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BACKGROUND/OBJECTIVE: Headgear designed to protect girls lacrosse athletes is widely available and permitted for voluntary use; however, it remains unknown how policies mandating headgear use may change the sport and, particularly regarding impacts during game-play. Therefore, this study compares the impact rates and game play characteristics of girls high school lacrosse in Florida which mandates headgear use (HM), with states having no headgear mandate (NHM). MATERIALS AND METHODS: Video from 189 randomly-selected games (HM: 64, NHM: 125) were analyzed. Descriptive statistics, Impact Rates (IR), Impact Rate Ratios (IRR), Impact Proportion Ratios (IPR), and 95% Confidence Intervals (CI) were calculated. IRRs and IPRs with corresponding CIs that excluded 1.00 were deemed statistically significant. RESULTS: 16,340 impacts (HM:5,821 NHM: 10,519; 86.6 impacts/game, CI: 88.6-93.3) were identified using the Lacrosse Incident Analysis Instrument (LIAI). Most impacts directly struck the body (n = 16,010, 98%). A minority of impacts directly struck a players head (n = 330, 2%). The rate of head impacts was significantly higher in the HM cohort than NHM cohort (IRR = 2.1; 95% CI = 1.7-2.6). Most head impacts (n = 271, 82%) were caused by stick contact in both groups. There was no difference in the proportion of penalties administered for head impacts caused by stick contact between the HM and NHM cohorts (IPR IRRHM/NHM = 0.98; CI = 0.79-1.16). However, there was a significantly greater proportion of head impacts caused by player contact that resulted in a penalty administered in the HM cohort (IPR = 1.44 CI = 1.17-1.54). CONCLUSION: These findings demonstrate that mandating headgear use was associated with a two-fold greater likelihood of sustaining a head impact during game play compared to NHM states. A majority of head impacts in both HM and NHM states were caused by illegal stick contact that did not result in penalty.

BackgroundCameroon is amongst the worst affected countries by road traffic injuries with an estimated 1443 disability-adjusted life years per 100,000 population. There have been very limited reports on the crucial prehospital response to road traffic injuries in Cameroon. This study aimed to identify prehospital factors associated with RTI mortality in Cameroon.MethodsWe included patients enrolled between June 2022 and March 2023 in the Cameroon Trauma Registry. Information about prehospital factors and demographic data was obtained from patients or their proxies. We examined the association of prehospital care factors like care at the crash scene and type of transportation during crash with final patient outcome. We used Chi-squared test to investigate the association between selected independent variables and mortality. A multivariable logistic regression model was built to identify independent predictors of dying from an RTI.ResultsRTIs constituted 69.5% (n = 3203) of all injuries in the Cameroon Trauma Registry. Only 20.7% (n = 102) of 4 + wheel vehicle occupants had seatbelts on and just 2.7% (n = 53) of motorcycle riders were wearing helmets during the collision. Only 4.9% (n = 156) of patients received any form of scene care. In-hospital mortality was 4.3% (n = 139) and was associated with male sex (AOR = 1.7, 95%CI = 1.08-2.80), crashing on a motorcycle (AOR = 2.08, 95%CI = 1.1-3.67) and scene care (AOR = 0.25, 95%CI = 0.04-0.80).ConclusionsReceiving any type of care at the scene such as bleeding control or being placed in the recovery position by bystanders is associated with improved survival. Improving on existing informal prehospital care responses should be a priority in Cameroon.

To compare the impact attenuating capabilities between ice hockey helmets manufactured with and without XRD impact protection foam, worn with and without a XRD skullcap, at reducing sub-concussive head accelerations. Quasi-experimental laboratory. Ice hockey helmets were fit onto a Hybrid III 50th Head Form Head and dropped 25 times onto the left temporal side for each condition: XRD foam helmet, XRD foam helmet with XRD skullcap adjunct, non-XRD foam helmet, and non-XRD foam helmet with XRD skullcap adjunct. The helmets were dropped from a height that resulted in sub-concussive linear accelerations (25–80 g's). Using a tri-axial accelerometer, peak linear accelerations (g) were measured, and the average was used to compare impact attenuation properties across the four conditions. The highest linear accelerations were observed in the XRD foam helmet without skullcap (32.97 ± 0.61 g) and were significantly greater (p < 0.001) than the XRD helmet with skullcap (21.38 ± 0.76 g). The helmet without XRD foam elicited the lowest peak linear accelerations (16.10 ± 0.73 g) which were significantly lower than the XRD foam helmet regardless of whether the skullcap was added (p < 0.001). Although sub-concussive loads are potentially just as dangerous, much of the research regarding helmet and skullcap efficacy appears to be at high concussive impacts; < 70 g's. The findings suggest that helmets with incorporated XRD foam, either within the design or added as an adjunct, are less effective at attenuating linear accelerations at sub-concussive levels than the low-density foam helmet. [ABSTRACT FROM AUTHOR]

Road traffic injuries present a significant public health burden, especially in developing countries. This systematic review and meta-analysis synthesized global evidence on motorcycle helmet use prevalence by including 299 records across 249 articles involving 5,006,476 participants from 1982 to 2022. The findings revealed a declining trend in helmet use prevalence over the past four decades, with an overall prevalence of 48.71%. The meta-regression analysis did not find any statistically significant change in the overall prevalence. Subgroup analysis showed higher helmet use prevalence in observation/survey records (54.29%) compared to crashed patient records (44.84%). Riders/Motorcyclists demonstrated a higher likelihood of wearing helmets than passengers in both observation/survey records (62.61 vs. 28.23%) and crashed patient records (47.76 vs. 26.61%). Countries with mandatory helmet use laws had higher helmet usage prevalence compared to those without (52.26 vs. 37.21%). The African continent had the lowest helmet use rates, while Latin America and the Caribbean regions had higher rates. This study provides a comprehensive overview of global helmet use prevalence, emphasizing disparities between high and low-income countries, variations in law enforcement, and trends over four decades. Targeted interventions are necessary to improve helmet-wearing habits, especially among passengers and regions with low usage rates. Effective legislation and awareness campaigns are crucial for promoting helmet use and reducing road traffic injuries burden. [ABSTRACT FROM AUTHOR]

From a global perspective, low helmet-wearing rates in children are an ongoing concern. International studies show adult helmet-wearing rates are consistently higher than those of children. Research also shows parents are highly influential in promoting healthy behavior in their children. Parent-focused helmet-wearing campaigns are a practical way to actively feature parents influencing helmet-wearing in children. The current study obtained anonymous parent-focused survey data on parent and child helmet-wearing practices, perceived affects of helmet use on children's health, and beliefs about brain injury prevention from a sample of Vietnams parents. Findings from this study are consistent with previous international research that shows adults wear helmets at higher rates than children. Data from this study may help those responsible for child helmet safety campaigns develop more effective child helmet-wearing campaigns, particularly in Southeast Asian countries. [ABSTRACT FROM AUTHOR]

Using data from the 2022 Korea Community Health Survey (n  = 13 320), this study investigated helmet use and related factors among Korean adults using personal mobility devices, without distinguishing between private and hired users. Among mobility device users, 32.1% responded that they always wore a helmet. The proportion of helmet use was 35.2% among men, 25.8% among women, 29.2% among those aged 19–44 years, 42.3% among those aged 45–64 years and 26.6% among those aged 65 years or older. Furthermore, those who drank less frequently and were physically active were more likely to wear helmets. Moreover, people who always wore a seat belt when driving a car or sitting in the rear seat and people who always wore a helmet when riding a motorcycle were more likely to wear a helmet while using electric personal mobility devices. Approximately one-third of users always wore a helmet. The helmet-wearing rate was related to general characteristics such as gender and education level, and to safety behaviors such as wearing a seat belt when driving a car, sitting in the rear seat of a car, or when riding a motorcycle. In addition to considering personal characteristics investigated in this study, the helmet-wearing rate should be improved through policies or systems at the national or regional levels. [ABSTRACT FROM AUTHOR]

