around schools. The observations have been conducted on a regular basis in different parts of the country following the same methodology over the years.

RESULTS

Bicycle helmet use among cyclists in city traffic in Denmark has increased from 6% in 2004 to 50% in 2022. Among cycling school children, helmet use has increased from 33% in 2004 to 79% in 2022. Throughout the years, helmet wearing rates have been highest among young children and lowest among young adults. Since 2015, female cyclists in city traffic have had a slightly higher helmet use than male cyclists.

DISCUSSION

Several factors might have affected bicycle helmet use in Denmark. One possible factor is a nationwide focus on traffic safety education and behavior change campaigns to encourage helmet wearing. Furthermore, among stakeholders on cycling safety there has been consensus on recommending bicycle helmet use and supporting the promotion of helmets while not recommending or promoting helmet legislation. Finally, more safety-oriented behavior in road traffic in general, and self-reinforcing effects of increased helmet use have plausibly been important factors.

PRACTICAL APPLICATIONS

Increasing bicycle helmet use in a country where cycling is popular is possible in the absence of mandatory bicycle helmet legislation. Persistent behavior change campaigning and education, stakeholder consensus, higher levels of road safety-oriented behaviors, and self-reinforcing processes could potentially be important factors.

Comparison of characteristics of kick- and electric-scooter-related dental and maxillofacial injuries: A retrospective study

BACKGROUND/AIM

Owing to the nearly three-year-long COVID-19 pandemic, small personal transportation devices that allow for greater freedom of movement within the cities have gained attention. Therefore, the number of people using kick or electric scooters has increased. This study aimed to compare the characteristics of kick and electric scooter-related dental and maxillofacial trauma and provide helpful information for preventing scooter accidents, appropriate treatment of patients with scooter-related trauma, and policy establishment.

MATERIALS AND METHODS

This retrospective observational study analysed the medical records of 310 patients who visited the emergency room of Ajou University Dental Hospital for kick and electric scooter-related oral and maxillofacial injuries between 1 January 2017 and 31 December 2022. Sex, age, scooter type, time, and mechanism of the accident, helmet use, alcohol consumption, dental and maxillofacial injury types, and treatment were analysed.

RESULTS

The average age in the kick-scooter group (5.71 ± 4.25) was lower than that in the electric-scooter group (28.24 ± 10.02) (p < .0001). There were more males in both groups. The helmet usage rates of the two groups were 2.80% and 7.88%, respectively. In the kick-scooter group, periodontal damage was more common than pulp injury, while in the electric-scooter group, pulp injury was more common than periodontal injury. There was no significant difference in soft-tissue damage between the two groups; however, bone fractures occurred significantly more frequently in the electric-scooter group (p < .0001).

CONCLUSIONS

Electric scooters cause more crown and bone fractures than kick scooters and require more active treatment of dental and maxillofacial injuries. Riders should use protective equipment to prevent dental and maxillofacial injury. Although there are regulations related to scooters, the effectiveness of both kick- and electric-scooter related laws needs to be evaluated.

Single-bicycle crashes in Finland - Characteristics and safety recommendations

PROBLEM

Increasing the role of cycling is necessary to reduce physical inactivity. While promoting cycling, attention should also be given to traffic safety. Hence, a better understanding on the underlying factors and safety recommendations of cyclist crashes is needed. This study aims to increase knowledge on fatal single-bicycle crashes (SBCs), where other road users are not collided with.

METHOD

Data from in-depth investigated fatal cyclist crashes in Finland is analyzed from 2010 to 2019. The study presents descriptive analysis of the characteristics, underlying factors, and safety recommendations of SBCs (n = 82) and other cyclist crashes (n = 151). Logistic regression analysis and chi-squared tests were performed to identify significant characteristics for SBCs.

RESULTS

Fatal SBCs commonly involved people aged 60 or older, males, and cyclist not wearing a helmet. Cyclist's health issues influenced the crash in 62.2% of the SBCs. Compared to other cyclist crashes, health issues, alcohol, males, other crash locations than intersections, and weekends were highlighted in SBCs. Safety recommendations emphasized human factors, such as informing cyclist about underlying factors and the use of safety equipment.

DISCUSSION

In addition to human factors, the safety recommendations included suggestions regarding the bicycle, the traffic environment, and traffic regulations. This highlights the need to focus on different safety improvement actions to reduce SBCs. This study identified key characteristics of SBCs, which may help traffic safety authorities address this road safety issue and ultimately help to promote cyclist safety.

PRACTICAL APPLICATIONS

Cooperation between the actors including health care providers and the police is also proposed to address cyclists' health issues that contribute to SBCs.

Estimated prevalence of helmet use while bicycling, rollerblading, and skateboarding among middle school students in selected U.S. States- Youth Behavior Risk Survey, 2013-2019

BACKGROUND

Helmet use helps prevent severe and fatal head and brain injuries from bicycle, rollerblade, and skateboard crashes. This study explores the prevalence of self-reported helmet use among middle school students while bicycling, skateboarding, and rollerblading.

METHODS

Data from the Middle School Youth Risk Behavior Survey (YRBS) for selected states were analyzed. Self-reported prevalence (frequency) of helmet use while bicycling, rollerblading, or skateboarding and other variables (sex, grade level, and race/ethnicity) are reported.

RESULTS

The overall prevalence of rarely or never wearing a helmet while bicycling among middle school students in selected states was 68.6%; decreasing from 71.7% in 2013 to 67.1% in 2019. The overall prevalence of rarely or never wearing a helmet while rollerblading or skateboarding in middle school students in selected states was 74.6%; decreasing from 76.4% in 2013 to 73.5% in 2019. Students in 7th and 8th grade and students of non-Hispanic race/ethnicity had significantly higher odds of rarely or never wearing a helmet while bicycling or while rollerblading and skateboarding than students in 6th grade and non-Hispanic White students.

CONCLUSIONS

While helmet use among middle school students improved over time, overall helmet use during bicycling, rollerblading, and skateboarding remained low. These estimates illustrate the continued call for universal implementation of helmet use efforts among kids using established strategies.

PRACTICAL APPLICATIONS

Future research on helmet use among youth who rollerblade and skateboard, as well as multi-pronged efforts to promote helmet use among middle schoolers who bicycle, skateboard, and rollerblade (inclusive of education, helmet distribution, and social marketing techniques, as well as the provision of helmets at no-cost) may be beneficial for addressing perceived risks for injury and other barriers.

Exploring the differences in rider injury severity in vehicle-two-wheelers accidents with dissimilar fault parties

Objective: The division of responsibility in vehicle-two-wheelers accidents reflects the extent to which different fault parties contributed to the occurrence of the accident, with significant differences in the injuries sustained by the riders in accidents where diverse parties were primarily responsible. We want to explore the difference in the severity of injury of riders in different fault parties of accidents so that we can make targeted protection improvements.Methods: In this study, three generalized ordered logit models were established for the total sample (n = 1204), the sample with drivers as the primary fault party (n = 607), and the sample with riders as the primary fault party (n = 597), respectively, to explore the differential impact factors on rider injury severity in vehicle-two-wheelers accidents involving different fault parties. Inter-group difference tests were conducted on the mean rider injury severity caused by differential factors in different accidents. Combining the impact effect trends and mean differences in the model, the differences in rider injury severity in accidents involving different fault parties were analyzed from the standpoints of human, vehicle, and road factors.Results: It was found that the effects of curve on injury severity was sheerly opposite in accidents with different fault parties and that factors, such as visual obstruction, road surface condition, gender, and helmet wearing differed in their effects on rider injury severity under different fault parties accidents. This reveals the driving tendencies and states of both parties in different environments.Conclusion: Based on the differential impact factor analysis and rider injury characteristics in accidents involving different fault parties, suggestions for improvement were made from the perspectives of road facilities, and safety awareness of drivers and riders, which are beneficial for improving rider safety and providing a theoretical reference for future regulations on liability allocation.

