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PubMed1990

Adaptation to discomfort in personal protective devices: an example with safety helmets.

Discomfort in the use of personal protective devices (PPD) has been one of the chief causes of their non-use. A field trial using industrial helmets was carried out to ascertain whether by training and repeated wearing subjects could experience a significant adaptation to discomfort. Ten subjects took part in the trial in a tropical environment by wearing helmets repeatedly (6 h a day) for one month. Subjective evaluations of discomfort were made at the end of the 1st, 3rd, 5th, 14th and 30th day. It was revealed that complaints of discomfort, viz. hotness, heaviness, bad fit, etc., decreased markedly throughout the 30 day period. Though positive responses of adaptation to discomfort seem to reach an optimum towards 30 days, it is difficult to draw any conclusions on the optimum period of adaptation for each discomfort factor. In relation to inherent discomforts that are extremely difficult to overcome without compromising the protection efficiency of a PPD, the principle of adaptation seems to be a very important facet which has to be developed for an effective PPD programme.

Adult↗
PubMed2005

Children's injuries in a Scottish district general hospital.

BACKGROUND: Injury is a common cause of emergency department (ED) attendance but there are few data published on the spectrum of paediatric injury in a typical district general hospital (DGH). This study aimed to provide a complete picture of injury presentations to such a centre. METHODS: Prospective questionnaire study of consecutive paediatric attendances at a DGH ED in Scotland (annual attendance 53,500 patients) due to injury or poisoning. Paediatric in this context was defined as less than 14 years on the day of presentation. Admission rates were identified from the hospital information system and information on deaths was sought from the local Procurator Fiscal (the Scottish equivalent of the Coroner). RESULTS: One thousand three hundred and seventy-eight questionnaires were completed from a potential 10,697 eligible patients. Safety devices (helmets, belts, etc.) were in use in only 99 cases. Cycle helmets were used in 26% of cycle incidents and seat belts were used in 71% of car incidents. Cycling and pedestrian incidents were more common during the summer months and outside school hours. Adult supervision was present in 49% of incidents. Seventy-three percent of incidents at school were unsupervised. There were 5.6 admissions to hospital per day in the 0-13 years age group for all causes, with little seasonal variation in admission rates. There were three deaths during the year, two from SIDS and one due to choking, all in infants. CONCLUSION: Trauma is a common cause of ED attendance in children. Preventative measures are still underutilised and could make a significant impact on the incidence of children's injuries and possibly ED attendances. Cycle helmets could play a major role in injury prevention in school age children in this area.

Accidental Falls↗
PubMed2006

Soft-helmet skull remodeling in canine models: intracranial volume unchanged by compensatory skull growth.

OBJECT: Habitual sleeping positions in infants can produce occipital plagiocephaly, which causes strabismus as well as skull and facial asymmetry. This condition can be managed using a hard helmet, but maintaining an infant in such a device is often intolerable. The authors studied whether the shape of a young canine skull could reform while inside a soft helmet and whether intracranial volume would be preserved by the compensatory growth of the skull. METHODS: The authors tracked the head sizes of 14 1-week-old beagles who wore long, soft helmets (study group) and seven beagles who did not (control group). From these measurements, the intracranial volume in each beagle was calculated. All crania were also studied radiologically by using plain skull radiography, computerized tomography (CT), and magnetic resonance (MR) imaging. The crania of all 14 beagles who wore soft helmets quickly adapted, resulting in a narrow, long head only 2 weeks into the experiment. This configuration continued to develop throughout the 7-week experimental period. At 8 weeks of age, animals in the study group showed no significantly different alteration in calculated intracranial volumes (p > 0.05). It is interesting that the helmet-treated animals initially underwent a paradoxical increase in intracranial volume growth. No structural difference in their brains was evident from CT or MR imaging findings, nor was there any functional disability. CONCLUSIONS: Intracranial volume can be preserved by the compensatory growth of the skull during successful remodeling of the developing skull achieved using a soft helmet.

Animals↗
PubMed2006

Predicting neck injuries due to head-supported mass.

