Effect of Aging on Brain Injury Prediction in Rotational Head Trauma—A Parameter Study with a Rat Finite Element Model

Objective: The aim of this study was to investigate the possible effects of age-related intracranial changes on the potential outcome of diffuse axonal injuries and acute subdural hematoma under rotational head loading.

Methods: A simulation-based parametric study was conducted using an updated and validated finite element model of a rat head. The validation included a comparison of predicted brain cortex sliding with respect to the skull. Further, model material properties were modified to account for aging; predicted tissue strains were compared with experimental data in which groups of rats in 2 different lifecycle stages, young adult and mature adult, were subjected to rotational trauma. For the parameter study, 2 age-dependent factors—brain volume and region-specific brain material properties—were implemented into the model. The models young adult and old age were subjected to several injurious and subinjurious sagittal plane rotational acceleration levels.

Results: Sequential analysis of the simulated trauma progression indicates that an increase in acute subdural hematoma injury risk indicator occurs at an early stage of the trauma, whereas an increase in diffuse axonal injury risk indicators occurs at a later stage. Tissue stiffening from young adult to mature adult rats produced an increase in strain-based thresholds accompanied by a wider spread of strain distribution toward the rear part of the brain, consistent with rotational trauma experiments with young adult and mature adult rats. Young adult to old age brain tissue softening and brain atrophy resulted in an increase in diffuse axonal injuries and acute subdural hematoma injury risk indicators, respectively.

Conclusions: The findings presented in this study suggest that age-specific injury thresholds should be developed to enable the development of superior restraint systems for the elderly. The findings also motivate other further studies on age-dependency of head trauma.     

Older Adults at Increased Risk as Pedestrians in Victoria,Australia: An Examination of Crash Characteristics and Injury Outcomes

Objectives: Engaging in active transport modes (especially walking) is a healthy and environmentally friendly alternative to driving and may be particularly beneficial for older adults. However, older adults are a vulnerable group: they are at higher risk of injury compared with younger adults, mainly due to frailty and may be at increased risk of collision due to the effects of age on sensory, cognitive, and motor abilities. Moreover, our population is aging, and there is a trend for the current cohort of older adults to maintain mobility later in life compared with previous cohorts. Though these trends have serious implications for transport policy and safety, little is known about the contributing factors and injury outcomes of pedestrian collision. Further, previous research generally considers the older population as a homogeneous group and rarely considers the increased risks associated with continued ageing.

Method: Collision characteristics and injury outcomes for 2 subgroups of older pedestrians (65–74 years and 75+ years) were examined by extracting data from the state police–reported crash dataset and hospital admission/emergency department presentation data over the 10-year period between 2003 and 2012. Variables identified for analysis included pedestrian characteristics (age, gender, activity, etc.), crash location and type, injury characteristics and severity, and duration of hospital stay. A spatial analysis of crash locations was also undertaken to identify collision clusters and the contribution of environmental features on collision and injury risk.

Results: Adults over 65 years were involved in 21% of all pedestrian collisions. A high fatality rate was found among older adults, particularly for those aged 75 years and older: this group had 3.2 deaths per 100,000 population, compared to a rate of 1.3 for 65- to 74-year-olds and 0.7 for adults below 65 years of age. Older pedestrian injuries were most likely to occur while crossing the carriageway; they were also more likely to be injured in parking lots, at driveway intersections, and on sidewalks compared to younger cohorts. Spatial analyses revealed older pedestrian crash clusters on arterial roads in urban shopping precincts. Significantly higher rates of hospital admissions were found for pedestrians over the age of 75 years and for abdominal, head, and neck injuries; conversely, older adults were underrepresented in emergency department presentations (mainly lower and upper extremity injuries), suggesting an increased severity associated with older pedestrian injuries. Average length of hospital stay also increased with increasing age.

Conclusion: This analysis revealed age differences in collision risk and injury outcomes among older adults and that aggregate analysis of older pedestrians can distort the significance of risk factors associated with older pedestrian injuries. These findings have implications that extend to the development of engineering, behavioral, and enforcement countermeasures to address the problems faced by the oldest pedestrians and reduce collision risk and improve injury outcomes.     

New Methodology for an Expert-Designed Map From International Classification of Diseases (ICD) to Abbreviated Injury Scale (AIS) 3+ Severity Injury

Objective: There has been a longstanding desire for a map to convert International Classification of Diseases (ICD) injury codes to Abbreviated Injury Scale (AIS) codes to reflect the severity of those diagnoses. The Association for the Advancement of Automotive Medicine (AAAM) was tasked by European Union representatives to create a categorical map classifying diagnoses codes as serious injury (Abbreviated Injury Scale [AIS] 3+), minor/moderate injury (AIS 1/2), or indeterminate. This study's objective was to map injury-related ICD-9-CM (clinical modification) and ICD-10-CM codes to these severity categories.

