Biomechanics of Brain and Spinal-Cord Injury: Analysis of Neuropathologic and Neurophysiology Experiments

This study analyzes 46 brain and 48 spinal-cord impact experiments. The velocity of brain impact was 2.0-10.0 m/s and displacement, 0.75-5.0 mm (5.3-33% compression) using a controlled pneumatic impact. The velocity of spinal-cord impact was 1.5-6.0 m/s and displacement, 1.25-3.25 mm (25-65% compression). Brain injury varied from cortical contusion, diffuse axonal injury (DAI), to fatalities, and spinal-cord injury from temporary to complete loss of somatosensory-evoked potentials. Logist functions were determined for each injury severity and various biomechanical parameters, VC, C, V, and combinations. Brain and spinal-cord injury is most strongly correlated to VC, the viscous response. The goodness-of-fit was x² = 22.1, R-0.84 and p< 0.0000 for fatal brain injury, x² = 27.5, R = 0.96 and p< 0.0000 for cortical contusion, and x² = 17.7, R = 0.49 and p < 0.0001 for partial recovery of spinal-cord conduction. Neural tissue is viscoelastic, with a rate-dependent tolerance related to energy absorption. VC is a measure of energy absorption by impact deformation and is predictive of neural contusion, DAI, long-duration coma, spinal-cord dysfunction, and death. Tolerances for various severities of neural injury are presented. At the tissue level, VC is the product of strain and strain-rate, ε dε/dt. The research shows that strain is not a sufficient parameter of neural injury risk, and that the product of strain and strain-rate is a key biomechanical parameter for brain and spinal-cord injury.     

Effects of physical exercise on musculoskeletal disorders,stress and quality of life in workers

Background. The effect of physical exercise in the workplace (PEW) on health promotion of workers is contradictory. Objective. To evaluate the effects of the PEW in musculoskeletal disorders (MSDs), perception of stress and quality of life in workers. Methods. The participants were divided into two groups: control group (n?=?46) including non-participant workers of the PEW program, and PEW group (n?=?50) including workers who regularly participate in the exercise program. All workers answered the Nordic general questionnaire, the perceived stress scale and the quality-of-life questionnaire. Results. The PEW group reported a lower prevalence of MSDs for the trunk in the last 7 days and 12 months (p?=?0.021 and p?=?0.001, respectively), and for the upper limbs in the last 12 months (p?=?0.001) compared with the control group. The results for the perception of stress and quality of life showed no significant differences between the groups. Conclusion. PEW is a potential method to reduce MSDs in workers, but it was not efficient in reducing stress levels or improving the quality of life of the workers.     

The casualties from electric bike and motorized scooter road accidents

Objective: The objective of this study was to describe demographic and injury characteristics of hospitalized injured patients involved in e-bike and motorized scooter accidents at a national level in Israel divided by different road user groups: riders and pedestrians.

Methods: This was a retrospective study based on data from the National Trauma Registry, between January 1, 2013, and December 31, 2015. All hospitalized casualties due to the involvement of an e-bike or motorized scooter were included. The type of hospitalized road user was further categorized and described by different variables.

Results: During the study period, the Israel Trauma Registry identified 795 hospitalized patients due to an e-bike or motorized scooter accident, with a dramatic 6-fold increase from 2013 to 2015. Although the majority of the injured patients were riders, 8% were pedestrians. Among the total casualties, 33% were children aged 0–14 years and among pedestrians 42% were children and 33% were seniors (ages 60+). Five persons died in hospital, 3 riders and 2 pedestrians.

Conclusions: E-bike and motorized scooter riders represent the majority of patients hospitalized due to related traffic incident. This finding questions the social and economic advantages of electric-powered 2-wheeled vehicles.     

Factors affecting conviction rates of intoxicated driver patients in two large trauma centers

Objective: Outcomes from previous studies report the driving under the influence (DUI) conviction rates for trauma patients in several cities within Canada and the United States over the last 2 decades. This study reports charge, conviction, and prosecution rates for trauma patients at 2 level I trauma centers servicing a large metropolitan city.

Methods: A retrospective review of the trauma databases was completed to identify patients meeting inclusion criteria. Four hundred sixty patients were identified and their records were compared with the district attorney's records for DUI charges and convictions.

Results: The conviction rate for this study was 8.7%, demonstrating continued low rates of conviction despite growing interest and public awareness of drinking and driving.

Conclusions: We discuss legal considerations that providers should consider when treating patients who have been drinking and driving.     

Ergonomic Program Effectiveness: Ergonomic and Medical Intervention

The implementation of a successful ergonomic and medical intervention program designed to reduce the number and severity of injuries and illnesses and the associated levels of discomfort in the workplace is presented. Because of the recent activity concerning the on-again-off-again Occupational Safety and Health Administration (OSHA) Ergonomic Program Standard questions have been raised as to the value and effectiveness of an organization’s ergonomics program. In light of these concerns, the immense cost associated with work-related injury and illness, and the related pain and suffering associated with such injuries and illnesses, it is important to present a workable and effective ergonomic and medical intervention program. The results of this applied study demonstrate that through the application of an ergonomic and medical intervention program, workplace-related injuries and illnesses can be reduced or eliminated.     