BACKGROUND: Technological advances in military equipment have resulted in more devices being mounted on the helmet to enhance the capability of the soldier. The soldier's neck must bear this head-supported mass (HSM) and the resulting dynamic characteristics of the head and neck system are changed. The purpose of this study was to vary the conditions of impact as well as the design criteria to quantify the effect of HSM on neck injury risk through computational modeling. METHODS: The TNO MADYMO detailed neck model was used for a matrix of 196 simulations designed to vary the impact conditions and HSM properties added to the model. These parameters included seven impact directions, three impact magnitudes, nine mass locations, and three mass magnitudes. The data collected from these simulations were evaluated for injury risk using the lower neck beam criterion equation. RESULTS: The results from these simulations provide detailed information regarding the risk of injury based on a particular HSM configuration and the acceleration of the body. The predominant factor in increasing risk in the lower neck is the increase in pulse magnitude. The effect of pulse magnitude is more dominant in the directions that create a flexion or lateral bending moment. CONCLUSION: HSM increases the level of injury, but the impact level that the subject is exposed to is a more dominating factor in determining injury risk.

Aerospace Medicine↗
PubMed2004

Endoscopy-assisted wide-vertex craniectomy, barrel stave osteotomies, and postoperative helmet molding therapy in the management of sagittal suture craniosynostosis.

OBJECT: Endoscopic techniques were introduced 7 years ago for the surgical management of patients with sagittal synostosis. In this study of 139 patients with sagittal synostosis, the authors assessed the efficacy, safety, complications, and outcomes after performing endoscopy-assisted wide-vertex craniectomies with bitemporal and biparietal barrel stave osteotomies. METHODS: The sample population consisted of a total of 99 boys and 40 girls who ranged in age from 0.4 to 9.2 months (mean 3.6 months). Two small incisions were made near the lambda and vertex. Using endoscopic visualization, wide-vertex craniectomies with bilateral temporal and parietal barrel stave osteotomies were performed. Postoperative treatment included custom-made surlyn cranial orthotic devices for cranial reshaping and maintenance. The mean craniectomy width was 5.4 cm and the length was 10 cm. The overall blood transfusion rate was 9% (two intraoperative and 12 postoperative transfusions). The mean estimated blood loss was 29 ml (range 5-150 ml). The mean preoperative hematocrit was 32%, whereas the postoperative level was 27%. One hundred thirty-two patients were discharged the morning following surgery. The majority of patients did not experience facial swelling, and none suffered postoperative fevers. Anthropometric cephalic index measurements indicated that excellent results were obtained in 87% of the patients (cephalic index > 75); good results in 8.7% (cephalic index 70-75); and poor results in 4.3% (cephalic index > 70). There were no cases of intraoperative death, infection, hemorrhage, or venous sinus injury. CONCLUSIONS: Analysis of the results indicates that use of the aforedescribed procedure in the early treatment of infants with sagittal synostosis provides excellent outcomes and that the morbidity rate is lower than that associated with traditional cranial vault reconstruction. Detailed anthropometric and radiographic analyses demonstrated that with adequate helmet therapy in our patients normocephaly was achieved and maintained without the need for secondary operations.

Blood Loss, Surgical↗
PubMed2005

A fully automated calibration method for an optical see-through head-mounted operating microscope with variable zoom and focus.

Ever since the development of the first applications in image-guided therapy (IGT), the use of head-mounted displays (HMDs) was considered an important extension of existing IGT technologies. Several approaches to utilizing HMDs and modified medical devices for augmented reality (AR) visualization were implemented. These approaches include video-see through systems, semitransparent mirrors, modified endoscopes, and modified operating microscopes. Common to all these devices is the fact that a precise calibration between the display and three-dimensional coordinates in the patient's frame of reference is compulsory. In optical see-through devices based on complex optical systems such as operating microscopes or operating binoculars-as in the case of the system presented in this paper-this procedure can become increasingly difficult since precise camera calibration for every focus and zoom position is required. We present a method for fully automatic calibration of the operating binocular Varioscope M5 AR for the full range of zoom and focus settings available. Our method uses a special calibration pattern, a linear guide driven by a stepping motor, and special calibration software. The overlay error in the calibration plane was found to be 0.14-0.91 mm, which is less than 1% of the field of view. Using the motorized calibration rig as presented in the paper, we were also able to assess the dynamic latency when viewing augmentation graphics on a mobile target; spatial displacement due to latency was found to be in the range of 1.1-2.8 mm maximum, the disparity between the true object and its computed overlay represented latency of 0.1 s. We conclude that the automatic calibration method presented in this paper is sufficient in terms of accuracy and time requirements for standard uses of optical see-through systems in a clinical environment.