Introduction: Dentists’ attire includes their choice of clothes and Personal Protective Equipment (PPE) required to follow infection control measures. Investigating and understanding the paediatric patient’s preferences and perceptions towards the dentist’s attire can aid in establishing a more efficient and smoother relationship between them. Aim: To determine the children’s preferences and perceptions of their paediatric dentist’s attire and PPE among four to 12-year-old children. Materials and Methods: This cross-sectional study included four to 12-year-old Arabic-speaking children attending Department of Paediatric Dentistry, King Abdulaziz University, Jeddah, Saudi Arabia for dental treatment with their parents/guardians between February 2022 and April 2022. Data were collected from the participants using a validated Arabic electronic questionnaire to determine their preferences regarding different parts and types of the dentist’s attire and PPE, as well as their perceptions and feelings of comfort towards the dentist wearing the full standard PPE. Data were summarised as frequencies and percentages for categorical variables or means and standard deviations for continuous variables. The significance threshold was set at 0.05. Results: A total of 362 participants with a mean age of 8.4±2.3 years and their parents/guardians participated in the study. Female dentists were significantly more favoured by both male and female participants, with statistical significance among females (p

Introduction: Dentists' attire includes their choice of clothes and Personal Protective Equipment (PPE) required to follow infection control measures. Investigating and understanding the paediatric patient's preferences and perceptions towards the dentist's attire can aid in establishing a more efficient and smoother relationship between them. Aim: To determine the children's preferences and perceptions of their paediatric dentist's attire and PPE among four to 12-year-old children. Materials and Methods: This cross-sectional study included four to 12-year-old Arabic-speaking children attending Department of Paediatric Dentistry, King Abdulaziz University, Jeddah, Saudi Arabia for dental treatment with their parents/guardians between February 2022 and April 2022. Data were collected from the participants using a validated Arabic electronic questionnaire to determine their preferences regarding different parts and types of the dentist's attire and PPE, as well as their perceptions and feelings of comfort towards the dentist wearing the full standard PPE. Data were summarised as frequencies and percentages for categorical variables or means and standard deviations for continuous variables. The significance threshold was set at 0.05. Results: A total of 362 participants with a mean age of 8.4±2.3 years and their parents/guardians participated in the study. Female dentists were significantly more favoured by both male and female participants, with statistical significance among females (p<0.001) and younger participants (p<0.001). Both males and females (p=0.025) and older participants (p = 0.001) significantly favoured the traditional white coats over colourful paediatric coats. Furthermore, older participants significantly preferred surgical masks over paediatric masks (p<0.001), face shields as eye protection (p<0.001), and no head cover over colourful paediatric caps (p<0.001). Male participants showed significantly better acceptability towards the dentist wearing the full standard PPE. Conclusion: Both genders and younger children preferred female dentists. The traditional white coat is the most preferred attire by both genders and older children. Male and older children showed higher acceptability for the full standard PPE. [ABSTRACT FROM AUTHOR]

ABSTRACT Objectives: to describe traffic accidents involving motorcyclists and analyze the association between possession of a motorcycle driver’s license and use of helmets according to the severity of injuries. Methods: a cross-sectional study was conducted among all patients hospitalized in the traumatology and orthopedics sector of a public reference hospital in northeastern Brazil. Results: 170 patients were surveyed, the majority were male (95.9%). Their ages ranged from 18 to 67 years. Most were black or brown (52.3%), had completed elementary school (58.9%) and had monthly income smaller than two minimum wages (56.5%). An association was found between being licensed to drive a motorcycle and wearing a helmet. Among those who suffered moderate injuries, this association was OR=5.66(1.85-17.23) and among those who suffered severe injuries it was OR=13.57(2.82-65.14). Conclusions: people who were licensed to drive motorcycles used a helmet as protective equipment more often and, in accidents, suffered fewer injuries.

Maxillofacial injury is a common injury resulting from bicycle (including e-bike) and scooter accidents. With 80,000 admissions to emergency departments in 2019, bicycle accidents account for more than half of all traffic-related emergency department visits in the Netherlands. The United States reports approximately 130,000 injuries and 1000 fatalities related to cycling annually. This systematic review and meta-analysis was performed to examine the protective effect of helmets against maxillofacial injuries resulting from bicycle and scooter (including e-bike and e-scooter) accidents. After a systematic literature search, 14 studies were found to be eligible for this systematic review. Of these, 11 were included in the meta-analysis. None of the included studies focused on vehicles with motors (e-bikes and e-scooters); all focused only on non-motorized vehicles. All included studies were non-randomized, which could have led to bias in the pooled results. Data from the included studies were tested for heterogeneity using the binary random-effects model (DerSimonian–Laird method), and the odds ratio for the occurrence of maxillofacial injury in cyclists wearing a helmet versus those not wearing a helmet was calculated by random-effects meta-analysis. Patients who had worn a helmet suffered significantly fewer maxillofacial injuries than patients who had not, in bicycle accidents (odds ratio 0.682). In conclusion, wearing a helmet has a significant protective effect against maxillofacial injury, indicating the need for strict helmet legislation. [ABSTRACT FROM AUTHOR]

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Abstract Background Road traffic injuries (RTI) are one of the most prominent causes of morbidity and mortality, especially among children and young adults. Motorcycle crashes constitute a significant part of RTIs. Policymakers believe that safety helmets are the single most important protection against motorcycle-related injuries. However, motorcyclists are not wearing helmets at desirable rates. This study systematically investigated factors that are positively associated with helmet usage among two-wheeled motorcycle riders. Methods We performed a systematic search on PubMed, Scopus, Web of Science, Embase, and Cochrane library with relevant keywords. No language, date of publication, or methodological restrictions were applied. All the articles that had evaluated the factors associated with helmet-wearing behavior and were published before December 31, 2021, were included in our study and underwent data extraction. We assessed the quality of the included articles using the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist for observational studies. Results A total of 50 articles were included. Most evidence suggests that helmet usage is more common among drivers (compared to passengers), women, middle-aged adults, those with higher educations, married individuals, license holders, and helmet owners. Moreover, the helmet usage rate is higher on highways and central city roads and during mornings and weekdays. Travelers of longer distances, more frequent users, and riders of motorcycles with larger engines use safety helmets more commonly. Non-helmet-using drivers seem to have acceptable awareness of mandatory helmet laws and knowledge about their protective role against head injuries. Importantly, complaint about helmet discomfort is somehow common among helmet-using drivers. Conclusions To enhance helmet usage, policymakers should emphasize the vulnerability of passengers and children to RTIs, and that fatal crashes occur on low-capacity roads and during cruising at low speeds. Monitoring by police should expand to late hours of the day, weekends, and lower capacity and less-trafficked roads. Aiming to enhance the acceptance of other law-abiding behaviors (e.g., wearing seat belts, riding within the speed limits, etc.), especially among youth and young adults, will enhance the prevalence of helmet-wearing behavior among motorcycle riders. Interventions should put their focus on improving the attitudes of riders regarding safety helmets, as there is acceptable knowledge of their benefits.