Measurement of Head Kinematics Using Instrumented Mouthguards During Introductory Boxing Courses in U.S. Military Academy Cadets

INTRODUCTION

Use of wearable impact sensor devices to quantitatively measure head impact exposure remains largely unstudied in military-style martial arts training and combat sports, particularly at the beginner levels. The baseline frequency and severity of head impact exposure during introductory military-style martial arts trainings, such as combatives training, is valuable information for developing future programs of instruction and exposure monitoring programs. The purpose of this study was to describe head impact exposures experienced during introductory combatives training (a boxing course) at U.S. Military Academy.

METHODS

This study used instrumented mouthguards to measure head impact exposure in U.S. Military Academy cadets during a compulsory boxing course. Summary exposures from a preliminary dataset are presented.

RESULTS

Twenty-two male subjects (19.9 ± 1.1 years, 86.6 ± 11.7 kg) participated in 205 analyzed player-bouts (full contact sparring sessions) with 809 video verified impacts (average 3.9 impacts per player-bout). The mean peak linear acceleration was 16.5 ±7.1 G, with a maximum of 70.8 G. There was a right-skewed distribution, with 640/809 (79.1%) events falling between 10 and 20 G. The mean peak angular acceleration was 1.52 ± 0.96 krad/s2, with a maximum of 8.85 krad/s2.

CONCLUSIONS

Compared to other high-risk sports at Service Academies, head impacts from beginner boxing were of similar magnitude to those reported for Service Academy football and slightly lower than those reported for Service Academy rugby. Based on these preliminary data, the risk profile for introductory military-style martial arts training, such as boxing or combatives, may be similar to other contact sports like football and rugby, but further research is required to confirm these findings and understand the effects of the exposures in a shorter duration.

Preliminary Head-Supported Mass Performance Guidance for Dismounted Soldier Environments

INTRODUCTION

The helmet is an ideal platform to mount technology that gives U.S. Soldiers an advantage over the enemy; the total system is recognized quantitatively as head-supported mass (HSM). The stress placed on the head and neck is magnified by adding mass and increasing the center of mass offset away from the atlanto-occipital complex, the head's pivot point on the spine. Previous research has focused on HSM-related spinal degeneration and performance decrement in mounted environments. The increased capabilities and protection provided by helmet systems for dismounted Soldiers have made it necessary to determine the boundaries of HSM and center of mass offset unique to dismounted operations.

MATERIALS AND METHODS

A human subject volunteer study was conducted to characterize the head and neck exposures and assess the impact of HSM on performance in a simulated field-dismounted operating environment. Data were analyzed from 21 subjects who completed the Load Effects Assessment Program-Army obstacle course at Fort Benning, GA, while wearing three different experimental HSM configurations. Four variable groups (physiologic/biomechanical, performance, kinematic, and subjective) were evaluated as performance assessments. Weight moments (WMs) corresponding to specific performance decrement levels were calculated using the quantitative relationships developed between each metric and the study HSM configurations. Data collected were used to develop the performance decrement HSM threshold criteria based on an average of 10% total performance decrement of dismounted Soldier performance responses.

RESULTS

A WM of 134 N-cm about the atlanto-occipital complex was determined as the preliminary threshold criteria for an average of 10% total performance decrement. A WM of 164 N-cm was calculated for a corresponding 25% average total performance decrement.

CONCLUSIONS

The presented work is the first of its kind specifically for dismounted Soldiers. Research is underway to validate these limits and develop dismounted injury risk guidance.

Midline peripheral catheters inserted in the superficial femoral vein at mid-thigh: Wise choice in COVID-19 acute hypoxemic respiratory failure patients with helmet continuous positive airway pressure

BACKGROUND

During coronavirus disease 2019 (COVID-19) pandemic, Helmet Continuous Positive Airway Pressure (h-CPAP) has been widely used to treat Acute Hypoxemic Respiratory Failure (AHRF). In COVID-19 patients undergoing h-CPAP a simple short peripheral catheter could be insufficient. According to the European Recommendations for Proper Indication and Use of Peripheral venous access consensus, a stable peripheral Vascular Access Device is indicated for intravenous treatment compatible with the peripheral route scheduled for more than 1 week.

OBJECTIVE

The aim of this prospective study was to evaluate the performance and the potential complications of superficial femoral midline catheters (SFMC) inserted in the Superficial Femoral Vein by direct Seldinger technique with peripheral tip (Arrow®, Teleflex; 20 cm length four FR single lumen and seven FR dual lumen) in AHRF COVID-19 patient. Complications were divided in early (accidental puncture of superficial femoral artery (APSFA); accidental saphenous nerve puncture (ASNP); bleeding) and late (Catheter Related Thrombosis (CRT); Catheter-Related Bloodstream Infections (CRBSI); Accidental Removal (AR); persistent withdrawal occlusion (PWO)).

METHODS

From 1st October 2020 to 30th June 2021 we conducted a prospective observational study in COVID-19 sub-intensive wards at Luigi Sacco Hospital (Milan).

RESULTS

Hundred seventy five SFMC (mean dwell time 11.1 ± 9.8 days) were implanted in COVID-19 patients, 107 (61.1%) during h-CPAP treatment (10.5 ± 8.9 days), the remaining 68 (38.9%) in patients with severe disease. We recorded two minor immediate/early complications (APSFA without sequelae) and no major complications.The long-term follow-up registered four CRBSI (2.3%-2.5/1000 catheters days (CD)), five CRT (2.9%: 2.6/1000 CD), 22 AR (12.6%; 11.4/1000 CD), 38 PWO (36.5%), 34 of which occurred due to fibroblastic sleeve (32.7%).

CONCLUSIONS

SFMC proved to be safe, easy and time-saving. It could be implemented, after a careful benefits and risks evaluation, in particular settings such as h-CPAP, delirium, bleeding risk factors and palliative care patients.

Electric Scooter-related Craniofacial Injuries

OBJECTIVES

Injuries associated with the use of electric scooters are a serious problem in modern society and traffic in relation to their increasing frequency of use. Although injuries involving all body parts are seen in such injuries, craniofacial ones are also very common. The aim of this study was to evaluate the craniofacial and other accompanying injuries in electric scooter-related accidents in Istanbul.

MATERIALS AND METHODS

Between January 2020 and December 2022, patients with electric scooter-related trauma among the patients admitted to the emergency unit for trauma were evaluated retrospectively. All electronic medical records, CT scans, other examinations, and treatments were retrospectively reviewed, and craniofacial fractures and other injuries seen in the patients were classified.

RESULTS

A total of 20.358 patients were admitted to the trauma unit between January 2020 and December 2022. Two hundred ten patients (142 male, 68 female) had electric scooter-related trauma and 58.1 % of them had craniofacial injuries. Thirty patients (14.3 %) (23 male, 7 female) had craniofacial fractures, whereas 43.8 % of them had craniofacial soft tissue injuries. The nasal fracture was the most common craniofacial fracture (14 patients, 46.7%). Orbital wall and zygomaticomaxillary complex fractures were found to be the second most common fractures.

CONCLUSIONS

The rate of electric scooter-related injuries among all trauma patients admitted to the emergency trauma unit during the mentioned period was 1.03%. The results of this study were found to be in accordance with the data in the literature. The craniofacial region is the most frequently injured body part in patients with electric scooter-related trauma, and patients should be comprehensively evaluated for possible soft tissue injuries, craniofacial fractures, and other accompanying system injuries.