Algorithms↗
PubMed2005

New mechanism for inducing closed head injury in the rat.

Due to the frequency of closed head injuries and cost of treatment, there is great interest in the mechanical parameters involved in provoking the injury. A new device has been developed to produce closed head injury due to impact-induced angular acceleration in the rat. A 488-gram mass was propelled down a 2-meter drop tube by springs at a velocity of 21 mph (9.5 m/s), depending on strength and displacement of the springs. The projectile then impacts a lever arm protruding laterally from an aluminum helmet fixed at the anterior face with a ball-bearing pivot allowing only lateral rotation, which has been shown to cause severe brain injury. A sodium silicate elastomeric material with a thickness of 1 cm was placed at the impact interface to increase the contact time between the projectile and the lever arm. Biomechanical results from a lumped parameter mathematical model and testing indicated an angular acceleration of 300,000 +/- 20,000 rad/s2, angular velocity of 300 +/- 50 rad/s, and impact duration of 2.0 +/- 0.3 ms. When scaled to the human, the results indicated an angular acceleration of 4,100 rad/s2, angular velocity of 32 rad/s, and impact duration of 20 ms, consistent with values associated with classical concussion. Magnitudes and durations at these levels have not been produced in the rat by rotational loading caused by impact, and due to the flexibility of the design, these parameters can be further increased.

Animals↗
PubMed2000

Gamma knife radiosurgery as a primary treatment for prolactinomas.

OBJECT: The purpose of this study was to estimate the efficacy of gamma knife radiosurgery (GKS) in controlling tumor growth and endocrinopathy associated with prolactinomas. METHODS: Between 1993 and 1997, 164 of 469 patients with pituitary adenomas treated by GKS harbored prolactinomas. The dose to the tumor margin ranged from 9 to 35 Gy (mean 31.2 Gy), and the visual pathways were exposed to a dose of less than 10 Gy. The mean tumor diameter was 13.4 mm. The mean follow-up time for 128 cases was 33.2 months (range 6-72 months). Tumor control was observed in all but two patients who underwent surgery 18 and 36 months, respectively, after GKS. Clinical cure was achieved in 67 cases. Clinical improvement was noted with a decrease in the hyperprolactinemia after GKS. Nonetheless, in 31 (29%) of 108 patients who were followed for more than 2 years no improvement in serum prolactin levels was demonstrated, although this could be normalized by bromocriptine administration after treatment. Nine infertile women became pregnant 2 to 13 months after GKS and all gave birth to normal children. There was no visual deterioration related to GKS. Five women experienced premature menopause. In these patients there was subtotal disappearance of the tumor and an empty sella developed. CONCLUSIONS: Gamma knife radiosurgery as a primary treatment for prolactinomas can be safe and effective both for controlling tumor growth and for normalization of prolactin hypersecretion. A higher margin dose (> or = 30 Gy) seemed to be associated with a better clinical outcome. Gamma knife radiosurgery may make prolactinomas more sensitive to the bromocriptine.

Humans↗
PubMedDate not supplied

Reported bicycle helmet use among adults in the United States.