Background: It is essential to identify factors that predict helmet use, so as to mitigate the injury and mortality from bicycle accidents.Objective: To examine the relationship between helmet use and the bicycle-related trauma injury outcomes among bicyclists with head/neck injury in the US.Methods: Data from the 2002-2012 National Trauma Data Bank were used, including all trauma bicycle riders involved in bicycle-related accidents whose primary reason for the hospital or Intensive Care Unit stay was head or neck injury. Using multiple logistic regression, the association between helmet use, Injury severity score (ISS), length of stay in hospital (HLOS) and Intensive Care Unit (ICULOS), and mortality was examined.Results: Of the 76,032 bicyclists with head/neck injury, 22% worn helmets. The lowest was among Blacks, Hispanics, and

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. [ABSTRACT FROM AUTHOR]

Introduction Motorcycles are used as a common means of transportation, and motorcycle accidents are responsible for a major portion of trauma injuries. Objectives The purpose of this study was to analyze the patterns of facial injuries in motorcyclists, to evaluate the types of injuries, and to investigate if the accident-related factors had any impact on the characteristics of the injuries. Methods This retrospective observational study included 74 patients with maxillofacial injuries following motorcycle-related accidents. Investigated data were divided into four main categories: sociodemographic, accident-related, injury-related, and treatment-related. Results All the patients were males with a mean age (±SD) of 25.03 (±9.986) years. Most accidents (n = 44, 59.4%) occurred in the evening. Most of the patients (n = 40, 54%) were traveling on motorcycle models that had maximum speed of over 120 km/h. Furthermore, 15 patients (18.9%) were under the influence of alcohol during the crashes and only one patient was wearing a helmet. Fractures of the maxillofacial bones were observed in 50 (67.5%) crash victims; 24 of them (48%) had middle third fractures, 11 (22%) had mandibular fractures, and 15 patients (30%) presented with a combination of lower, middle, and upper third fractures. Conclusion Almost all patients were not wearing helmets at the moment of the crash. The most common fractured site was the maxilla. The majority of the patients received surgical treatment. Increased enforcement of safety measures for riders and raising awareness about the dangers of motorcycle crashes are required measures to improve traffic safety and, ultimately, population health. [ABSTRACT FROM AUTHOR]

Repetitive head impact exposure sustained by athletes of contact sports has been hypothesized to be a mechanism for concussion and a possible explanation for the high degree of variability in sport-related concussion biomechanics. In an attempt to limit repetitive head impact exposure during the football preseason, the NCAA eliminated two-a-day practices in 2017, while maintaining the total number of team practice sessions. The objective of this study was to quantify head impact exposure during the preseason and regular season in Division I college football athletes to determine whether the 2017 NCAA ruling decreased head impact exposure. 342 unique athletes from five NCAA Division I Football Bowl Subdivision (FBS) programs were consented and enrolled. Head impacts were recorded using the Head Impact Telemetry (HIT) System during the entire fall preseasons and regular seasons in 2016 and 2017. Despite the elimination of two-a-day practices, the number of preseason contact days increased in 2017, with an increase in average hourly impact exposure (i.e., contact intensity), resulting in a significant increase in total head impact burden (+ 26%) for the 2017 preseason. This finding would indicate that the 2017 NCAA ruling was not effective at reducing the head impact burden during the football preseason. Additionally, athletes sustained a significantly higher number of recorded head impacts per week (+ 40%) during the preseason than the regular season, implicating the preseason as a time of elevated repetitive head impact burden. With increased recognition of a possible association between repetitive head impact exposure and concussion, increased preseason exposure may predispose certain athletes to a higher risk of concussion during the preseason and regular season. Accordingly, efforts at reducing concussion incidence in contact sports should include a reduction in overall head impact exposure.

Studies of football athletes have implicated repetitive head impact exposure in the onset of cognitive and brain structural changes, even in the absence of diagnosed concussion. Those studies imply accumulating damage from successive head impacts reduces tolerance and increases risk for concussion. Support for this premise is that biomechanics of head impacts resulting in concussion are often not remarkable when compared to impacts sustained by athletes without diagnosed concussion. Accordingly, this analysis quantified repetitive head impact exposure in a cohort of 50 concussed NCAA Division I FBS college football athletes compared to controls that were matched for team and position group. The analysis quantified the number of head impacts and risk weighted exposure both on the day of injury and for the season to the date of injury. 43% of concussed athletes had the most severe head impact exposure on the day of injury compared to their matched control group and 46% of concussed athletes had the most severe head impact exposure for the season to the date of injury compared to their matched control group. When accounting for date of injury or season to date of injury, 72% of all concussed athletes had the most or second most severe head impact exposure compared to their matched control group. These trends associating cumulative head impact exposure with concussion onset were stronger for athletes that participated in a greater number of contact activities. For example, 77% of athletes that participated in ten or more days of contact activities had greater head impact exposure than their matched control group. This unique analysis provided further evidence for the role of repetitive head impact exposure as a predisposing factor for the onset of concussion. The clinical implication of these findings supports contemporary trends of limiting head impact exposure for college football athletes during practice activities in an effort to also reduce risk of concussive injury.

Water polo is a contact sport that is gaining popularity in the United States and carries a risk of repeated head impacts and concussion. The frequency and magnitude of sport-related head impacts have not been described for water polo. We aimed to compare patterns of empirically measured head impact exposure of male collegiate water polo players to patterns previously reported by a survey of current and former water polo athletes. Participants wore water polo caps instrumented with head impact sensors during three seasons of collegiate water polo. Peak linear acceleration (PLA) and peak rotational acceleration (PRA) were recorded for head impacts. Athlete positions were recorded by research staff at the occurrence of each head impact. Head impacts were sustained by athletes in offensive positions more frequently than in defensive and transition positions (246, 59.9% vs. 93, 22.6% vs. 72, 17.5%). 37% of all head impacts during gameplay were sustained by athletes playing the offensive center position. Impact magnitude (means ± SD: PLA = 36.1±12.3g, PRA = 5.0±2.9 krads/sec2) did not differ between position or game scenario. Among goalies, impact frequency and magnitude were similar between games (means ± SD: 0.54±.51 hits/game, PLA = 36.9±14.2g, PRA = 4.3±4.2 krads/sec2) and practices (means ± SD: 0.96±1.11 hits/practice, PLA = 43.7±14.5g, PRA = 3.9±2.5 krads/sec2). We report that collegiate water polo athletes are at risk for sport-related head impacts and impact frequency is dependent on game scenario and player position. In contrast, magnitude does not differ between scenarios or across positions.

Introduction Motorcycles are used as a common means of transportation, and motorcycle accidents are responsible for a major portion of trauma injuries. Objectives The purpose of this study was to analyze the patterns of facial injuries in motorcyclists, to evaluate the types of injuries, and to investigate if the accident-related factors had any impact on the characteristics of the injuries. Methods This retrospective observational study included 74 patients with maxillofacial injuries following motorcycle-related accidents. Investigated data were divided into four main categories: sociodemographic, accident-related, injury-related, and treatment-related. Results All the patients were males with a mean age (±SD) of 25.03 (±9.986) years. Most accidents (n = 44, 59.4%) occurred in the evening. Most of the patients (n = 40, 54%) were traveling on motorcycle models that had maximum speed of over 120 km/h. Furthermore, 15 patients (18.9%) were under the influence of alcohol during the crashes and only one patient was wearing a helmet. Fractures of the maxillofacial bones were observed in 50 (67.5%) crash victims; 24 of them (48%) had middle third fractures, 11 (22%) had mandibular fractures, and 15 patients (30%) presented with a combination of lower, middle, and upper third fractures. Conclusion Almost all patients were not wearing helmets at the moment of the crash. The most common fractured site was the maxilla. The majority of the patients received surgical treatment. Increased enforcement of safety measures for riders and raising awareness about the dangers of motorcycle crashes are required measures to improve traffic safety and, ultimately, population health.