Nationwide Analysis of Motorcycle-Associated Injuries and Fatalities in the United States: Insufficient Prevention Policies or Abandoned Laws?

BACKGROUND

Motorcycle road traffic collisions are a major cause of mortality in the United States. We aimed to analyze the temporal and statewide trends in motorcycle collision fatalities (MCFs) nationwide and their association with state laws regarding motorcycle helmet requirements, lane splitting, speeding, intoxicating driving, and red light cameras.

METHODS

A retrospective review of United States MCF/capita from 2015 to 2019 was performed using the Fatality Analysis Reporting System database. MCF/capita was defined as a motorcyclist death per 100 000 motorcyclist registrations. Independent-samples t-test and ANOVA were used to determine differences, with significance defined as P < .05. Linear regression analysis and Pearson's correlation were used to further determine associations between variables.

RESULTS

The majority of fatalities occurred in males (n = 21 354, 91.0%), ages 25-54 (n = 13 728, 58.5%), and Caucasians (n = 19 195, 81.8%). A total of 24 states and DC exhibited positive trends in MCF/capita from 2015 to 2019. There was no significant difference in MCF/capita between states who had mandatory helmet laws for all, partial requirements, and states with no law (63.4 vs 54.3 vs 33.6, P = .360). Among fatalities involving alcohol, a significantly greater number of MCF/capita were found above the legal limit of .08 compared to the group with a blood alcohol concentration of .01-.07 (17.8 vs 4.5, P < .001).

CONCLUSION

Motorcyclist fatalities continue to pose a public health risk, with 24 states showing an upward trend. Additional interventions and laws are needed to decrease the number of motorcyclist deaths. Further strategy on implementation and enforcement of helmet laws and alcohol consumption may be an essential component.

Efficacy of Guardian Cap Soft-Shell Padding on Head Impact Kinematics in American Football: Pilot Findings

Sport-related concussion prevention strategies in collision sports are a primary interest for sporting organizations and policy makers. After-market soft-shell padding purports to augment the protective capabilities of standard football helmets and to reduce head impact severity. We compared head impact kinematics [peak linear acceleration (PLA) and peak rotational acceleration (PRA)] in athletes wearing Guardian Cap soft-shell padding to teammates without soft-shell padding. Ten Division I college football players were enrolled [soft-shell padding (SHELL) included four defensive linemen and one tight end; non-soft-shell (CONTROL) included two offensive linemen, two defensive linemen, and one tight end]. Participants wore helmets equipped with the Head Impact Telemetry System to quantify PLA (g) and PRA (rad/s2) during 14 practices. Two-way ANOVAs were conducted to compare log-transformed PLA and PRA between groups across helmet location and gameplay characteristics. In total, 968 video-confirmed head impacts between SHELL (n = 421) and CONTROL (n = 547) were analyzed. We observed a Group x Stance interaction for PRA (F1,963 = 7.21; p = 0.007) indicating greater PRA by SHELL during 2-point stance and lower PRA during 3- or 4-point stances compared to CONTROL. There were no between-group main effects. Protective soft-shell padding did not reduce head impact kinematic outcomes among college football athletes.

Electrocardiographic semi-spiked helmet sign in critically Ill patients: A case series

RATIONALE

ST-segment elevation on electrocardiogram (ECG) is an alarming sign. Although acute myocardial infarction (AMI) is the most common cause of ST-segment elevation, many non-ischemic conditions may produce pseudo-ST segment elevation. Spiked Helmet (SH) sign is one of the pseudo-ST segment elevations that is associated with critical illness and high risk of death. SH sign was characterized by an upward shift starting before the onset of the QRS complex; however, we found some patients presented with a peculiar characteristic on ECG with an upward convex ST-segment elevation after the QRS wave but without elevation before the QRS wave, therefore called Semi-SH sign. Also, this electrocardiographic feature exists in patients with critical disease and is related to poor prognosis. The purpose of this case series is to describe the electrocardiographic Semi-SH sign and enhance the awareness of such electrocardiographic manifestation for clinicians.

PATIENTS CONCERNS

This case series explores the possibility of severe infection induced electrocardiographic changes resembling spiked-helmet sign.

DIAGNOSES

Sepsis-induced secondary myocardial injury or coronary vasospasm.

INTERVENTIONS

Gastric decompression, antibiotics, diuretics, advanced life support.

OUTCOMES

The outcome of this case series is the association of the electrocardiographic Semi-SH sign with the prognosis. All 3 patients died several days post manifestation of electrocardiographic Semi-SH sign.

LESSON

Like SH sign, electrocardiographic Semi-SH sign is a life-threatening or deadly ECG sign, and therefore early recognition and aggressive treatment are important.

The spiked helmet sign in a patient with erysipelas: an alarming electrocardiogram sign (a case report)

Early diagnosis of the spiked helmet sign is challenging. This ST-elevation myocardial infarction mimic was first described in 2011 by Littmann and colleagues and was linked to severe non-coronary pathologies, with a high risk of mortality. We present a case of a 60-year-old female patient who developed severe erysipelas with sepsis associated with severe hypokalemia. She had a spiked helmet sign on her routine electrocardiogram at hospital admission. We performed a coronary angiogram that showed no culprit artery. She developed afterward an ischemic stroke. Through intensive management of the patient's sepsis and electrolyte disturbance, she had a favorable outcome.

E-scooter attitudes and risk-taking behaviours: an international systematic literature review and survey responses in the West Midlands, United Kingdom

Introduction

Micromobility initiatives, including electric scooters (e-scooters), are part of the United Kingdom government's sustainability drive. Since summer 2020, multiple trials have been conducted across the United Kingdom. Safety concerns have been raised around e-scooters joining other vehicles on United Kingdom roads, alongside the numerous private e-scooters illegally ridden on public land. Although literature has been published abroad on perceptions, risk-taking behaviours and attitudes surrounding e-scooters, independent United Kingdom research has concentrated on analysing trauma. Our aim was to identify common themes and recommendations to form conclusions on factors affecting e-scooter trauma hospital admissions.

Methods

A systematic literature search in June 2023 extracted studies focused on the primary outcomes of risk factors, perceptions, and attitudes surrounding e-scooters globally from the EMBASE, PubMed, and Web of Sciences databases. Two independent reviewers conducted a critical appraisal to extract potential biases and study characteristics. A critical appraisal skills programme (CASP) analysis was also completed. Two online surveys distributed in Birmingham and Wolverhampton focused on: public perception towards e-scooters, and road user attitudes around e-scooters. The target population was residents of the West Midlands who were both riders and non-riders of e-scooters. The surveys were opened in late-March 2023 and closed in late-July 2023.

Results

443 studies were retrieved with 13 studies being eligible according to our inclusion and exclusion criteria. CASP assessment concluded that the studies were of good quality, however heterogeneity meant sample sizes could not be meaningfully aggregated. Many studies focused on safety concerns whilst others observed risk-taking behaviour, non-rider perceptions, and infrastructure. Our surveys received 299 responses and respondents reported risk-taking behaviours such as pavement riding, alcohol consumption, and minimal helmet use. However, positive opinions were expressed on e-scooter convenience but concerns were raised regarding rider and non-rider safety.