Evaluation of Grip Force Using Electromyograms in Isometric Isotonic Conditions

The purpose of this study was to develop a relationship to evaluate the grip force (force_rel) using the electromyogram (EMG_rel) of the flexor digitorum superficialis (FDS) and of the extensor digitorum (ED) according to the flexion-extension wrist angle (θ_f.e) and to the pronation-supination forearm angle (θ_p-s).

Fifteen participants had to exert 3 levels of grip forces in 4 positions of the wrist combined with 3 positions of the forearm.

The relationship is:

force_rel = 0.0045· θ_f-e· EMG_rel(FDS) + 0.48· EMG_rel(FDS)–0.0014 · θ_f-e · EMG_rel(ED) –0.0016 · θ_p.s · EMG_rel(ED) + 0.4· EMG_rel(ED)

This relationship can be used to estimate grip force for levels of strength lower than 50% of the maximal voluntary contraction.     

Road trauma among young Australians: Implementing policy to reduce road deaths and serious injury

Objective: The objective of this study was to estimate the likely reduction in road trauma associated with the implementation of effective interventions to reduce road trauma among young Australians.

Methods: A desktop evaluation was conducted to model the likely reduction in road trauma (deaths and serious injuries resulting in hospitalization) among young people aged 17–24 years residing in Queensland, New South Wales, and Victoria. Potential interventions were identified using a rapid literature review and assigned a score based on evidence of effectiveness and implementation feasibility with the 3 highest scoring interventions included in the modeling. Likely reduction in road trauma was estimated by applying the average risk reduction effect sizes for each intervention to baseline risk (passenger or driver death or serious injury per 100,000 population) of road trauma for young Australians. Point estimates were calculated for the potential number of deaths and serious injuries averted in each state and per 100,000 population, with a one-way sensitivity analysis conducted using uncertainty ranges identified.

Results: Peer passenger and night driving restrictions as well as improved vehicle safety measures had the greatest potential to reduce road trauma. Peer passenger restrictions could avert 14 (range: 5–24) and 24 (range: 8–41) hospitalizations per year in Queensland and New South Wales, respectively, and night driving restrictions could avert 17 (range: 7–26), 28 (range: 12–45), and 13 (range: 6–21) hospitalizations annually in Queensland, New South Wales, and Victoria. These interventions reduced fatalities by less than 1 death annually in each state. Improved vehicle safety measures could avert 0–3, 0–4, and 0–3 deaths and 3–91, 4–156, and 2–75 hospitalizations in Queensland, New South Wales, and Victoria.

Conclusions: Key elements of graduated licensing (peer passenger and night driving restrictions) along with vehicle safety interventions offer modest but practically significant reductions in road trauma for young Australians. State governments need to revise current legislation to ensure that these reductions in road trauma can be realized.     

Debriefing with teachers after the Marmara earthquake: an evaluation study1

The aim of this study was to evaluate the effectiveness of the debriefing meetings conducted after the 1999 earthquakes in Marmara, Turkey. The sample consisted of 265 teachers, 223 of whom attended the debriefing meetings. The personal satisfaction ratings of the teachers who attended the meetings revealed that they found the sessions satisfactory. The results of the comparison between those who reported that they benefited from the meetings and those who felt they did not indicated that the first group had lower scores on all of the psychopathology measures. A comparison between 42 teachers who did not attend the meetings and a randomly chosen group of 45 teachers who did attend revealed that the two groups differed significantly in terms of their post‐traumatic stress symptom scores. The findings of the study suggest that, in general, the teachers' debriefing sessions were satisfactory.     

Abdominopelvic injuries due to road traffic accidents: Characteristics in a registry of 162,695 victims

Objective: Road traffic accidents (RTAs) are the first cause of abdominopelvic injuries (APIs). The objective of this study was to describe the characteristics and severity of APIs due to traffic accidents in a large French trauma registry and to identify risk factors for API.

Methods: All victims from the French Rhône registry of victims of RTAs were analyzed from 1996 to 2013. This registry contained data that were issued over a 20-year period from 245 medical departments, from prehospital care until re-adaptation, and forensic medicine departments. All APIs, defined as an injury between the diaphragm and the pelvic bone, were extracted and studied.

Results: Among 162,695 victims, 10,165 had an API (6.7%). Accidents frequently involved young men and 2 cars. Mean Injury Severity Score (ISS) was 8.7. Mortality rate was 5.6%. Soft tissue injuries largely predominated (n = 6,388; 54.4% of patients). Overall, 2,322 victims had a pelvic bone injury. Internal abdominal organs were involved in 2,425 patients; the most frequent were the spleen, liver, and kidney. Wearing of the seat belt appeared to be a significant protective factor in API, including serious injuries. A partial analysis over the past 2 years among the most severe patients hospitalized in the intensive care unit indicated that nonoperative management was carried out in two thirds of the wounded. In uni- or multivariate analysis, sex, age, type of user, antagonist, time of occurrence, associated severe lesions, or wearing of the seat belt were statistically associated with the occurrence of API, highlighting a more dangerous user profile.

Conclusions: Abdominopelvic injuries concern a minority of road traffic injuries, but they are responsible for significant mortality. Large solid organs are the most frequently affected. Women drivers wearing a seat belt and driving in town during the day appear to be more protected against API.