Background: Road traffic injuries (RTI) are one of the most prominent causes of morbidity and mortality, especially among children and young adults. Motorcycle crashes constitute a significant part of RTIs. Policymakers believe that safety helmets are the single most important protection against motorcycle-related injuries. However, motorcyclists are not wearing helmets at desirable rates. This study systematically investigated factors that are positively associated with helmet usage among two-wheeled motorcycle riders. Methods: We performed a systematic search on PubMed, Scopus, Web of Science, Embase, and Cochrane library with relevant keywords. No language, date of publication, or methodological restrictions were applied. All the articles that had evaluated the factors associated with helmet-wearing behavior and were published before December 31, 2021, were included in our study and underwent data extraction. We assessed the quality of the included articles using the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist for observational studies. Results: A total of 50 articles were included. Most evidence suggests that helmet usage is more common among drivers (compared to passengers), women, middle-aged adults, those with higher educations, married individuals, license holders, and helmet owners. Moreover, the helmet usage rate is higher on highways and central city roads and during mornings and weekdays. Travelers of longer distances, more frequent users, and riders of motorcycles with larger engines use safety helmets more commonly. Non-helmet-using drivers seem to have acceptable awareness of mandatory helmet laws and knowledge about their protective role against head injuries. Importantly, complaint about helmet discomfort is somehow common among helmet-using drivers. Conclusions: To enhance helmet usage, policymakers should emphasize the vulnerability of passengers and children to RTIs, and that fatal crashes occur on low-capacity roads and during cruising at low speeds. Monitoring by police should expand to late hours of the day, weekends, and lower capacity and less-trafficked roads. Aiming to enhance the acceptance of other law-abiding behaviors (e.g., wearing seat belts, riding within the speed limits, etc.), especially among youth and young adults, will enhance the prevalence of helmet-wearing behavior among motorcycle riders. Interventions should put their focus on improving the attitudes of riders regarding safety helmets, as there is acceptable knowledge of their benefits. [ABSTRACT FROM AUTHOR]

Summary: Objectives: The aim of this study was to quantify helmet use in skiing and snowboarding in Switzerland. Design: Regular cross-sectional surveys of skiers and snowboarders were conducted on Swiss slopes from the 2002/2003 to the 2021/2022 seasons. Method: Surveys included information on helmet use, sport, gender, age, skill level, and country of residence. Data from 15 single surveys were used to trace the evolution of helmet use in Switzerland. A logistic regression on data from the most recent survey was conducted to detect differences in helmet use among demographic groups. Results: In the 2002/2003 season, 14% of skiers (95% confidence interval [CI] ​= ​12%–18%) and 20% of snowboarders (CI 16%–26%) used a helmet. By the most recent season (2021/2022), wearing rates for both skiers and snowboarders had increased significantly (skiers: 95% [CI 93%–97%]; snowboarders: 92% [CI 89%–95%]). The regression results showed that skiers, females, younger people, and people in the German-speaking part of Switzerland were more likely to wear a helmet. Conclusions: The results show an impressive evolution of helmet use rates among skiers and snowboarders since the 2002/2003 season. Steep differences detected in earlier seasons have leveled out, and most people on the slopes today wear helmets. Nevertheless, the ongoing efforts for promoting helmet use should be maintained.

Background & objective: This study aims to assess the effect of cooling helmet during surgery on neuron specific enolase (NSE) and delirium levels following open heart surgery patients with cardiopulmonary bypass (CPB) using a heart-lung machine. Methodology: This double-blind randomized clinical trial took place from October to December 2021 in a tertiary care hospital. The research used a modified cooling helmet to decrease brain temperature. Inclusion criteria were adult patients who were scheduled for open heart surgery with CPB. The subjects were randomized into two groups: patients with the cooling helmet on as the treatment group (n = 12) and the patients with the non-cooling helmet on as the control group (n = 13). The differences between NSE and delirium levels in both groups were assessed at specific times. Results: NSE levels in the treatment group were lower than the control group (7.13 ± 7.63 vs. 12.49 ± 6.81; P < 0.05). Regarding the delirium, no statistically significant difference was found in both groups (P > 0.05). Conclusion: The hypothermia effect of the cooling helmet is associated with a decrease of neuron specific enolase levels, but it did not significantly correlate to prevent the delirium after open heart surgery patients with the cardiopulmonary bypass machine. [ABSTRACT FROM AUTHOR]

Background/Aim: The mandible makes up a substantial part of the lower face, and is susceptible to injury. Even in helmeted cyclists, accidents may lead to fractures of the mandible because conventional helmets provide little protection to the lower part of the face. In addition, some studies indicate that helmets may lead to an increased risk of mandibular fractures. Thus, the aim of this study was to examine the anatomic distribution of mandibular fractures in injured cyclists and to assess if helmet use influenced the fracture locations. Material and Methods: Data from a Norwegian Level 1 trauma center were collected in the Oslo University Hospital Trauma Registry over a 12‐year period. Of 1543 injured cyclists, the electronic patient charts of 62 cyclists with fractures of the mandible were retrospectively evaluated in detail. Demographic data, helmet use, and fracture type were assessed. Results: Sixty‐two patients (4%) had fractures of the mandible, and women had an increased risk (OR 2.49, 95% CI 1.49–4.16, p <.001). The most common fracture site was the mandibular body, followed by the condyle. Isolated mandibular fractures occurred in 45% of the patients and 55% had other concomitant facial fractures. There were 42% of the patients with fractures in multiple sites of the mandible, and 42% had a concomitant dentoalveolar injury. Half of the cyclists were wearing a helmet at the time of the accident and 39% were not. There was no significant difference in fracture distribution between the helmeted and non‐helmeted groups. Conclusions: Fracture of the mandibular body was the most prevalent mandibular fracture type following bicycle accidents. Women had an increased risk of mandibular fractures compared with men, whereas helmet wearing did not affect the anatomical fracture site. [ABSTRACT FROM AUTHOR]

Objectives: The purpose was to evaluate the characteristics of off-highway vehicle (OHV) crashes correlated with neurological injury and accident severity in the pediatric population in El Paso, Texas.Methods: A retrospective review of 213 patients who were victims of an OHV crash attended at a regional Level I trauma center from 2012 to 2020 was performed. OHVs were defined as vehicles designated for use outside public roads. Neurological outcomes included any traumatic brain injury (TBI) or a brain hemorrhage/hematoma. Severe injury was defined as a Glasgow Coma Scale less than 8, a length of stay longer than 7 days, a Pediatric Trauma Score lower than 8, and requiring pediatric intensive care unit admission. Bivariate and multivariate analyses by logistic regression models were conducted to determine the factors related to the neurological outcomes and accident severity.Results: Of 213 OHV crash patients, 104 (48.8%) had TBI and 22 (10.3%) had brain hemorrhages or hematomas. Risk analyses demonstrated that children younger than age 6 years and occupants of recreational OHVs have a significantly higher risk of severe injuries. Off-highway motorcycles and all-terrain vehicles were risk factors for TBI, whereas helmets were a protective factor.Conclusions: OHVs are associated with both TBIs and severe injuries. Stricter laws requiring helmets and forbidding children younger than 6 to ride are required, as modifying these factors could reduce the incidence of OHV crashes and their complications. [ABSTRACT FROM AUTHOR]

Objectives: Headgear use is a controversial issue in girls' lacrosse. We compared concussion rates among high school lacrosse players in an American state with a headgear mandate (HM) to states without an HM.Methods: Participants included high schools with girls' lacrosse programmes in the USA. Certified athletic trainers reported athlete exposure (AE) and injury data via the National Athletic Treatment, Injury and Outcomes Network during the 2019-2021 seasons. The HM cohort was inclusive of high schools from the state of Florida, which mandates the use of ASTM standard F3137 headgear, while the non-HM (NHM) cohort was inclusive of high schools in 31 states without a state-wide HM. Incidence rate ratios (IRRs) and 95% CIs were calculated.Results: 141 concussions (HM: 25; NHM: 116) and 357 225 AEs were reported (HM: 91 074 AEs; NHM: 266 151 AEs) across all games and practices for 289 total school seasons (HM: 96; NHM: 193). Overall, the concussion injury rate per 1000 AEs was higher in the NHM cohort (0.44) than the HM cohort (0.27) (IRR=1.59, 95% CI: 1.03 to 2.45). The IRR was higher for the NHM cohort during games (1.74, 95% CI: 1.00 to 3.02) but not for practices (1.42, 95% CI: 0.71 to 2.83).Conclusions: These findings suggest a statewide HM for high school girls' lacrosse is associated with a lower concussion rate than playing in a state without an HM. Statewide mandates requiring ASTM standard F3137 headgear should be considered to reduce the risk of concussion. [ABSTRACT FROM AUTHOR]