Discussion

Whilst global literature had investigated e-scooter attitudes, risk-taking behaviours and perceptions, there was no comparable independent United Kingdom literature. Our literature review and analysis of survey responses concluded that e-scooters were perceived as a sustainable form of transport; however, safety concerns were raised. Our study points to risk-taking behaviours by riders being associated with admissions into hospital emergency departments. We conclude that well maintained infrastructure could improve the safety of both e-scooter riders and vulnerable pedestrians, whilst education and enforcement of clear rules may reduce risk-taking behaviour. The recommendations found in the PACTS reports, and documents from the RNIB confirm our findings. We recommend that hospital data and future studies should differentiate between private and rental e-scooters for robust conclusions to be made.

A new method for safety helmet detection based on convolutional neural network

Considering practical issues such as cost control of hardware facilities in engineering projects, it is a challenge to design a robust safety helmet detection method, which can be implemented on mobile or embedded devices with limited computing power. This paper presents an approach to optimize the BottleneckCSP structure in the YOLOv5 backbone network, which can greatly reduce the complexity of the model without changing the size of the network input and output. To eliminate the information loss caused by upsampling and enhance the semantic information of the feature map on the reverse path, this paper designs an upsampling feature enhancement module. Besides, To avoid the negative impact of redundant information generated by feature fusion on the detection results, this paper introduces a self-attention mechanism. That is, using the designed channel attention module and location attention module, adjacent shallow feature maps and upsampled feature maps are adaptively fused to generate new feature maps with strong semantics and precise location information. Compared with the existing methods with the fastest inference speed, under the same compute capability, the proposed method not only has faster inference speed, the FPS can reach 416, but also has better performance with mAP of 94.2%.

Electrocardiographic spiked-helmet sign in critical non-cardiac illness

The spiked-helmet sign (SHS) is an electrocardiographic finding characterised by a distinctive pattern associated with critical illness, resolving once the clinical condition improves. While the underlying mechanism remains uncertain, different mechanisms have been proposed to account for these findings including changes in intrathoracic or intra-abdominal pressures, transient compression of the coronary arteries, repolarisation abnormalities and electromechanical artefacts. We describe the development of the SHS in a patient with underlying left bundle branch pacing following the development of respiratory failure due to haemoptysis and review proposed mechanisms for its pathophysiology.

Inverse identification of region-specific hyperelastic material parameters for human brain tissue

The identification of material parameters accurately describing the region-dependent mechanical behavior of human brain tissue is crucial for computational models used to assist, e.g., the development of safety equipment like helmets or the planning and execution of brain surgery. While the division of the human brain into different anatomical regions is well established, knowledge about regions with distinct mechanical properties remains limited. Here, we establish an inverse parameter identification scheme using a hyperelastic Ogden model and experimental data from multi-modal testing of tissue from 19 anatomical human brain regions to identify mechanically distinct regions and provide the corresponding material parameters. We assign the 19 anatomical regions to nine governing regions based on similar parameters and microstructures. Statistical analyses confirm differences between the regions and indicate that at least the corpus callosum and the corona radiata should be assigned different material parameters in computational models of the human brain. We provide a total of four parameter sets based on the two initial Poisson's ratios of 0.45 and 0.49 as well as the pre- and unconditioned experimental responses, respectively. Our results highlight the close interrelation between the Poisson's ratio and the remaining model parameters. The identified parameters will contribute to more precise computational models enabling spatially resolved predictions of the stress and strain states in human brains under complex mechanical loading conditions.

Using e-scooters: An easy way to get home or a nightmare? An orthopedic perspective on e-scooter accidents

BACKGROUND

The percentage of e-scooter use quickly escalated in our community due to its convenience, low cost, and eases of use. The number of accidents causing high-energy traumas has also increased. This study aims to describe the demographic char-acteristics and fracture patterns of patients admitted to the emergency department following an e-scooter accident and to identify common, correctable factors that increased the likelihood of accidents.

METHODS

Between January 2022 and August 2022, 43 patients (20 females and 23 males) who were admitted to the emergency department after an e-scooter accident and developed extremity fractures were included. The patients were divided into 2 groups those treated surgically and conservatively. Parameters such as the time of the accident, education level of the user, alcohol use, e-scooter malfunction, and compliance with traffic rules were evaluated.

RESULTS

Accidents that led to treatment by surgery mostly occurred between 11 pm and 7 am. Surgically treated patients were mostly high school graduates. Alcohol use and recreational scooter use rates were statistically higher in the operated patients when compared to patients who were treated conservatively. The number of patients who reported a malfunction in the e-scooter was significantly lower in the operated group than in the conservative group. The rates of accidents due to non-compliance with traffic laws, driving at full speed of the e-scooter, use on the driveway, and presence of wet ground at the time of the accident were higher in the surgically treated patient group. Surgically treated patients also had a higher rate of being 1st time e-scooter users.

CONCLUSION

Although governments have introduced many regulations regarding e-scooter use, the current situation seems insufficient in solving the problem. E-scooter users should be further educated about the associated risks. Authorities should tighten their supervision of scooter rental companies and drivers. Nighttime usage conditions should be reviewed, and the use of alcohol should be controlled. The use of helmets should be mandatory. If such regulations are tightened, accident rates can be reduced or high-energy impacts from existing accidents can be avoided. The results suggest that experienced, slow, non-alcoholic, and rule-abiding drivers require less operative treatment. This article will hopefully raise awareness and improve e-scooter regulations.

E-scooter-related orthopedic injuries and the treatments applied: are these scooters a new means of transportation or a new source of trauma?

INTRODUCTION

E-scooters have become increasingly popular in Turkey due to easy accessibility. In parallel with this, the number of e-scooter-related injuries has increased gradually. The aim of this study was to determine the types of e-scooter-related orthopedic injuries, to evaluate hospitalization and surgical treatments, and to investigate the loss of work of patients and the burden incurred by the healthcare system.

MATERIALS AND METHODS

This retrospective multicentre study included all orthopaedic referrals, who were admitted to two major trauma departments in Diyarbakır from January 2022 to July 2022. Patient data were analyzed, including demographic characteristics, injury pattern, types of injury and subsequent treatment.

RESULTS

In a total of 62 patients, 105 orthopaedic injuries were identified, comprising 72.5% males and 27.5% females, with a median age of 34.21 years. Fifty-six (90.3%) patients were riders, and six were pedestrians. All associated e-scooters were rented. There were 44 fractures (41.9% of the total recorded injuries) including 8 (12.9%) open fractures. Surgery was required by 32 patients (51.6%) and 35 (56.4%) required hospital admission leading to hospitalization of 3.7 days on average. The average job loss of working patients after injury was determined as 2.4 months. Helmet use was detected in 6.4% of the e-scooter users, but no other protective equipment was detected in any of the patients. Furthermore, 19,3% of the patients had a blood alcohol level of > 10 mg/dl.

CONCLUSIONS

The injuries that may result from an e-scooter accident can have long-term hospitalization and long-term job loss in the community. This imposes a significant financial burden on the national healthcare system and adversely affects public health. There is a need for precautions to be implemented such as infrastructure organisation, increased awareness of motor vehicle riders and e-scooter riders, and increased enforcement of rule compliance including not using e scooters after alcohol consumption and the use of protective equipment.

Electric scooter-related accidents: a possible protective effect of helmet use on the head injury severity

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

Spiked Helmet Sign in the Inferior Leads

This case report describes a patient in their 80s who was admitted to the critical care unit with pulseless electrical activity cardiac arrest.