This study estimates bicycle helmet use among adults in the United States, examines factors associated with helmet use among adult bicyclists in 1994, and examines other safety-related practices. A telephone survey of 5238 randomly dialed households in the United States was conducted. The participants were randomly selected adult (aged > or = 18 years) respondents, and the main outcome measure was bicycle riding and helmet use in the last 30 days. We estimate that 20.2% of adults reported riding a bicycle in the 30 days preceding their interview. Of the bicyclists, 18.3% report they always wear their helmet when bicycling. Persons between the ages of 18 and 24 years had the highest proportion of bicycle riders for any adult age group (31.3%) but reported using helmets less than any other adult age group (5.1%). In univariate and multivariate analyses, age older than 24 years, female sex, higher educational level, and living in the west or northeast region of the country were associated with helmet use among adults. Helmet users were also more likely than nonusers to report a higher prevalence of other safety behaviors (ie, always wearing a safety belt, having a smoke detector in the house, and having a fire escape plan). Further efforts to increase the wearing of bicycle helmets by adults are necessary to meet the year 2000 objective of 50% helmet use. Adults should be targeted for increased helmet promotion efforts, especially those between the ages of 18 and 24 years. Increasing consistent use of helmets among adults may also help increase consistent use of helmets among children through role modeling.

Adult↗
PubMed1979

Woodpecker drilling behavior. An endorsement of the rotational theory of impact brain injury.

High-speed cinematograph films of a drilling woodpecker were examined by direct visual inspection and by a microdensitometer and computer-imaging technique. These showed (1) that the drilling trajectory is essentially linear, with very little, if any, rotation of the head; (2) that there is minimal movement after impact; (3) that the impact velocity is of the order of 600 to 700 cm/s; and (4) that the impact deceleration is of the order of 1,000 g. Dynamic and morphologic findings in the woodpecker may be highly relevant to the prevention of concussion and brain injury in man. Taken in the context of modern packaging technology and other animal and mathematical modelling research, they suggest that brain injury preventive systems could be greatly improved over those now in common use.

Animals↗
PubMed1976

Ocular injuries in hockey.

Ocular injuries suffered by 38 hockey players during a three-year period were studied. The severity of the injuries required hospitalization for 16 of the patients. Twelve players require follow-up care for possible late complications from the following conditions: angle recession (seven cases), subluxated lens (three cases), traumatic cataract (three cases), detachment of the retina (two cases), and enucleation (one case). The use of a full-face protective mask affixed to an adequate helmet is recommended for all hockey players.

Adolescent↗
PubMed1989

Auricular injury and the use of headgear in wrestlers.

Questionnaires designed to assess attitudes and use of headgear were completed by 537 Division I collegiate wrestlers. Only 35.2% of the wrestlers wore headgear all of the time during practice as opposed to 92.4% during competition, which was a statistically significant difference. The most common reason for not wearing headgear was discomfort (35%). There were 482 participating in nonschool team events, and 203 (42%) described headgear use as "seldom or never." However, there was a statistically significant difference of developing auricular hematoma while wearing headgear (26%) vs not wearing headgear (52%). There were 208 (39%) who reported a permanent auricular deformity resulting from an injury that occurred with (10.6%) or without (26.6%) headgear. These results suggest that headgear provides only partial protection and that nonuse is widespread, causing a surprisingly high frequency of permanent auricular deformities.

Adolescent↗
PubMed1996

Injury prevention counseling opportunities in pediatric otolaryngology.

OBJECTIVE: To determine the prevalence of injury prevention counseling opportunities in children referred to a pediatric otolaryngologist. DESIGN: A caregiver questionnaire was administered during office registration. SETTING: Hospital-based pediatric otolaryngology practice in a metropolitan area. PATIENTS: Random sample of 300 caregiver questionnaires stratified by the age of the child. MAIN OUTCOME MEASURES: Prevention counseling opportunities, defined as ignorance of hottest water temperature, child exposure to passive smoke, missing smoke detectors on one or more floors in the home, or failure to use a seat belt or bicycle helmet. RESULTS: The hottest water temperature was unknown by 72% of the caregivers, smokers were present in 25% of the households, bicycle helmets were not used by 22% of the children, car seats or seat belts were not used by 11% of the children, and 10% of the homes did not have a working smoke alarm on each floor. Older children were significantly less likely to use a seat belt than were younger children. Although 98% of the caregivers had a regular pediatrician, 91% of the families still offered one or more counseling opportunities (95% confidence interval, 87% to 94%). CONCLUSIONS: Substantial opportunities exist for injury prevention counseling in pediatric otolaryngology. At least one opportunity for counseling is present for about 90% of the families, most often concerning the maximum safe hot water temperature.

