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All-terrain vehicles (ATVs) are becoming increasingly popular recreational devices. Multiple injuries have been associated with ATV accidents. This report reviews pediatric injuries treated at a regional pediatric trauma center, with special attention to facial trauma, as well as the ATV injury data for the United States.
A radiophotoluminescent (RPL) glass rod dosimeter (GRD) and a small active volume p-type silicon diode detector are used for the measurement of the helmet output factors from five Gamma-Knife units, which include four Model B units and a Model C unit. The output factors for the five units measured with the GRD from 14, 8 and 4 mm helmets relative to the 18 mm helmet are 0.984 +/- 0.003, 0.951 +/- 0.003 and 0.884 +/- 0.006, respectively. Similarly, the corresponding output factors measured with the p-type silicon diode detector are 0.983 +/- 0.002, 0.952 +/- 0.003 and 0.867 +/- 0.015, respectively. The output factors are corrected with the end effect for each helmet of the five units. The end effect time for the four Model B units ranges from 4 sec for the 18 mm helmet to 2 sec for the 4 mm helmet. The results for the Model C unit are within 1 sec for all the helmets. The output factors for the five units obtained from both detectors are in good agreement with the values in a recent publication and the values recommended by Elekta, the device manufacturer, except for that of the 4 mm helmet measured with the GRD. The average GRD output factor for the 4 mm helmet is 1.6% higher than Elekta's value, 0.870, but is in good agreement with the published value which was measured using small active volume detectors. The helmet output factors for the five Gamma-Knife units measured with the GRD agree within measurement deviation.
Rapid cooling of the brain in the first minutes following the onset of cerebral ischemia is a potentially attractive preservation method. This computer modeling study was undertaken to examine brain-cooling profiles in response to various external cooling methods and protocols, in order to guide the development of cooling devices suitable for deployment on emergency medical vehicles. The criterion of successful cooling is taken to be the attainment of a 33 degrees C average brain temperature within 30 min of treatment. The transient cooling of an anatomically correct realistic 3-D head and neck with realistically varying local tissue properties was numerically simulated using the finite-element method (FEM). The simulations performed in this study consider ice packs applied to head and neck as well as using a head-cooling helmet. However, it was found that neither of these cooling approaches satisfies the 33 degrees C temperature within 30 min. This central conclusion of insubstantial cooling is supported by the modest enhancements reported in experimental investigations of externally applied cooling. The key problem is overcoming the protective effect of warm blood perfusion, which reaches the brain via the uncooled carotid arterial supply and effectively blocks the external cooling wave from advancing to the core of the brain. The results show that substantial cooling could be achieved in conjunction with neck cooling if the blood speed in the carotid artery is reduced from normal by a factor of 10. The results suggest that additional cooling means should be explored, such as cooling of other pertinent parts of the human anatomy.
We are entering a new era of craniosynostosis repair. When detected early, endoscopic skull remodeling, combined with a postoperative external skull-molding device, gives an excellent long-standing reconstruction of the cranial skeleton. This technique diminishes the morbidity of the operation and decreases the overall cost. It does not replace classic plate and screw cranial vault reconstruction in the older patient but is a useful weapon in the armamentarium of the craniofacial surgeon for the treatment of craniosynostosis in the neonatal period.
BACKGROUND: In the late 1980's, an Army Apache helicopter crashed during a training mission, resulting in fatal injuries to the rear seat pilot and survivable injuries to the front seat copilot. U.S. Army investigators assessed the aircraft damage and aircrew injuries, and examined the helmets, restraint systems, and crashworthy seats. HYPOTHESIS: Computer simulations that approximate an actual crash event can provide insightful output (human body motions and forces on the human body) that illuminates our understanding of the injury dynamics and the effect of safety systems designed to minimize injury. METHODS: Crash kinematics and vehicle accelerations were derived from the investigation and inferred from the aircraft damage, and input to a computer-based analytical simulation that calculated the dynamics and forces to which the crew were exposed. RESULTS: We treat the simulation like a looking glass into the event, revealing how and when safety devices could have responded during the crash, and the nature of injury-producing forces experienced by the occupants. Computer simulated whole-body and head-neck motion are graphically displayed, along with plots of joint forces, seat stroke, harness belt acceleration, and occupant accelerations. CONCLUSIONS: The calculated motions and forces indicated that injuries found in the accident were likely, hence the simulation may indeed be representative of the actual event.