Effects of different helmet-mounted devices on pilot's neck injury under simulated ejection

The helmet plays an important role in protection of pilot's head and enhances the pilot's capabilities and performance significantly with the use of mounted devices such as the Night Vision Goggle (NVG). However, the use of helmet-mounted devices might increase the risk of injury due to the increased helmet weight and change in the centre of gravity of head. In this study, four helmets with different combinations of mounted devices were modelled in a validated human head-neck multi-body model to analyse their effects on the pilot's neck injury during simulated ejection. The probability of neck injury was evaluated and predicted using the N i j neck injury criteria and human injury risk curves, considering the tolerance of injury for upper and lower cervical segment. It was demonstrated that the helmet-mounted devices would increase the compression force and bending moment on cervical spine, especially for the lower cervical segments with higher N i j . In the cases with Night Vision Goggle, N i j of the lower cervical segment reached 0.54, which exceeded the requirement in aviation filed. For the cases with Visor, excessive extension occurred, resulting in a high N i j . The simulation results of this study could provide a reference for helmet and mounted devices design and offer a proposal for the protection of pilots during ejection.

Generating consensus on road safety issues and priorities in Ghana: A modified Delphi approach

BACKGROUND

Implementation of evidence-based approaches to reduce the substantial health, social, and financial burdens of road traffic injuries and deaths in Ghana and other low-and-middle-income countries (LMICs) is vitally important. Consensus from national stakeholders can provide insight into what evidence to generate and which interventions to prioritize for road safety. The main objective of this study was to elicit expert views on the barriers to reaching international and national road safety targets, the gaps in national-level research, implementation, and evaluation, and the future action priorities.

MATERIALS AND METHODS

We used an iterative three-round modified Delphi process to generate consensus among Ghanaian road safety stakeholders. We defined consensus as 70% or more stakeholders selecting a specific response in the survey. We defined partial consensus (termed "majority") as 50% or more stakeholders selecting a particular response.

RESULTS

Twenty-three stakeholders from different sectors participated. Experts generated consensus on barriers to road safety goals, including the poor regulation of commercial and public transport vehicles and limited use of technology to monitor and enforce traffic behaviors and laws. Stakeholders agreed that the impact of increasing motorcycle (2- and 3-wheel) use on road traffic injury burden is poorly understood and that it is a priority to evaluate road-user risk factors such as speed, helmet use, driving skills, and distracted driving. One emerging area was the impact of unattended/disabled vehicles along roadways. There was consensus on the need for additional research, implementation, and evaluation efforts of several interventions, including focused treatment of hazardous spots, driver training, road safety education as part of academic curricula, promotion of community involvement in first aid, development of strategically positioned trauma centers, and towing of disabled vehicles.

CONCLUSION

This modified Delphi process with stakeholders from Ghana generated consensus on road safety research, implementation, and evaluation priorities.

Neurocognitive Outcomes in Deformational Plagiocephaly: Is There an Association between Morphologic Severity and Results?

BACKGROUND

The neurodevelopmental effects of skull asymmetry and orthotic helmet therapy for deformational plagiocephaly (DP) have had limited investigation. This study assessed the long-term neurocognitive outcomes in patients with DP and their association with orthotic helmet therapy and head shape abnormality.

METHODS

A total of 138 school-age children with a history of DP, 108 of whom received helmet therapy, were tested with a neurocognitive battery assessing academic achievement, intelligence quotient, and visual-motor function. Severity of presenting plagiocephaly was calculated using anthropometric and photometric measurements. Analysis of covariance was used to compare outcomes between helmeted and nonhelmeted cohorts, unilateral plagiocephaly and concomitant brachycephaly, and left-sided and right-sided plagiocephaly. The association between severity of plagiocephaly and neurocognitive outcome was assessed through a residualized change approach.

RESULTS

There were no significant differences in neurocognitive outcomes between the helmeted and nonhelmeted DP cohorts or the unilateral plagiocephaly and brachycephaly cohorts. Participants with left-sided DP had significantly lower motor coordination scores than participants with right-sided DP (84.8 versus 92.7; effect size = -0.50; P = 0.03). There was a significant laterality by cephalic index interaction, with a negative association between cephalic index and reading comprehension and spelling for participants with left-sided DP. No significant associations were found between severity of presenting or posttreatment deformity and neurocognitive outcome.

CONCLUSIONS

Pretreatment and posttreatment severity of plagiocephaly were not correlated with neurocognitive function at school age. Helmet therapy was not associated with better or worse long-term neurocognitive function. However, participants with left-sided DP demonstrated worse neurocognitive outcomes than participants with right-sided DP in the domains of motor coordination and some types of academic achievement.

CLINICAL QUESTION/LEVEL OF EVIDENCE

Therapeutic, III.

Electric personal mobility device driver behaviors, their antecedents and consequences: A narrative review

INTRODUCTION

Electric personal mobility devices (ePMDs), as well as crashes involving ePMDs, have been on the rise all over the world. The objectives of this study were: (a) to summarize the literature based on a narrow definition of ePMD (excluding e-bikes) and (b) to sort out the results to fit into a psychological and behavioral framework. The available literature was sorted into three main categories: the behaviors of ePMD drivers, their antecedents, and their consequences.

METHOD

A narrative review of the literature was carried out in 101 documents published between January 2018 and July 2021.

RESULTS

Regarding behavioral antecedents, regulations vary from country to country. ePMDs were found to be used primarily by males under 40 years of age. We found no studies on driving skills or learning, driver education or training, or on the effect of health messages on attitudes and behavior. Regarding the main behaviors themselves, the drivers' reasons for focusing on ePMDs were our main focus (use for short distances and mainly for commuting, shopping, and leisure). Few of the studies we reviewed explored the interactions between ePMD drivers and other road users in natural or simulated environments, and the influence of road infrastructure on behavior has rarely been studied. Regarding health consequences, reported ePMD crashes resulted in serious head and limb injuries, especially head and leg fractures. The lack of personal protective equipment (e.g., a helmet) increased the severity of crashes. The conclusion highlights gaps in the literature from a psychological and behavioral point of view.

Helmet Continuous Positive Airway Pressure in the Emergency Department: A Practical Guide

Helmet continuous positive airway pressure is a simple, noninvasive respiratory support strategy to treat several forms of acute respiratory failure, such as cardiogenic pulmonary edema and pneumonia. Recently, it has been largely used worldwide during the COVID-19 pandemic. Given the increased use of helmet continuous positive airway pressure in the emergency department, we aimed to provide an updated practical guide for nurses and clinicians based on the latest available evidence. We focus our attention on how to set the respiratory circuit. Moreover, we discuss the interactions between flow generators, filters, and positive end-expiratory pressure valves and the consequences regarding the delivered gas flow, fraction of inspired oxygen, positive end-expiratory pressure, and noise level.

Quantifying head impact biomechanical differences between commonly employed cleaning levels: a critical research interpretation consideration

INTRODUCTION

Wearable accelerometry devices quantify on-field frequency and severity of head impacts to further improve sport safety. Commonly employed post-data collection cleaning techniques may affect these outcomes.

OBJECTIVE

Our purpose was to compare game impact rates and magnitudes between three different cleaning levels (Level-1: impacts recorded within start and end times, Level-2: impacts during pauses/breaks removed, Level-3: video verified) for male youth tackle football.

METHODS

Participants (n = 23, age = 10.9 ± 0.3 yrs, height = 150.0 ± 8.3 cm, mass = 41.6 ± 8.4 kg) wore Triax SIM-G sensors throughout Fall 2019. Impact rates, ratios (IRRs), and 95% confidence intervals (95%CI) were used to compare levels. Random-effects general linear models were used to compare peak linear acceleration (PLA;g) and angular velocity (PAV;rads/s).