Bicycling↗
PubMed2002

Helmet use: a survey of 4 common childhood leisure activities.

OBJECTIVE: To compare the distribution and observation of helmet use patterns among 4 common childhood leisure activities-bicycle riding, in-line skating, skateboarding, and scooter riding-in a setting with no helmet use legislation. DESIGN: A cross-sectional, unobtrusive, direct observation of children engaged in 1 of the 4 activities was conducted during an 8-week period. SETTING: Eight communities of at least 1000 persons each in a 2-county Central Texas area. MAIN OUTCOME MEASURES: Prevalence of activity, helmet use, and correct helmet use. RESULTS: Of 841 children observed, most rode bicycles (74.8%); only 4.2% rode skateboards. They included 127 children estimated to be younger than 6 years (15.1%) and 495 estimated to be aged between 6 and 12 years (58.9%). Most were male (67.3%) and observed in urban communities (61.7%). The locations of highest concentration of the 4 activities were minor streets for bicycle riding, playgrounds for in-line skating, and sidewalks for skateboarding and scooter riding. The rate of overall helmet use was 13.6% and did not vary significantly by activity: in-line skating, 18.2%; skateboarding, 14.3%; bicycle riding, 13.5%; and scooter riding, 11.5%. However, the observed correct helmet use prevalence of 72.6% differed significantly by activity. Most children riding scooters wore their helmets incorrectly. Helmet use was positively associated with helmet use by accompanying children and/or adults. CONCLUSIONS: While bicycle riding was the most popular activity observed, helmet use was most prevalent among in-line skaters and least prevalent among scooter riders, many of whom also wore them incorrectly. Observed helmet use was influenced mostly by adult and peer helmet use, indicating that public education and interventions should target children and their parents as well as scooter riders.

Accident Prevention↗
PubMed1987

Bicycle-related injuries.

To obtain epidemiologic data and information on the probable causes and severity of bicycle-related injuries, we interviewed all patients with such trauma. Between April 1 and Oct 1, 1983, 520 children presented to the Emergency Department of The Children's Hospital of Philadelphia with trauma related to two-wheeled nonmotorized bicycles. The ages of the patients ranged from 1 to 18 years (mean, 8.7 years), and most (72%) were males. Most accidents (84%) occurred less than five blocks from home, and 49% occurred in the street. Thirty-six percent of the patients admitted to stunt riding or going too fast when the accident occurred, and 36% claimed there was a problem with the surface on which they were riding. The accidents occurred when a patient lost control of the bike (45%), a patient on a bicycle was hit by a car (17%), or a pedestrian was hit by a bicyclist (10%). Only three patients were wearing protective equipment at the time of the accident. Most (54%) had received no specific safety instructions about bicycling. The extremities were injured in 53% of the accidents, but head and neck injuries accounted for 31%. Six percent required hospital admission. Males and children over 12 years of age were more likely to have multiple injuries. Accidents that occurred in the street or involved cars were associated with a greater number of serious and multiple injuries. The infrequent use of protective equipment and minimal safety instructions received by the patients in this study suggest that many bicycle-related injuries are preventable. Education of parents and children is recommended to improve bicycle safety.

Accident Prevention↗
PubMed1988

Bicycle-mounted child seats. Injury risk and prevention.

Little information is available about bicycle-mounted child seats despite their general use for a decade. We analyzed two existing data sets to gain information about frequency, trend, and characteristics of bicycle-mounted child seat injuries to children 5 years old and younger. Available data suggest an increased frequency of these injuries, with the rate of passenger injuries rising from 17% to 28% of all reported bicycle-related injuries to children in this age group in California during the years 1977 to 1986. In a detailed sample of 52 injuries related to the use of bicycle-mounted child seats, 42% occurred when the bicycle crashed or tipped over and 25% occurred when the child fell out of the seat. Sixty-five percent involved the head and face, and 27% of the head injuries were serious. Substantial morbidity associated with these injuries could be amellorated if children using these seats wore appropriate bicycle helmets.

Athletic Injuries↗