The assessment of cervical intervertebral kinematics can serve as the basis for understanding any degenerative changes in the cervical spine due to the prolonged wear of a heavyweight, imbalanced firefighting helmet. Therefore, this study aimed to analyze cervical intervertebral kinematics using the OpenSim musculoskeletal modeling platform in order to provide much-needed insights into how the inertial properties of firefighter helmets affect cervical spinal mobility. A total of 36 firefighters (18 males and 18 females) were recruited to perform static and dynamic neck flexion, extension, and left and right lateral bending tasks for three conditions: 1) no-helmet, 2) US-style helmet with a comparatively superior center of mass (COM), and 3) European-style helmet with relatively higher mass but an inferior COM. Three custom-made OpenSim head-neck models were created to calculate cervical intervertebral kinematics for each helmet condition. Results showed that helmet use significantly (p < 0.001) affects neck and cervical spinal kinematics. Despite its lighter weight, the superior COM placement in the US-style helmet caused more pronounced angular changes and higher velocity of peak flexion and extension angles compared to the European-style helmet across all cervical joints. Moreover, results revealed discrepancies between OpenSim-derived neck and cervical range-of-motion and those reported in previous in-vivo studies. In conclusion, the present study underscores the importance of designing firefighter helmets with a lower profile (less superior COM) to enhance neck range of motion and minimize potential neck injuries., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

This study investigates the risk of head injuries, specifically concussions, from falling objects in workplace accidents. A case study focuses on a construction worker who sustained a head injury despite wearing a protective helmet. Utilizing finite element (FE) analysis, the helmet-head system was modeled to assess impact forces and head accelerations. The helmet, made of High-Density Polyethylene with a 6-point suspension system, was tested against falling objects of 332 g and 665 g. Simulations, conducted from heights of 5 to 25 m, revealed that objects weighing as little as 332 g could cause severe concussions from a 10-meter fall. These findings demonstrate that helmets, while mitigating some impact, absorb significantly less energy than the kinetic energy of falling objects. The analyses carried out confirmed the worker's statement that his injury was caused by a foreign object falling on his head, which was protected by a helmet., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier B.V. All rights reserved.)

This study explores the effectiveness of architected lattice structures, specifically made of polyamide 12 (PA12) material, as potential helmet liners to mitigate traumatic brain injuries (TBI), with a focus on rotational acceleration. Evaluating three lattice unit cell topologies (simple cubic, dode-medium, and rhombic dodecahedron), the research builds upon prior investigations indicating that PA12 lattice liners may outperform conventional EPS liners. Employing a high-fidelity finite element male head model and utilizing direct and oblique impact scenarios, mechanical quantities, such as maximum principal strain (MPS) and shear strain, cumulative strain damage measure and intracranial pressure were measured at the tissue level in different brain regions. Results indicate that lattice liners, especially with dode-medium topology, exhibit promising reductions in brain tissue strains. On average, during oblique impacts, less than 1 % of the brain volume experienced an MPS level of 0.4 when the lattice liners were adopted, whereas that percentage was above 70 % with the expandable polystyrene (EPS) foam liners. Pressure-based assessments suggest that lattice liners may outperform EPS liners in oblique impacts, showcasing the limitations of EPS for effective TBI mitigation. Despite certain model limitations, this study emphasizes the need for advancements in helmet technology, particularly in the development of commercial lattice liners using additive manufacturing, to address the limitations of existing EPS liners in preventing rotational consequences of impacts and reducing TBI., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Purpose: The study purpose was to investigate the laboratory-based performance of three commercially available shell add-on products under varsity-level impact conditions., Methods: Pendulum impact tests were conducted at multiple locations (front, front boss, rear, side) and speeds (3.1, 4.9, 6.4 m/s) using two helmet models. Tests were performed with a single add-on configuration for baseline comparisons and a double add-on configuration to simulate collisions with both players wearing shell add-ons. A linear mixed-effect model was used to evaluate peak linear acceleration (PLA), peak rotational acceleration (PRA), and concussion risk, which was calculated from a bivariate injury risk function, based on shell add-on and test configuration., Results: All shell add-ons decreased peak head kinematics and injury risk compared to controls, with the Guardian NXT producing the largest reductions (PLA: 7.9%, PRA: 14.1%, Risk: 34.1%) compared to the SAFR Helmet Cover (PLA: 4.5%, PRA: 9.3%, Risk: 24.7%) and Guardian XT (PLA: 3.2%, PRA: 5.0%, Risk: 15.5%). The same trend was observed in the double add-on test configuration. However, the Guardian NXT (PLA: 17.1%; PRA: 11.5%; Risk: 62.8%) and SAFR Helmet Cover (PLA: 12.2%; PRA: 9.1%; Risk: 52.2%) produced larger reductions in peak head kinematics and injury risk than the Guardian XT (PLA: 5.7%, PRA: 2.2%, Risk: 21.8%)., Conclusion: In laboratory-based assessments that simulated varsity-level impact conditions, the Guardian NXT was associated with larger reductions in PLA, PRA, and injury risk compared to the SAFR Helmet Cover and Guardian XT. Although shell add-ons can enhance head protection, helmet model selection should be prioritized., (© 2024. The Author(s).)

Objective: To explore head impact magnitude (linear head acceleration and rotational velocity) during heading for four different header types in youth male footballers. A secondary objective was to explore whether head impact magnitude was influenced by player-related factors (i.e. age, neck strength)., Design: An observational field-based research design was utilised for this research., Participants: 27 youth male footballers (mean age14.81, SD1.88) from one football club., Main Outcome Measures: Peak linear acceleration and peak angular velocity were measured during four different header types (two from 15-m and two from 5-m). Maximal isometric neck strength of each player was also assessed (flexors, extensors, left and right-side flexors)., Results: Statistically significant differences were observed between header type and both peak linear acceleration (F(3,78) = 60.90, R 2  = 0.76, p=<0.001) and peak angular velocity (F(3,78) = 43.63, R 2  = 0.75, p=<0.001). In terms of players related factors, for linear acceleration, 6% (P = 0.008) of the variance was predicted by age, and for angular velocity, 12% (P = 0.003) was predicted by age, with neck strength accounting for <9% of the variance., Conclusions: In this youth cohort, head impact magnitude during heading is influenced by the type of header being performed., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: EB and RC are contracted doctors for Football Australia. KP is a contracted injury spotter for FIFA organised tournaments (2023 and 2024). All authors declare no other relevant financial or non-financial competing interests., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

This paper presents significant improvements in the accuracy and computational efficiency of safety helmet detection within industrial environments through the optimization of the you only look once version 5 small (YOLOv5s) model structure and the enhancement of its loss function. We introduce the convolutional block attention module (CBAM) to bolster the model's sensitivity to key features, thereby enhancing detection accuracy. To address potential performance degradation issues associated with the complete intersection over union (CIoU) loss function in the original model, we implement the modified penalty-decay intersection over union (MPDIoU) loss function to achieve more stable and precise bounding box regression. Furthermore, considering the original YOLOv5s model's large parameter count, we adopt a lightweight design using the MobileNetV3 architecture and replace the original squeeze-and-excitation (SE) attention mechanism with CBAM, significantly reducing computational complexity. These improvements reduce the model's parameters from 15.7 GFLOPs to 5.7 GFLOPs while increasing the mean average precision (mAP) from 82.34% to 91.56%, demonstrating its superior performance and potential value in practical industrial applications.