RESULTS

Level-1 resulted in higher impact rates (4.57; 95%CI = 4.14-5.05) compared to Level-2 (3.09; 95%CI = 2.80-3.42; IRR = 1.48; 95%CI = 1.34-1.63) and Level-3 datasets (2.56; 95%CI = 2.30-2.85; IRR = 1.78; 95%CI = 1.60-1.98). Level-2 had higher impact rates compared to Level-3 (1.21; 95%CI = 1.08-1.35). Level-1 resulted in higher PAV than Level-2 and Level-3 (p < 0.001) datasets. PLA did not differ across datasets (p = 0.296).

CONCLUSIONS

Head impact data should be filtered of pauses/breaks, and does not substantially differ outcome estimates compared to time-intensive video verification.

Perceptions, barriers, and strategies regarding helmet use by female pillion riders in Pakistan: A qualitative study

INTRODUCTION

Despite the existence of a national motorcycle helmet law that applies to both riders and pillion riders, the use of helmets among female pillion riders is low in Pakistan. This study aimed to explore perceptions, barriers, and strategies related to helmet use by female pillion riders.

METHODS

Data was collected from nine focus group discussions held with female pillion riders and male riders working at the Aga Khan University. Focus group discussions were transcribed verbatim and checked for accuracy before being imported into NVivo2. Transcriptions were analyzed using a thematic analysis approach.

RESULTS

Four overarching themes emerged, including: (1) motorcycle as mode of transportation, (2) law on helmet use and its enforcement, (3) barriers to helmet use among female pillion riders, and (4) strategies to improve helmet use among female pillion riders. Female participants never wore a helmet or considered wearing it even though "safety" was the most important benefit of helmet usage expressed. The motorcycle is an economical mode of transportation for families, particularly those in the middle and lower socioeconomic groups. Helmet laws are not strictly enforced for pillion riders, including females. Possible barriers to helmet use among female pillion riders included discomfort in wearing a helmet, uninvited attention from others, concerns about physical appearance, and substandard quality and design of helmets. Suggested strategies for implementing helmet use among female pillion riders encompassed awareness generation through media, complementary distribution of helmets, strict law enforcement in the form of fines, and the influence of religious leaders regarding social norms and cultural barriers.

CONCLUSION

Motorcycles are a risky mode of transport, and there are several social and cultural barriers regarding helmet use by female pillion riders. Enforcing helmet laws for female pillion riders, raising awareness about helmet laws, and making helmet use among pillion riders a norm are some essential steps to take to promote helmet use among female pillion riders in Pakistan.

Western Australian State Trauma Registry analysis of incidence and injury patterns associated with e-Scooter injuries: 5-year retrospective case series

BACKGROUND

Electric scooters (e-Scooters) are a form of motorized vehicle that offers cheap, efficient and environmentally friendly transportation. Increased e-Scooter utilization has been accompanied by increases in e-Scooter related injuries in multiple countries. This project describes the incidence, injury pattern, injury severity and patient factors associated with e-Scooter use from the Western Australian State Trauma Registry.

METHODS

Retrospective cohort of all trauma patients captured by the Western Australian State Trauma Registry between 01 July 2017 and 30 June 2022 were analysed. Patient demographics, helmet use, reported drug use, and injury details (including principal and additional diagnoses, ISS) were collected.

RESULTS

Eighty-one patients sustained e-Scooter related injuries between 2017 and 2022. Fifty-four (66%) of hospital admissions were recorded in 2021-2022, an annual percent change of 385.7% from the previous year. Most patients were male (80%). Median age was 40 years (IQR: 32-50). Helmet use was reported in 43% of patients. Helmet use was associated with a significantly lower odds of head injury (OR = 4.42, CI: 1.38-14.21; P = 0.01). Thirty-five percent of patients were intoxicated with either alcohol or drugs. Forty-four (54%) patients required surgery.

CONCLUSION

E-Scooter crashes are a new mechanism of injury affecting patients captured by the Western Australian State Trauma Registry. Helmet use correlated with a reduced risk of head injury.

Research on Safety Helmet Detection Algorithm Based on Improved YOLOv5s

Safety helmets are essential in various indoor and outdoor workplaces, such as metallurgical high-temperature operations and high-rise building construction, to avoid injuries and ensure safety in production. However, manual supervision is costly and prone to lack of enforcement and interference from other human factors. Moreover, small target object detection frequently lacks precision. Improving safety helmets based on the helmet detection algorithm can address these issues and is a promising approach. In this study, we proposed a modified version of the YOLOv5s network, a lightweight deep learning-based object identification network model. The proposed model extends the YOLOv5s network model and enhances its performance by recalculating the prediction frames, utilizing the IoU metric for clustering, and modifying the anchor frames with the K-means++ method. The global attention mechanism (GAM) and the convolutional block attention module (CBAM) were added to the YOLOv5s network to improve its backbone and neck networks. By minimizing information feature loss and enhancing the representation of global interactions, these attention processes enhance deep learning neural networks' capacity for feature extraction. Furthermore, the CBAM is integrated into the CSP module to improve target feature extraction while minimizing computation for model operation. In order to significantly increase the efficiency and precision of the prediction box regression, the proposed model additionally makes use of the most recent SIoU (SCYLLA-IoU LOSS) as the bounding box loss function. Based on the improved YOLOv5s model, knowledge distillation technology is leveraged to realize the light weight of the network model, thereby reducing the computational workload of the model and improving the detection speed to meet the needs of real-time monitoring. The experimental results demonstrate that the proposed model outperforms the original YOLOv5s network model in terms of accuracy (Precision), recall rate (Recall), and mean average precision (mAP). The proposed model may more effectively identify helmet use in low-light situations and at a variety of distances.

Comparing Impact and Concussion Risk in Leatherhead and Modern Football and Hockey Helmets

BACKGROUND

Improvements in the modern helmet have demonstrated beneficial effects in reducing concussion risk in football players. However, previous studies yield conflicting results regarding the protective quality of leatherhead football helmets. There is limited research comparing the modern football helmet and the modern hockey helmet, with one previous study demonstrating the football helmet as providing a lower risk of concussion.

OBJECTIVE

To compare the head acceleration produced in a leatherhead football helmet vs a modern football helmet vs a modified modern football helmet with softer padding vs a modern hockey helmet in helmet-to-helmet strikes.

METHODS

Accelerometers were placed on the frontal, apex, and parietal regions of a Century Body Opponent Bag manikin. Each type of helmet was placed on the manikin and struck by a swinging modern football helmet. The G-force acceleration was determined in three-dimensional axes of 100 total helmet-to-helmet impacts.

RESULTS

The leatherhead football helmet was the least protective in reducing G-forces. The modified modern football helmet did not provide a significant difference compared with the modern football helmet. Significantly greater G-forces were produced in a collision between 2 modern football helmets in comparison with 2 modern hockey helmets.

CONCLUSION

The leatherhead football helmet was the least protective, and the hockey helmet was the most protective, with the football helmet being intermediate. This study provides additional insight into the inconclusive evidence regarding the safety of leatherhead football helmets and into the design of football and hockey helmets in the future.

Design Considerations for the Attenuation of Translational and Rotational Accelerations in American Football Helmets

Participants in American football experience repetitive head impacts that induce negative changes in neurocognitive function over the course of a single season. This study aimed to quantify the transfer function connecting the force input to the measured output acceleration of the helmet system to provide a comparison of the impact attenuation of various modern American football helmets. Impact mitigation varied considerably between helmet models and with location for each helmet model. The current data indicate that helmet mass is a key variable driving force attenuation, however flexible helmet shells, helmet shell cutouts, and more compliant padding can improve energy absorption.

Protective equipment in youth ice hockey: are mouthguards and helmet age relevant to concussion risk?

OBJECTIVES

To compare the incidence rates and odds of concussion between youth ice hockey players based on mouthguard use and helmet age.