Methods: Approximately 19,000 ICD codes were mapped, including injuries from the following categories: amputations, blood vessel injury, burns, crushing injury, dislocations/sprains/strains, foreign body, fractures, internal organ, nerve/spinal cord injury, intracranial, laceration, open wounds, and superficial injury/contusion. Two parallel activities were completed to create the maps: (1) An in-person expert panel and (2) an electronic survey. The panel consisted of expert users of AIS and ICD from North America, the United Kingdom, and Australia. The panel met in person for 5 days, with follow-up virtual meetings to create and revise the maps. Additional qualitative data were documented to resolve potential discrepancies in mapping. The electronic survey was completed by 95 injury coding professionals from North America, Spain, Australia, and New Zealand over 12 weeks. ICD-to-AIS maps were created for: ICD-9-CM and ICD-10-CM. Both maps indicated whether the corresponding AIS 2005/Update 2008 severity score for each ICD code was AIS 3+, 1/2, or indeterminable. Though some ICD codes could be mapped to multiple AIS codes, the maximum severity of all potentially mapped injuries determined the final severity categorization.

Results: The in-person panel consisted of 13 experts, with 11 Certified AIS specialists (CAISS) with a median of 8 years and an average of 15 years of coding experience. Consensus was reached for AIS severity categorization for all injury-related ICD codes. There were 95 survey respondents, with a median of 8 years of injury coding experience. Approximately 15 survey responses were collected per ICD code. Results from the 2 activities were compared, and any discrepancies were resolved using additional qualitative and quantitative data from the in-person panel and survey results, respectively.

Conclusions: Robust maps of ICD-9-CM and ICD-10-CM injury codes to AIS severity categories (3+ versus <3) were successfully created from an in-person panel discussion and electronic survey. These maps provide a link between the common ICD diagnostic lexicons and the AIS severity coding system and are of value to injury researchers, public health scientists, and epidemiologists using large databases without available AIS coding.     

The Contribution of Pre-impact Posture on Restrained Occupant Finite Element Model Response in Frontal Impact

Objective: The objective of this study was to discuss the influence of the pre-impact posture to the response of a finite element human body model (HBM) in frontal impacts.

Methods: This study uses previously published cadaveric tests (PMHS), which measured six realistic pre-impact postures. Seven postured models were created from the THUMS occupant model (v4.0): one matching the standard UMTRI driving posture as it was the target posture in the experiments, and six matching the measured pre-impact postures. The same measurements as those obtained during the cadaveric tests were calculated from the simulations, and biofidelity metrics based on signals correlation (CORA) were established to compare the response of the seven models to the experiments.

Results: The HBM responses showed good agreement with the PMHS responses for the reaction forces (CORA = 0.80 ± 0.05) and the kinematics of the lower part of the torso but only fair correlation was found with the head, the upper spine, rib strains (CORA= 0.50 ± 0.05) and chest deflections (CORA = 0.67 ± 0.08). All models sustained rib fractures, sternal fracture and clavicle fracture. The average number of rib fractures for all the models was 5.3 ± 1.0, lower than in the experiments (10.8 ± 9.0).

Variation in pre-impact posture greatly altered the time histories of the reaction forces, deflections and the rib strains, mainly in terms of time delay, but no definite improvement in HBM response or injury prediction was observed. By modifying only the posture of the HBM, the variability in the impact response was found to be equivalent to that observed in the experiments. The postured HBM sustained from 4 to 8 rib fractures, confirming that the pre-impact posture influenced the injury outcome predicted by the simulation.

Conclusions: This study tries to answer an important question: what is the effect of occupant posture on kinematics and kinetics. Significant differences in kinematics observed between HBM and PMHS suggesting more coupling between the pelvis and the spine for the models which makes the model response very sensitive to any variation in the spine posture. Consequently, the findings observed for the HBM cannot be extended to PMHS. Besides, pre-impact posture should be carefully quantified during experiments and the evaluation of HBM should take into account the variation in the predicted impact response due to the variation in the model posture.     

Assessment of potential dermal and inhalation exposure of workers to the insecticide imidacloprid using whole-body dosimetry in China

In China, although improvements to the pesticide registration process have beenmade in last thirty years, no occupational exposure data are required to obtain a commercial license for a pesticide product. Consequently, notably little research has been conducted to establish an exposure assessment procedure in China. The present study monitored the potential dermal operator exposure from knapsack electric sprayer wheat field application of imidacloprid in Liaocheng City, Shandong Province and in Xinxiang City, Henan Province, China, using whole-body dosimetry. The potential inhalation exposure was determined using a personal air pump and XAD-2 sample tubes. The analytical method was developed and validated, including such performance parameters as limits of detection and quantification, linear range, recovery and precision. The total potential dermal and inhalation exposures were 14.20, 16.80, 15.39 and 20.78 mL/hr, respectively, for the four operators in Liaocheng and Xinxiang, corresponding to 0.02% to 0.03% of the applied volume of spray solution. In all trials, the lower part (thigh, lower leg) of the body was the most contaminated, accounting for approximately 76% to 88% of the total exposure. The inhalation exposure was less than 1% of the total exposure. Such factors as the application pattern, crop type, spray equipment, operator experience and climatic conditions have been used to explain the exposure distribution over the different parts of the body. As indicated by the calculated Margin of Exposure, the typical wheat treatment scenarios when a backpack sprayer was used are considered to be safe in terms of imidacloprid exposure.     