OBJECTIVE: To identify bicycle-related injuries in children and the effect of helmet use on injury patterns and prevention. DESIGN: A prospective cohort of injured children with case-control design looking at serious head injuries and helmet use. SETTING: A tertiary care childrens' hospital emergency room. PATIENTS: All patients presenting between April 1, 1991 and September 30, 1993, between the ages of 3 and 16 years, with bicycle-related injuries were included. INTERVENTION: The Childrens' Hospital Injury Research and Prevention Program (CHIRPP) Database was used. Standardized information collected on each child included age and sex of the child; nature, location, and time of accident/injury; whether any safety devices were being used at the time of the accident; and the attending physician's determination of the injury(s) and treatment rendered. MAIN OUTCOME MEASURES: Injuries were categorized as major or minor, based upon a consensus of the authors, in a retrospective fashion. RESULTS: Separate bicycle accidents (n = 699) were recorded resulting in 856 injuries. Only 13.7% of the children were wearing helmets at the time of their accidents. Seventy-six serious head injuries were recorded. The risk of serious head injury was significantly greater when a helmet was not worn (chi 2 0.01 < p < 0.05) This represents an odds ratio of 3.12 [confidence interval (CI) = 95% 1.13-8.75]. There was no significant difference in terms of serious injuries overall comparing helmeted and nonhelmeted children (odds ratio = 1.11, 95% CI = 0.72-1.72). CONCLUSIONS: Helmets afford a protective effect with respect to serious head injuries.
PURPOSE: The purpose of this article is to communicate ways in which the nurse practitioner (NP) working with the pediatric population can incorporate bicycle helmet use education into the primary care setting. DATA SOURCES: Review of literature on bicycle helmets, safety, and head injury, retrieved from scientific journals and reliable Internet sources. CONCLUSIONS: Bicycling has become a popular sport for both children and adults. Despite excellent benefits, bicycling can pose hazards to riders when safety measures are not practiced. Head injury has been cited as the leading cause of death in bicycle-related injuries. The simplest and single most effective device available to reduce head injury and death is the bicycle helmet. IMPLICATIONS FOR PRACTICE: NPs working with the pediatric population can have a profound impact on safety and health through promoting bicycle helmet use to both the child and accompanying parent during children's primary care visits. NPs can also become involved beyond the institution and act as role models for children, form coalitions, and serve as community advocates for new or stronger helmet legislation and enforcement of bicycle helmet laws.
PURPOSE: To describe the level of usage of protective devices and equipment in a cohort of New Zealand rugby players. METHODS: Male and female players (N = 327) from a range of competitive grades were followed over the course of the season. Participants were interviewed weekly about their participation in rugby and use of protective equipment. The main outcome measure was percentage of all player-weeks of follow-up for which each equipment item was used. RESULTS: Mouthguards, the most commonly used equipment item, were worn for 64.9% of player-weeks. Mouthguard usage ranged from 55.0% of player-weeks in Schoolgirls grade to 72.9% of player-weeks in Senior A competition. The next most common item was taping of body joints (23.7% of player-weeks). The sites most commonly taped were the ankle, knee, and hand. Overall usage for the other protective equipment items studied (shin guards, padded headgear, head tape, support sleeves, and grease) was below 15%. In general, forwards had higher usage of protective equipment than backs, and male players had higher usage than female players. The most common self-reported reasons for using protective equipment were to prevent injury and because of a past injury. Players exhibited considerable week-to-week variation in their usage of protective equipment. CONCLUSIONS: In general, equipment usage was highest in those at greatest risk of injury, namely, forwards, male players, and the senior grades. The high voluntary use of mouthguards is encouraging and indicative of a base of player support for their role in this sport.
In this work we present preliminary results of nuclear composition measurements on board space station MIR obtained with SILEYE-2 particle telescope. SILEYE-2 was placed on MIR in 1997 and has been working since then. It consists of an array of 6 active silicon strip detectors which allow nuclear and energetic identification of cosmic rays in the energy range between approximately 30 and 200 MeV/n. The device is attached to an helmet and connected to an eye mask which shields the cosmonaut eyes from light and allow studies of the Light Flashes (LF) phenomenon. In addition to the study of the causes of LF, the device is used to perform real time long term radiation environment monitoring inside the MIR, performing measurements in solar quiet and active days.