MATERIALS AND METHODS

Within a 5-year longitudinal cohort (2013/2014 to 2017/2018) of male and female ice hockey players (ages 11-18; n=3330 players) in Alberta (Canada), we analysed the relationship of equipment and concussion in both a prospective cohort and nested case (concussion) control (acute musculoskeletal injury) approach. The prospective cohort included baseline assessments documenting reported mouthguard use (yes/sometimes, no use), helmet age (newer/<2 years old, older/≥2 years old) and important covariables (weight, level of play, position of play, concussion history, body checking policy), with weekly player participation throughout the season. The nested case-control component used injury reports to document equipment (mouthguard use, helmet age) and other information (eg, mechanism and type of injury) for the injury event. Multivariable mixed effects negative binomial regression (prospective cohort, incidence rate ratios (IRRs)) and multivariable mixed effects logistic regression (nested case-control, odds ratios (OR)) examined the association between equipment and concussion.

RESULTS

Players who reported wearing a mouthguard had a 28% lower concussion rate (IRR=0.72, 95% CI 0.56 to 0.93) and 57% lower odds of concussion (OR=0.43, 95% CI 0.27 to 0.70) compared with non-wearers. There were no associations in the concussion rate (IRR=0.94, 95% CI 0.75 to 1.15) and odds (OR=1.16, 95% CI 0.73 to 1.86) between newer and older helmets.

CONCLUSIONS

Wearing a mouthguard was associated with a lower concussion rate and odds. Policy mandating use should be considered in youth ice hockey. More research is needed to identify other helmet characteristics (eg, quality, fit) that could lower concussion risk.

Padded Headgear in Junior and Youth Australian Football: Player Insights From a National Survey

OBJECTIVES

To investigate beliefs and factors associated with padded headgear (HG) use in junior (<13 years) and youth (≥13 years) Australian football.

DESIGN

Online survey.

SETTING

Junior and youth athletes in Australia.

PARTICIPANTS

Australian football players aged U8 to U18.

ASSESSMENT OF VARIABLES

Survey questions regarding demographics, HG use, concussion history, beliefs about HG, and risk-taking propensity.

MAIN OUTCOME MEASURES

Rates of padded HG use, and beliefs associated with HG use.

RESULTS

A total of 735 players (including 190, 25.9% female) representing 206 clubs participated. Headgear was worn by 315 players (42.9%; 95% CI: 39.3-46.4). Most (59.5%) HG users wore it for games only and wore it voluntarily (59.7%), as opposed to being mandated to do so. Junior players were more likely than youth players to agree to feeling safer ( P < 0.001) and being able to play harder while wearing HG ( P < 0.001). Median responses were "disagree" on preferring to risk an injury than wear HG, and on experienced players not needing to wear HG. Beliefs did not differ between males and females. Headgear use was associated with players belonging to a club where HG was mandated for other age groups (OR 16.10; 95% CI: 7.71-33.62, P < 0.001), youth players (OR 2.79; 95% CI: 1.93-3.93, P < 0.001), and female players (OR 1.57; 95% CI: 1.07-2.30, P = 0.019).

CONCLUSIONS

Club HG culture, older age and being female were prominent variables associated with voluntary HG use. Players reported believing that HG offers protection. The rate of voluntary and mandated HG use identified is at odds with current scientific evidence that does not support HG as effective concussion prevention.

Impact on the health service in the Top End, Northern Territory following the introduction of an electric scooter sharing service

OBJECTIVE

To investigate patients presenting to EDs following the recent introduction of a shared electric scooter (e-scooter) scheme in Northern Territory (NT).

METHODS

We conducted a prospective observational cohort study in Darwin, a regional city in NT, Australia with a population of approximately 150 000. Any patient who disclosed involvement of an e-scooter in the reason for their presentation to the ED was included. A descriptive analysis was derived for age, sex, triage time, alcohol level, injury type and the requirement of operating theatre, inpatient stay or ED discharge. Categorical variables were analysed using χ² -tests, with odds ratios (ORs), 95% confidence intervals (CIs) and P-values reported. Costing analysis to ED of attendances and inpatient hospital admissions was undertaken.

RESULTS

There were 111 presentations over the 8-month study period (January-September 2021). Forty-nine percent (n = 51) of patients were male and 51% (n = 54) were female. Extremity (n = 70) and craniofacial (n = 61) injuries were most common and approximately a quarter of patients (n = 24) required operative management for injuries sustained. Approximately half (n = 51) of patients were intoxicated and the average alcohol level of those tested was 0.18% (range 0.05-0.49%). The average cost per ED attendance was AU$777 and total cost of inpatient admissions being AU$352 255. All inpatient admissions were a result of injury while intoxicated.

CONCLUSION

Harm minimisations strategies targeting implementation of alcohol testing and penalties for riders may be able to reduce the effect that the introduction of e-scooters on the strained health system in the NT.

Electric scooter-related trauma, alcohol and other drugs

OBJECTIVE

To report the frequency of electric scooter-related trauma and association with alcohol and other drug (AOD) use.

METHODS

A retrospective cohort study was conducted, including presentations from 1 January 2017 to 31 May 2022 to a metropolitan health service.

RESULTS

There were 272 cases included, with increasing frequency, of which 65 (24%) had AOD exposure. Most AOD-related trauma occurred at night, among males, without helmet use, had higher injury severity, requirement for surgical intervention and longer hospital length of stay.

CONCLUSIONS

Urgent preventive measures with a focus on reducing AOD exposure and promoting of helmet use is indicated.

Analysis of Risky Riding Behavior Characteristics of the Related Road Traffic Injuries of Electric Bicycle Riders

Electric bicycle (EB) riders, being vulnerable road users (VRUs), are increasingly becoming victims of road traffic injuries (RTIs). This study aimed to determine the current status and epidemiological characteristics of RTIs among EB riders through a questionnaire survey and roadside observations in Shantou to provide a scientific basis for the prevention and control of electric bicycle road traffic injuries (ERTIs). A total of 2412 EB riders were surveyed, and 34,554 cyclists were observed in the study. To analyze the relationship between riding habits and injuries among EB riders, chi-square tests and multi-factor logistic regression models were employed. The findings reveal that the prevalence of ERTIs in Shantou was 4.81%, and the most affected group was children under 16 years old, accounting for 9.84%. Risky behavior was widespread among EB riders, such as the infrequent wearing of safety helmets, carrying people on EBs, riding on sidewalks, and listening to music with headphones while bicycling. Notably, over 90% of those who wore headphones while bicycling engaged in this risky behavior. The logistic regression analysis showed that honking the horn (odds ratio (OR): 2.009, 95% CI: 1.245-3.240), riding in reverse (OR: 4.210, 95% CI: 2.631-6.737), and continuing to ride after a fault was detected (OR: 2.010, 95% CI: 1.188-3.402) all significantly increased the risk of ERTIs (all p < 0.05). Risky riding behavior was significantly less observed at traffic intersections with traffic officers than at those without (all p < 0.001).

Physiological and Biomechanical Monitoring in American Football Players: A Scoping Review

American football is the sport with the highest rates of concussion injuries. Biomedical engineering applications may support athletes in monitoring their injuries, evaluating the effectiveness of their equipment, and leading industrial research in this sport. This literature review aims to report on the applications of biomedical engineering research in American football, highlighting the main trends and gaps. The review followed the PRISMA guidelines and gathered a total of 1629 records from PubMed (n = 368), Web of Science (n = 665), and Scopus (n = 596). The records were analyzed, tabulated, and clustered in topics. In total, 112 studies were selected and divided by topic in the biomechanics of concussion (n = 55), biomechanics of footwear (n = 6), biomechanics of sport-related movements (n = 6), the aerodynamics of football and catch (n = 3), injury prediction (n = 8), heat monitoring of physiological parameters (n = 8), and monitoring of the training load (n = 25). The safety of players has fueled most of the research that has led to innovations in helmet and footwear design, as well as improvements in the understanding and prevention of injuries and heat monitoring. The other important motivator for research is the improvement of performance, which has led to the monitoring of training loads and catches, and studies on the aerodynamics of football. The main gaps found in the literature were regarding the monitoring of internal loads and the innovation of shoulder pads.