Magnetoencephalography based on optically pumped magnetometers can passively detect the ultra-weak brain magnetic field signals, which has significant clinical application prospects for the diagnosis and treatment of cerebral disorders. This paper proposes a brain magnetic signal measurement method on the basis of the active-passive coupling magnetic shielding strategy and helmet-mounted detection array, which has lower cost and comparable performance over the existing ones. We first utilized the spatially-grid constrained coils and biplanar coils with proportion-integration-differentiation controller with tracking differentiator to ensure a near-zero and stable magnetic field environment with large uniform region. Subsequently, we implemented the brain magnetic signal measurement with the subject randomly moving fingers through tapping a keyboard and with the condition of opening and closing the eyes. Effectively induced brain magnetic signals were detected at the motor functional area and occipital lobe area in the two experiments, respectively. The proposed method will contribute to the development of functional brain imaging., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.)

Introduction: Strong neck muscles may decrease the risk of flight-induced neck pain and possible disability among fast jet pilots. The purpose of this study was to examine the intra- and interrater reliability of a commercial force gauge attached to a pilot's helmet for measuring isometric force production of the neck muscles., Methods: A total of 41 subjects performed maximal isometric cervical flexion, extension, and lateral flexion in two measurement sessions for intrarater reliability, and 31 of these subjects participated in a third session for measuring interrater reliability. Delayed muscle soreness and neck pain were assessed using the Visual Analog Scale before and after each measurement session. The intraclass correlation coefficient (ICC) was used to compare values between the test and retest assessments., Results: The overall interrater reliability was good (ICC 0.79-0.90), whereas the intrarater reliability varied from moderate to good (ICC 0.58-0.84). In both intra- and interrater reliability, the flexion test had good (ICC 0.84-0.89) reliability, while the lateral flexion test results had moderate to good (ICC 0.73-0.90) reliability. The extension test had the lowest reliability in both intra- (ICC 0.58) and interrater (ICC 0.79) tests. The average visual analog scale score (from 1-100 scale) prior to the second measurement session was 16 ± 18 in delayed muscle soreness and 0 ± 0 in neck pain., Discussion: The present study demonstrated that the helmet-attached force gauge is a reliable, safe, and clinically applicable method to evaluate isometric neck strength in the flexion and lateral flexion directions. Honkanen T, Mattila V, Kinnunen O, Janhunen M, Sovelius R, Vaara JP, Kyröläinen H. Reliability of a flight helmet-attached force gauge in measuring isometric neck muscle strength. Aerosp Med Hum Perform. 2024; 95(10):788-793.

Helmets and shoulder pads are required equipment intended to protect American football athletes by attenuating collision forces during participation. Surprisingly, research differentiating kinematics from head impacts initiated by helmets from those initiated by shoulder pads among adolescent athletes has not been completed. The current study's purpose was to determine the effects of equipment on head impact kinematics. Sixty-nine male American football athletes from three high schools wore helmets equipped with Head Impact Telemetry (HIT) System instrumentation to quantify peak linear (g) and rotational (rad/s 2 ) accelerations. Data were extracted for video-confirmed impacts during two competitions. Separate multivariable linear regressions using ordinary least squares were conducted to determine if equipment type (helmet vs. shoulder pad) was associated with log-transformed linear and rotational accelerations. In total, 1150 video-confirmed impacts involved helmet (N = 960) or shoulder pad (N = 190) initiated contact. Linear (p = 0.809) and rotational (p = 0.351) acceleration were not associated with equipment type. Head impact kinematics were similar between impacts initiated by either helmets or shoulder pads and suggests an opponent's shoulder pads and helmet can deliver comparable forces to the struck player. Equipment manufacturers may need to consider the unintended role shoulder pads may contribute to head injury risk., (© 2024. The Author(s) under exclusive licence to Biomedical Engineering Society.)

Instrumented mouthguard systems (iMGs) are commonly used to study rigid body head kinematics across a variety of athletic environments. Previous work has found good fidelity for iMGs rigidly fixed to anthropomorphic test device (ATD) headforms when compared to reference systems, but few validation studies have focused on iMG performance in human cadaver heads. Here, we examine the performance of two boil-and-bite style iMGs in helmeted cadaver heads. Three unembalmed human cadaver heads were fitted with two instrumented boil-and-bite mouthguards [Prevent Biometrics and Diversified Technical Systems (DTS)] per manufacturer instructions. Reference sensors were rigidly fixed to each specimen. Specimens were fitted with a Riddell SpeedFlex American football helmet and impacted with a rigid impactor at three velocities and locations. All impact kinematics were compared at the head center of gravity. The Prevent iMG performed comparably to the reference system up to ~ 60 g in linear acceleration, but overall had poor correlation (CCC = 0.39). Prevent iMG angular velocity and BrIC generally well correlated with the reference, while underestimating HIC and overestimating HIC duration. The DTS iMG consistently overestimated the reference across all measures, with linear acceleration error ranging from 10 to 66%, and angular acceleration errors greater than 300%. Neither iMG demonstrated consistent agreement with the reference system. While iMG validation efforts have utilized ATD testing, this study highlights the need for cadaver testing and validation of devices intended for use in-vivo, particularly when considering realistic (non-idealized) sensor-skull coupling, when accounting for interactions with the mandible and when subject-specific anatomy may affect device performance., (© 2024. The Author(s) under exclusive licence to Biomedical Engineering Society.)

Dummy headforms used for impact testing have changed little over the years, and frictional characteristics are thought not to represent the human head accurately. The frictional interface between the helmet and head is an essential factor affecting impact response. However, few studies have evaluated the coefficient of friction (COF) between the human head and helmet surface. This study's objectives were to quantify the human head's static and dynamic COF and evaluate the effect of biological sex and hair properties. Seventy-four participants slid their heads along a piece of helmet foam backed by a fixed load cell at varying normal force levels. As normal force increased, static and dynamic human head COF decreased following power-law curves. At 80 N, the static COF is 0.32 (95% CI 0.30-0.34), and the dynamic friction coefficient is 0.27 (95% CI 0.26-0.28). Biological sex and hair properties were determined not to affect human head COF. The COFs between the head and helmet surface should be used to develop more biofidelic head impact testing methods, define boundary conditions for computer simulations, and aid decision-making for helmet designs., (© 2023. The Author(s).)

Protective headgear effects measured in the laboratory may not always translate to the field. In this study, we evaluated the impact attenuation capabilities of a commercially available padded helmet shell cover in the laboratory and on the field. In the laboratory, we evaluated the padded helmet shell cover's efficacy in attenuating impact magnitude across six impact locations and three impact velocities when equipped to three different helmet models. In a preliminary on-field investigation, we used instrumented mouthguards to monitor head impact magnitude in collegiate linebackers during practice sessions while not wearing the padded helmet shell covers (i.e., bare helmets) for one season and whilst wearing the padded helmet shell covers for another season. The addition of the padded helmet shell cover was effective in attenuating the magnitude of angular head accelerations and two brain injury risk metrics (DAMAGE, HARM) across most laboratory impact conditions, but did not significantly attenuate linear head accelerations for all helmets. Overall, HARM values were reduced in laboratory impact tests by an average of 25% at 3.5 m/s (range: 9.7 to 39.6%), 18% at 5.5 m/s (range: - 5.5 to 40.5%), and 10% at 7.4 m/s (range: - 6.0 to 31.0%). However, on the field, no significant differences in any measure of head impact magnitude were observed between the bare helmet impacts and padded helmet impacts. Further laboratory tests were conducted to evaluate the ability of the padded helmet shell cover to maintain its performance after exposure to repeated, successive impacts and across a range of temperatures. This research provides a detailed assessment of padded helmet shell covers and supports the continuation of in vivo helmet research to validate laboratory testing results., (© 2023. The Author(s) under exclusive licence to Biomedical Engineering Society.)