OBJECTIVE: To determine if high-risk behavior is associated with increased injury severity and cost and if public agencies bear a disproportionate burden of that cost. DESIGN: Case comparison study utilizing patient data collected over a 10-year period. SETTING: Five level 1 and 2 trauma centers in an urban-suburban community with a population of 2.4 million. PARTICIPANTS: Trauma registry data from 37,304 consecutive hospitalized adult patients with trauma. Financial data were reported and analyzed on 28,842 of these. MAIN OUTCOME MEASURES: Incidence of alcohol intoxication, other drug use, use of vehicular protective devices, and firearm violence injuries in patients with private vs public health care sponsorship. Length of hospital stay, injury severity, and hospital unit charges were assessed for high-risk behavior. RESULTS: High-risk behavior was more prevalent among trauma patients relying on public funding to cover the costs of their injuries (P < .001). Total hospital unit charges were 28% and 35% higher for motorists not wearing seat belts and motorcyclists not wearing helmets, respectively. Injury severity and length of stay were also higher (P < .001). CONCLUSIONS: High-risk behavior is associated with increased injury severity and cost. Trauma victims exhibiting high-risk behavior more often depend on public agencies to cover the cost of acute injury. Failure to establish and enforce laws and policies designed to reduce or prevent injury may generate enormous trauma care costs, borne to a large extent by public agencies. Further restriction of certain types of high-risk behavior and the institution of "users' fees," taxes, or penalties may be necessary to reduce the disproportionate public agency cost generated by this activity.
Bicycling remains one of the most popular recreational sports among children in America and is the leading cause of recreational sports injuries treated in emergency departments. An estimated 23 000 children younger than 21 years sustained head injuries (excluding the face) while bicycling in 1998. The bicycle helmet is a very effective device that can prevent the occurrence of up to 88% of serious brain injuries. Despite this, most children do not wear a helmet each time they ride a bicycle, and adolescents are particularly resistant to helmet use. Recently, a group of national experts and government agencies renewed the call for all bicyclists to wear helmets. This policy statement describes the role of the pediatrician in helping attain universal helmet use among children and teens for each bicycle ride.
The use of isolation helmets has gained popularity as a method of possible protection of the operating-room personnel from diseases that can be transmitted during operative procedures. However, the use of these systems has been associated with a variety of symptoms, including fatigue, diaphoresis, nausea, headache, and irritability. These symptoms have often been attributed to the mental stress of the operative procedure or the physical discomfort of the helmet. As far as we know, no manufacturers include the measured levels of carbon dioxide or the rate of air exchange of their helmet system. A possible common cause of discomfort with helmet systems is the level of carbon dioxide to which the person wearing the device is exposed. We measured the levels of carbon dioxide in four helmet systems from three different manufacturers during light exercise designed to approximate the exertion during an orthopaedic operation. All but one unit failed to meet the exposure limits recommended by the National Institute for Occupational Safety and Health and the Occupational Safety and Health Administration regarding exposure to carbon dioxide. One unit, the Stackhouse Freedom Aire self-contained system, did meet these standards, but the levels of carbon dioxide in this helmet were more than 1000 per cent greater than the ambient levels in air (440 parts per million compared with 4939 parts per million). Isolation systems must be evaluated carefully not only for comfort but also for the physiological effects caused by exposure to elevated levels of carbon dioxide. Operating-room personnel who use such systems should be aware that many of the physical symptoms that they experience may be associated with elevated levels of carbon dioxide.
The ALTEA project participates to the quest for increasing the safety of manned space flights. It addresses the problems related to possible functional damage to neural cells and circuits due to particle radiation in space environment. Specifically it aims at studying the functionality of the astronauts' Central Nervous Systems (CNS) during long space flights and relating it to the peculiar environments in space, with a particular focus on the particle flux impinging in the head. The project is a large international and multidisciplinary collaboration. Competences in particle physics, neurophysiology, psychophysiology, electronics, space environment, data analyses will work together to construct the fully integrated vision electrophysiology and particle analyser system which is the core device of the project: an helmet-shaped multi-sensor device that will measure concurrently the dynamics of the functional status of the visual system and passage of each particle through the brain within a pre-determined energy window. ALTEA is scheduled to fly in the International Space Station in late 2002. One part of the multi-sensor device, one of the advanced silicon telescopes, will be launched in the ISS in early 2002 and serve as test for the final device and as discriminating dosimeter for the particle fluences within the ISS.