Comparison of Head Strike Incidence under K1 Rules of Kickboxing with and without Helmet Protection-A Pilot Study

BACKGROUND

Kickboxing is a combat sport that encompasses various forms of competition. K1 kickboxing is conducted without any restrictions on the force of strikes, and the bout can end prematurely through a knockout. Headgear has been introduced in amateur kickboxing to safeguard the head. However, scientific studies have shown that despite their use, serious head injuries can still occur. The aim of this study was to evaluate the temporal structure of the bout by calculating the number of head strikes in K1 kickboxing bouts with and without headgear.

METHODS

Thirty K1 kickboxing bouts were analyzed, with 30 participants included in the study. The fights were conducted according to the World Association Kickboxing Organization (WAKO) rules. The bouts consisted of three rounds of 2 min each, with a 1 min break between rounds. Sparring pairs were arranged according to weight categories. The first bouts were conducted without headgear, and two weeks later, the fights were repeated with WAKO-approved headgear. The number of head strikes was assessed retrospectively by analyzing video recordings of the bouts, categorizing strikes as hand or foot strikes, and differentiating between strikes that hit the head directly or indirectly.

RESULTS

The results showed statistically significant differences between bouts with and without headgear in terms of the number of strikes to the head (p = 0.002), strikes directly to the head (p < 0.001), all hand strikes to the head (p = 0.001), hand strikes directly to the head (p = 0.003), and foot strikes directly to the head (p = 0.03). Higher values were observed in bouts with headgear.

CONCLUSIONS

Headgear increases the probability of direct strikes to the head. Therefore, it is important to familiarize kickboxers with the use of headgear in their sport to minimize head injuries.

Head-ground impact conditions and helmet performance in E-scooter falls

OBJECTIVE

Head injuries are common injuries in E-scooter accidents which have dramatically increased in recent years. The head impact conditions and helmet performance during E-scooter accidents are barely investigated. This study aims to characterize the head-ground impact biomechanics and evaluate bicycle helmet protection in typical E-scooter falls.

METHOD

The finite element (FE) model of a hybrid III dummy riding an E-scooter was developed and validated. The FE model with and without a bicycle helmet was used to reproduce twenty-seven E-scooter falls caused by the collision with a curb, in which different riding speeds (10, 20, and 30 km/h), curb orientations (30, 60, and 90°), and E-scooter orientations (-15, 0, and 15°) were simulated. Head-ground impact velocities and locations were evaluated for the unhelmeted configurations while the helmet performance was evaluated with the reduction of head injury metrics.

RESULTS

E-scooter falls always resulted in an oblique head-ground impact, with 78 % on the forehead. The mean vertical and tangential head-ground impact velocities were respectively 5.7 ± 1.5 m/s and 3.7 ± 2.0 m/s. The helmet significantly (p < 0.1) reduced the head linear acceleration, angular velocity, HIC_36, and BrIC, but not the angular acceleration. However, even with the helmet, the head injury metrics were mostly above the thresholds of severe head injuries.

CONCLUSION

Typical E-scooter falls might cause severe head injuries. The bicycle helmet was efficient to reduce head injury metrics but not to prevent severe head injuries. Future helmet standard evaluations should involve higher impact energy and the angular acceleration assessment in oblique impacts.

Drunk or Sober? Number of alcohol units perceived to be safe before riding e-scooter

Riding an e-scooter under the influence of alcohol is one of the most frequently reported risky behaviours among riders in various countries, especially in the Nordic countries. What is the Number of Alcohol Units perceived to be Safe (NAUS) before riding an e-scooter? Who is more likely to report higher perceived alcohol tolerance before riding an e-scooter? What is the level of risk perception in this transport domain? The current study advances the literature by aiming to address these questions. Using a cross-sectional survey (n = 395) in Trondheim, Norway we developed an integrated model combining a path analysis with negative binomial regression to predict NAUS before riding an e-scooter. Results show that (i) around 56 % of participants reported that it is safe to consume one or more units of alcohol prior to riding an e-scooter, (ii) younger people, frequent users of e-scooters, individuals with low education, and people with lower perceived risks of an accident were more likely to report higher NAUS. Alcohol health warnings and random blood alcohol concentration tests on e-scooter sites could be prioritised among these segments of the population, and (iii) there is a rather high risk perception in this transport domain. We found that there are strong connections between higher risk perception, worry and fewer NAUS. Policymakers could highlight risks of accidents by e-scooters under the influence of alcohol.

Temporal Instability of Motorcycle Crash Fatalities on Local Roadways: A Random Parameters Approach with Heterogeneity in Means and Variances

Motorcycle accidents can impede sustainable development due to the high fatality rate associated with motorcycle riders, particularly in developing countries. Although there has been extensive research conducted on motorcycle accidents on highways, there is a limited understanding of the factors contributing to accidents involving the most commonly used motorcycles on local roads. This study aimed to identify the root causes of fatal motorcycle accidents on local roads. The contributing factors consist of four groups: rider characteristics, maneuvers prior to the crash, temporal and environmental characteristics, and road characteristics. The study employed random parameters logit models with unobserved heterogeneity in means and variances while also incorporating the temporal instability principle. The results revealed that the data related to motorcycle accidents on local roads between 2018 and 2020 exhibited temporal variation. Numerous variables were discovered to influence the means and variances of the unobserved factors that were identified as random parameters. Male riders, riders over 50 years old, foreign riders, and accidents that occurred at night with inadequate lighting were identified as the primary factors that increased the risk of fatalities. This paper presents a clear policy recommendation aimed at organizations and identifies the relevant stakeholders, including the Department of Land Transport, traffic police, local government organizations, and academic groups.

Helmet-Wearing Tracking Detection Based on StrongSORT

Object detection based on deep learning is one of the most important and fundamental tasks of computer vision. High-performance detection algorithms have been widely used in many practical fields. For the management of workers wearing helmets in construction scenarios, this paper proposes a framework model based on the YOLOv5 detection algorithm, combined with multi-object tracking algorithms, to monitor and track whether workers wear safety helmets in real-time video. The improved StrongSORT tracking algorithm of DeepSORT is selected to reduce the loss of the tracked object caused by the occlusion, trajectory blur, and motion scale of the object. The safety helmet dataset is trained with YOLOv5s, and the best result of training is used as the weight model in the StrongSORT tracking algorithm. The experimental results show that the mAP@0.5 of all classes in the YOLOv5s model can reach 95.1% in the validation dataset, mAP@0.5:0.95 is 62.1%, and the precision of wearing helmet is 95.7%. After the box regression loss function was changed from CIOU to Focal-EIOU, the mAP@0.5 increased to 95.4%, mAP@0.5:0.95 increased to 62.9%, and the precision of wearing helmet increased to 96.5%, which were increased by 0.3%, 0.8% and 0.8%, respectively. StrongSORT can update object trajectories in video frames at a speed of 0.05 s per frame. Based on the improved YOLOv5s combined with the StrongSORT tracking algorithm, the helmet-wearing tracking detection can achieve better performance.