Responses of soil ammonia oxidizers to a short-term severe mercury stress

The responses of soil ammonia-oxidizing archaea(AOA) and ammonia-oxidizing bacteria(AOB) to mercury(Hg) stress were investigated through a short-term incubation experiment.Treated with four different concentrations of Hg(CK,Hg25,Hg50,and Hg100,denoting 0,25,50,and 100 mg Hg/kg dry soil,respectively),samples were harvested after 3,7,and 28 day incubation.Results showed that the soil potential nitrification rate(PNR) was significantly inhibited by Hg stress during the incubation.However,lower abundances of AOA(the highest in CK: 9.20 × 10~7 copies/g dry soil; the lowest in Hg50: 2.68 × 10~7 copies/g dry soil) and AOB(the highest in CK: 2.68 × 10~7 copies/g dry soil; the lowest in Hg50:7.49 × 10~6 copies/g dry soil) were observed only at day 28 of incubation(P 0.05).Moreover,only the community structure of soil AOB obviously shifted under Hg stress as seen through DGGE profiles,which revealed that 2–3 distinct AOB bands emerged in the Hg treatments at day 28.In summary,soil PNR might be a very useful parameter to assess acute Hg stress on soil ecosystems,and the community structure of soil AOB might be a realistic biological indicator for the assessment of heavy metal stress on soil ecosystems in the future.     

Alien plant invasions--incorporating emerging invaders in regional prioritization: a pragmatic approach for Southern Africa

Plant invasions are a serious threat to natural and semi-natural ecosystems worldwide. Most management-orientated research on invasions focuses on invaders that are already widespread and often have major impacts. This paper deals with "emerging" invaders-those alien species with the potential to become important problems without timely intervention. A climate matching procedure was developed to define areas of South Africa, Lesotho and Swaziland that could be invaded by 28 plant species that had previously been classified as emerging invaders. Information on the location of populations of these species in the study area was combined with information on their distributions (as native or alien) in parts of Australia and the United States of America. These two countries had the best available distribution data for this study. They also share many invasive alien plant species with South Africa. Climatic data obtained for weather stations near points of known occurrence in these countries were used to define the climatically suitable areas for each species in the study area. Almost 80% of the remaining natural environment in southern Africa was found to be vulnerable to invasion by at least one of these species, 50% by six or more and 24% by 16 or more species. The most vulnerable areas are the highveld grasslands and the eastern escarpment. The emerging invaders with the greatest potential range included Acacia podalyriifolia and Cortaderia selloana. The globally important invaders Ulex europaeus and Lythrum salicaria had a more limited invasion potential but could still become major invaders. There was no relationship between the extent of the climatically suitable areas for the different species and an expert ranking of their invasion potential, emphasising the uncertainties inherent in making expert assessments based on very little information. The methods used in this analysis establish a protocol for future modelling exercises to assess the invasion potential of other emerging invaders.     

Formation of Two Xylem Frost Injuries in One Annual Ring in Siberian Spruce under Conditions of Western Siberian Forest-Tundra

The phenomenon of the formation of two damaged xylem layers in one frost ring is described in Siberian spruce grown in western Siberian forest-tundra. Temperature conditions providing for the formation of pathological cell and tissue structures are determined. The relationship between the formation of double frost injuries and cold periods is demonstrated.     

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.     

Should 'Cyrus the Centipede' take a hike? Effects of exposure to a pedestrian safety program on children's safety knowledge and self-reported behaviors

INTRODUCTION: We report the first evaluation of the popular "Cyrus the Centipede" child pedestrian safety program. METHOD: A pre-test/post-test control versus experimental condition design was used to assess Cyrus' impact on third graders' pedestrian safety knowledge, and self-reported pedestrian behaviors. RESULTS: Although some beneficial effects were observed, the program was not reliably effective. In particular, the impact of exposure to Cyrus was strongly influenced by the individual teacher who delivered it, likely due to the highly unstructured nature of the curriculum. SUMMARY: We suggest that: (a) the effectiveness and reliability of such programs be demonstrated before they are widely adopted; and (b) programs that focus on training children in actual or simulated traffic environments may be more effective than those that primarily focus on teaching safety facts and rules.