Bicycle-related head trauma is a significant source of death, disability, and health-care costs in the United States. Bicycle helmets are effective safety devices that can reduce most of this burden on society. Bicycle helmet laws and education programs are effective ways to increase helmet use rates. Osteopathic physicians can play a prominent role in bicycle-related injury prevention by actively supporting and participating in helmet legislation, research, and community-based education. This article provides a current summary of state bicycle helmet laws and highlights research that supports the effectiveness and necessity of these laws. The recent trend in safety standards for bicycle helmets is included to give a comprehensive view of bicycle helmet law in the United States.
Filtered exhaust helmets (space suits) have been reported as efficacious in decreasing wound infections following joint arthroplasty procedures; however, strict experimental control of the many variables related to the incidence of clinical infection has been lacking in these studies, making support of such conclusions difficult. Any potential benefit of filtered exhaust helmets in the control of infection rates can be logically assigned to the reduction of airborne bacterial counts within the operating room. A study was done using the Steri-Shield helmet (Bio-Medical Devices, Irvine, CA) to define its efficacy in limiting airborne bacterial contaminates during total joint arthroplasty. Forty-eight paired prosthetic hip and knee cases were evaluated using a block experimentation design. One case of each pair was done with all surgical and scrub personnel cloaked in Steri-Shield filtered exhaust helmets and the other with the same personnel in conventional paper hoods and masks. Air samples were obtained with an Anderson two-stage viable particle sampler (Anderson Samplers, Atlanta, GA) placed immediately adjacent to the wound. Quantitative microbial cultures were obtained. The filtered exhaust helmet evaluated in this study provided no increased protection against bacterial contamination in the area of the surgical field than conventional paper hoods and masks.
Approximately 600 children under the age of 15 years, die each year in bicycle-related accidents. Over 80% of these deaths involve trauma to the head. Almost one fourth of all significant brain injuries in children are bicycle related. In spite of these significant statistics, bicycle helmet use in Puerto Rico has not received the necessary publicity to increase their use. Pediatricians should encourage helmet use and counsel parents about the important of this device. A case control study of accidents among bicycle riders experiencing a crash demonstrates that safety helmets reduce the risk of head injury by 85% and brain injury by 88%. The recommendation of current safety counseling practices should be incorporated as part of the routine pediatrician visit. Educational campaigns targeted at parents and children focusing on the incidence of consequences of bicycle crashes should be the primary goal for all primary practitioners, since the effectiveness of helmets in preventing head injuries might substantially increase helmet ownership among children. To assess the prevalence of bicycle helmet ownership and the associated factors with this, we surveyed 146 school age children evaluated at the Pediatrics Clinics of the University Hospital Dr. Ramón Ruiz Arnau from January to March 1991. We concluded that only 7.5% of our sample use the helmets.
A device was constructed which allowed subatomospheric pressures of up to -50 mm Hg to be applied to the neck, or to the head plus neck, of volunteer subjects riding on the USAFSAM centrifuge. Breathing pressures were always atmospheric. The G tolerance was measured during gradual (0.1 G.s-1) and rapid onset (1.0 G.s-1) runs and heart rate was monitored. Neck suction decreased tolerance to an extent explicable by carotid sinus activation (about -0.8 G at -50 mm Hg), while combined head and neck suction of -25 mm Hg increased tolerance to an extent greater than predicted from pressure effects on the eye and carotid sinus. Neck suction of -50 mm Hg induced less bradycardia when applied at +3 Gz than under 1-G conditions. These results were discussed in relation to intraocular tension, baroreceptor responsiveness, and jugular venous siphon effect.
The aim of this study was to investigate the effect of flight helmet weight on cervical erector spinae muscle strain under high +Gz forces. Two helmets of different weight were compared by recording inflight neck muscle activities with a portable surface-integrated EMG (IEMG) device. The obtained IEMG activities were normalized by comparing them with activities representing maximal voluntary contraction (MVC) of the muscles. Two test pilots carried out a total of 16 flights consisting of a series of different maneuvers. The results indicate that a lighter flight helmet may--at least in some pilots--cause less strain on neck structures than a heavier one. The effect of helmet weight was readily apparent only under high +Gz forces; changing from a heavier to a lighter helmet reduced the mean muscular strain from 9.5 to 8.8% and from 20.2 to 17.1% of the MVC under +4.0 and +7.0 Gz, respectively. Thus, some, but not all, acute inflight neck pain and related problems might be avoided by using lighter flight helmets.