Helmet-testing headforms replicate the human head impact response, allowing the assessment of helmet protection and injury risk. However, the industry uses three different headforms with varying inertial and friction properties making study comparisons difficult because these headforms have different inertial and friction properties that may affect their impact response. This study aimed to quantify the influence of headform coefficient of friction (COF) and inertial properties on oblique impact response. The static COF of each headform condition (EN960, Hybrid III, NOCSAE, Hybrid III with a skull cap, NOCSAE with a skull cap) was measured against the helmet lining material used in a KASK prototype helmet. Each headform condition was tested with the same helmet model at two speeds (4.8 & 7.3 m/s) and two primary orientations (y-axis and x-axis rotation) with 5 repetitions, totaling 100 tests. The influence of impact location, inertial properties, and friction on linear and rotational impact kinematics was investigated using a MANOVA, and type II sums of squares were used to determine how much variance in dependent variables friction and inertia accounted for. Our results show significant differences in impact response between headforms, with rotational head kinematics being more sensitive to differences in inertial rather than frictional properties. However, at high-speed impacts, linear head kinematics are more affected by changes in frictional properties rather than inertial properties. Helmet testing protocols should consider differences between headforms' inertial and frictional properties during interpretation. These results provide a framework for cross-comparative analysis between studies that use different headforms and headform modifiers., (© 2024. The Author(s).)

This research sought to evaluate the thermal zones of the upper body and firefighter personal protective equipment (PPE) immediately following uncompensable heat stress (0.03 °C increase/min). We hypothesized that the frontal portion of the head and the inside of the firefighter helmet would be the hottest as measured by infrared thermography. This hypothesis was due to previous research demonstrating that the head accounts for ∼8-10% of the body surface area, but it accounts for ∼20% of the overall body heat dissipation during moderate exercise. Twenty participants performed a 21-min graded treadmill exercise protocol (Altered Modified Naughton) in an environmental chamber (35 °C, 50 % humidity) in firefighter PPE. The body areas analyzed were the frontal area of the head, chest, abdomen, arm, neck, upper back, and lower back. The areas of the PPE that were analyzed were the inside of the helmet and the jacket. The hottest areas of the body post-exercise were the frontal area of the head (mean: 37.3 ± 0.4 °C), chest (mean: 37.5 ± 0.3 °C), and upper back (mean: 37.3 ± 0.4 °C). The coldest area of the upper body was the abdomen (mean: 36.1 ± 0.4 °C). The peak temperature of the inside of the helmet increased (p < 0.001) by 9.8 °C from 27.7 ± 1.6 °C to 37.4 ± 0.7 °C, and the inside of the jacket increased (p < 0.001) by 7.3 °C from 29.2 ± 1.7 °C to 36.5 ± 0.4 °C. The results of this study are relevant for cooling strategies for firefighters., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Neck pain associated with helmet-wear is an occupational health problem often observed in helicopter pilots and aircrew. Whether aircrew helmet wearing is associated with physiological and biomechanical differences between sexes is currently unknown. This study investigated neuromuscular activation patterns during different helmet-wearing conditions. The helmet load was manipulated through a novel Helmet Balancing System (HBS) in healthy, non-pilot male and female participants (n = 10 each, age 19-45 years) in two phases. Phase A assessed the acute effects of helmet-wear on neck muscles activation during head movements. Phase B examined changes in muscle activity and cervical disc height after wearing a helmet for 45 min. In Phase A, muscle activity was similar between sexes in many movements, but it was higher in female participants when wearing a helmet than in males. The HBS reduced muscle activity in both sexes. In Phase B, female participants exhibited a greater level of muscular fatigue, and male participants' cervical disc height was significantly decreased [5.7 (1.4) vs. 4.4 (1.5) mm, P < 0.001] after continuous wearing. Both sexes showed no significant change in muscle fatigue and disc height [male: 5.0 (1.3) vs. 5.2 (1.4) mm, P = 0.604] after applying HBS. These findings demonstrate sex-specific physiological and biomechanical responses to wearing a helmet. They may indicate different postural and motor control strategies, associated with different neck pain aetiologies in male and female aircrew, the knowledge of which is important to reduce or prevent musculoskeletal injuries associated with helmet wearing., (© 2024 The Author(s). Experimental Physiology published by John Wiley & Sons Ltd on behalf of The Physiological Society.)

Purpose: Wearable sensors are used to measure head impact exposure in sports. The Head Impact Telemetry (HIT) System is a helmet-mounted system that has been commonly utilized to measure head impacts in American football. Advancements in sensor technology have fueled the development of alternative sensor methods such as instrumented mouthguards. The objective of this study was to compare peak magnitude measured from high school football athletes dually instrumented with the HIT System and a mouthpiece-based sensor system., Methods: Data was collected at all contact practices and competitions over a single season of spring football. Recorded events were observed and identified on video and paired using event timestamps. Paired events were further stratified by removing mouthpiece events with peak resultant linear acceleration below 10 g and events with contact to the facemask or body of athletes., Results: A total of 133 paired events were analyzed in the results. There was a median difference (mouthpiece subtracted from HIT System) in peak resultant linear and rotational acceleration for concurrently measured events of 7.3 g and 189 rad/s 2 . Greater magnitude events resulted in larger kinematic differences between sensors and a Bland Altman analysis found a mean bias of 8.8 g and 104 rad/s 2 , respectively., Conclusion: If the mouthpiece-based sensor is considered close to truth, the results of this study are consistent with previous HIT System validation studies indicating low error on average but high scatter across individual events. Future researchers should be mindful of sensor limitations when comparing results collected using varying sensor technologies., (© 2024. The Author(s).)

Male lacrosse and female lacrosse have differences in history, rules, and equipment. There is current debate regarding the need for enhanced protective headwear in female lacrosse like that worn by male lacrosse players. To inform this discussion, 17 high school lacrosse players (6 female and 11 male) wore the Stanford Instrumented Mouthguard during 26 competitive games over the 2021 season. Time-windowing and video review were used to remove false-positive recordings and verify head acceleration events (HAEs). The HAE rate in high school female lacrosse (0.21 per athlete exposure and 0.24 per player hour) was approximately 35% lower than the HAE rate in high school male lacrosse (0.33 per athlete exposure and 0.36 per player hour). Previously collected kinematics data from the 2019 high school male and female lacrosse season were combined with the newly collected 2021 kinematics data, which were used to drive a finite element head model and simulate 42 HAEs. Peak linear acceleration (PLA), peak angular velocity (PAV), and 95th percentile maximum principal strain (MPS95) of brain tissue were compared between HAEs in high school female and male lacrosse. Median values for peak kinematics and MPS95 of HAEs in high school female lacrosse (PLA, 22.3 g; PAV, 10.4 rad/s; MPS95, 0.05) were lower than for high school male lacrosse (PLA, 24.2 g; PAV, 15.4 rad/s; MPS95, 0.07), but the differences were not statistically significant. Quantifying a lower HAE rate in high school female lacrosse compared to high school male lacrosse, but similar HAE magnitudes, provides insight into the debate regarding helmets in female lacrosse. However, due to the small sample size, additional video-verified data from instrumented mouthguards are required., (© 2024. The Author(s) under exclusive licence to Biomedical Engineering Society.)

Traumatic brain injury (TBI) is a common injury in the workplace. Trips and falls are the leading causes of TBI in the workplace. However, industrial safety helmets are not designed for protecting the head under these impact conditions. Instead, they are designed to pass the regulatory standards which test head protection against falling heavy and sharp objects. This is likely to be due to the limited understanding of head impact conditions from trips and falls in workplace. In this study, we used validated human multi-body models to predict the head impact location, speed and angle (measured from the ground) during trips, forward falls and backward falls. We studied the effects of worker size, initial posture, walking speed, width and height of the tripping barrier, bracing and falling height on the head impact conditions. Overall, we performed 1692 simulations. The head impact speed was over two folds larger in falls than trips, with backward falls producing highest impact speeds. However, the trips produced impacts with smaller impact angles to the ground. Increasing the walking speed increased the head impact speed but bracing reduced it. We found that 41% of backward falls and 19% of trips/forward falls produced head impacts located outside the region of helmet coverage. Next, we grouped all the data into three sub-groups based on the head impact angle: [0°, 30°], (30°, 60°] and (60°, 90°] and excluded groups with small number of cases. We found that most trips and forward falls lead to impact angles within the (30°, 60°] and (60°, 90°] groups while all backward falls produced impact angles within (60°, 90°] group. We therefore determined five representative head impact conditions from these groups by selecting the 75th percentile speed, mean value of angle intervals and median impact location (determined by elevation and azimuth angles) of each group. This led to two representative head impact conditions for trips: 2.7 m/s at 45° and 3.9 m/s at 75°, two for forward falls: 3.8 m/s at 45° and 5.5 m/s at 75° and one for backward falls: 9.4 m/s at 75°. These impact conditions can be used to improve industrial helmet standards., (© 2023. The Author(s).)

Positional skull deformities have been on the rise for decades and can be treated with molding helmets in early childhood. Parents often fear later cosmetic stigmatization, but also a reduced quality of life (QoL) during treatment. The aim of this study was to examine therapy results in our patient collection from a new perspective. Cranial vault asymmetry (CVA), cranial vault asymmetry index (CVAI), and cranial index (CI) were compared before and after molding helmet therapy. Correction was defined by a decrease in CVA <3.5 mm and CI <90%. Subjective therapy outcome, side effects and QoL from the parents' perspective were determined using a questionnaire. There were 25 patients included. Differences between pretherapeutic and posttherapeutic CVA, CVAI, and CI were significant ( P <0.01). An objective correction according to the defined values was observed in only 12% of cases. However, 76% of parents stated that their child's skull shape was normal after therapy. There were 60 side effects reported in 23 cases. The QoL of 21 children was assessed as unimpaired during helmet therapy. Even though complete normalization was rarely observed, the parameters were significantly different after therapy, and subjective reduction in skull deformity was common., Competing Interests: The authors report no conflicts of interest., (Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of Mutaz B. Habal, MD.)

Sporting helmets contain force attenuating materials which reduce traumatic head injury risk and may influence sport-related concussion (SRC) sequelae. The purpose of this study was to examine the association of sport helmet status with SRC-clinical presentation and recovery trajectories in men's collegiate athletes. Sport helmet status was based on the nature of sports being either helmeted/non-helmeted. 1070 SRCs in helmeted (HELM) sports (Men's-Football, Ice Hockey, and Lacrosse), and 399 SRCs in non-helmeted (NOHELM) sports (Men's-Basketball, Cheerleading, Cross Country/Track & Field, Diving, Gymnastics, Soccer, Swimming, Tennis, and Volleyball) were analyzed. Multivariable negative binomial regression models analyzed associations between sport helmet status and post-injury cognition, balance, and symptom severity, adjusting for covariate effects (SRC history, loss of consciousness, anterograde/retrograde amnesia, event type). Kaplan-Meier curves evaluated median days to: initiation of return to play (iRTP) protocol, and unrestricted RTP (URTP) by sport helmet status. Log-rank tests were used to evaluate differential iRTP/URTP between groups. Two independent multivariable Weibull accelerated failure time models were used to examine differential iRTP and URTP between groups, after adjusting for aforementioned covariates and symptom severity score. Overall, the median days to iRTP and URTP was 6.3 and 12.0, respectively, and was comparable across NOHELM- and HELM-SRCs. Post-injury symptom severity was lower (Score Ratio 0.90, 95%CI 0.82, 0.98), and cognitive test performance was higher (Score Ratio 1.03, 95%CI 1.02, 1.05) in NOHELM-compared to HELM-SRCs. Estimated time spent recovering to iRTP/URTP was comparable between sport helmet status groups. Findings suggest that the grouping of sports into helmeted and non-helmeted show slight differences in clinical presentation but not recovery., (© 2024. The Author(s) under exclusive licence to Biomedical Engineering Society.)

It was the aim of the study to analyze the distribution and pattern of facial fractures following e-scooter trauma. Prospective audit data of facial fractures were retrospectively collected to investigate the impact of e-scooter hire, specifically in the form of facial fractures associated with their use. Data collected included patient demographics, mode of injury, date of injury, facial bones involved, presence of soft tissue injury, and factors associated with injury, including intoxication and helmet use. A total of 849 patients were treated for facial fractures during the study period, of which 34 were attributed to e-scooter use. One-half of those injured riding e-scooters were intoxicated, and one-quarter were wearing helmets. There have been an increasing number of facial fractures associated with e-scooter use following the start of the shared e-scooter trial. Zygomaticomaxillary complex fractures were the most common pattern of facial fracture seen. Most patients required surgical management of their injuries. Policymakers should consider how to improve the enforcement of current regulations, given the healthcare cost associated with the management of these preventable injuries., (Copyright © 2024 European Association for Cranio-Maxillo-Facial Surgery. All rights reserved.)

Competing Interests: The authors have disclosed no conflicts of interest.

Several parameters affect our brain's neuronal system and can be identified by analyzing electroencephalogram (EEG) signals. One of the parameters is alcoholism, which affects the pattern of our EEG signals. By analyzing these EEG signals, one can derive information regarding the alcoholic or normal stage of an individual. Many road accident cases around the world, including drinking and driving scenarios, which result in loss of life, have been reported. Another reason for such incidents is that riders avoid wearing helmets while driving two-wheelers. Many road accident cases involving two-wheelers, including drinking, driving, overspeeding, and nonwearing helmets, have been reported. Therefore, to solve such issues, the present work highlights the features of an intelligent model that can predict the alcoholism level of the subject, wearing of a helmet, vehicle speed, location, etc. The system is designed with the latest technologies and is smart enough to make decisions. The system is based on multilayer perceptron, histogram of oriented gradients (HoG) feature extraction, and random forest to make decisions in real time. The accuracy of the proposed method is approximately 95%, which will reduce the fatality rate due to road accidents. The system is tested under different working environments, i.e., indoor and outdoor, and satisfactory outcomes are observed., (© 2024. The Author(s).)

The prevalence of positional cranial asymmetry has significantly increased since the introduction of the "Back to Sleep" campaign. Some deformities require therapeutic measures, such as growth-guiding head prostheses. The diagnosis is based on the clinical features, a thorough clinical examination and measurement of the infant's head. Prevention includes early education of parents about alternative positioning methods. Early interventions such as positioning therapy and physiotherapy can be effective in mild cases. In severe cases, the use of growth-guiding orthoses is necessary. The treatment and timing are crucial as head growth is highest in the first year of life. Helmet treatment should be started early to achieve optimal results in order to achieve an improvement in the head shape and ear position. Multidisciplinary approaches including physiotherapy and osteopathy are essential., (© 2024. The Author(s), under exclusive licence to Springer Medizin Verlag GmbH, ein Teil von Springer Nature.)