Reduce Injury Rates Research Articles

Nerve monitoring in the hands of less experienced surgeons.

To the Editor, We read with interest the paper titled “Is Nerve Monitoring Required in Total Thyroidectomy? Cerrahpasa Experience” by Teksoz et al. in the Indian Journal of Surgery [1]. In their study, 322 recurrent laryngeal nerves (RLN) under risk were evaluated. Patients who underwent total thyroidectomy including visual identification of RLN combined with intraoperative neurophysiological monitoring (IONM) were identified as group 1(n = 162), whereas those who underwent total thyroidectomy without RLN identification were identified as group 2 (n = 160). As the results of their study, they clinically supposed that “nerve monitoring does not provide any contribution to an experienced surgeon; however, it might be used to assist less experienced surgeons with anatomical identification”. In our surgery clinic, IONM is a preferred and well-known procedure in the treatment of thyroid diseases. Based on our experience, this procedure has some limitations and should not be performed by less experienced surgeons. It may be dangerous in the hands of less experienced surgeons. We would like to express our opinion, based on some important questions: First, the neuromonitoring system has special pitfalls, which have to be described. The amplitude (number of oscillations) of the wave, which was evoked by stimulation of the RLN, is typically a biphasic waveform which represents the summated motor action. During the thyroid surgery, the amplitude may be affected negatively by several factors such as inadequate probe–nerve contact, fluid or blood in the place of stimulation, covering of the nerve by the fascia, the environmental temperature and endotracheal tube electrode surface position [2]. Second, intermittent RLN monitoring alone was shown to be not accurate enough in predicting RLN injury because lesions at the RLN can be proximal from the stimulation point. The adoption of the IONM technique is precluded by a steep learning curve. Device malfunction may result in unsuccessful monitoring, which could potentially give rise to misleading information and, hence, increase the risk of RLN injury [3]. A false result such as “not nerve” because of the above-mentioned reasons may be very frustrating and dangerous especially for a less experienced surgeon. The surgeon may cut the nerve by misleading information. The initial rule of neuromonitoring is visualisation of the nerve. How could a surgeon with less experience in anatomical identification be adept in neuromonitoring? Third, in group 2, the authors did not identify the RLN. Additionally, they did not find a statistically significant difference between groups for RLN paralysis. On the other hand, in the literature, routine visualisation of the RLN has been suggested in thyroid surgery. Regarding the identification of RLN and its preservation, it is now believed that the “nerve not seen is damaged” rather than “seen is damaged” as was earlier believed. In their daily surgical practice, do the authors really not identify RLN, or do they perform routine RLN dissection? Finally, we believe that the main factors influencing a reduction of RLN injury rates are meticulous dissection technique and respect of the gold standard that includes routine visualisation of the RLN.

Injuries in Commercial Whitewater Rafting on the New and Gauley Rivers of West Virginia

To describe the rates, patterns, and likelihood of injuries in commercial whitewater rafting on the New and Gauley rivers, West Virginia. Standardized injury report forms developed by the West Virginia Whitewater Commission were reviewed for years 2005-2010 to provide a statistical account of injuries reported by licensed commercial rafting outfitters operating on the New and Gauley rivers. Overall, musculoskeletal injuries (sprains/strains, 21.1%; dislocations, 13.8%; fractures, 12.2%) comprised the majority (47.4%) of incidents followed by injuries to soft tissue (lacerations, 29.0%; abrasions, 13.3%; contusions, 2.3%). Almost one half (44.3%) of injuries were to the head, neck, and shoulders followed by the lower extremities (foot/ankle/leg/knee/hip, 33.9%) and upper extremities (hand/wrist/arm, 14.3%). Data analyzed using the Somers' D statistic revealed the likelihood of an injury occurring inside the raft is P = .55, and P = .39 when passengers are ejected from the raft into the river. The most likely injuries to occur to passengers are a laceration (P = .51) or a sprain (P = .20). The main probabilities for the risks of injuries were found to be to the head (P = .24), shoulder (P = .16), and face (P = .13) of the passenger. By knowing what injuries are common, their likelihood of occurrence, and the settings in which they happen, commercial outfitters can initiate practices to reduce injury rates.

Lower limb kinematics and plantar pressure distribution with different foot strike patterns during running

Some runners opt to run barefoot amid speculation that this might be associated with reduced injury rates compared to shod running. However, there is a lack of research on habitual barefoot runners...

Could Targeted Exercise Programmes Prevent Lower Limb Injury in Community Australian Football?

Australian football is a popular sport in Australia, at both the community and elite levels. It is a high-speed contact sport with a higher incidence of medically treated injuries when compared with most other organized sports. Hamstring injuries, ligament injuries to the knee or ankle, hip/groin injuries and tendinopathies are particularly common and often result in considerable time lost from sport. Consequently, the prevention of lower limb injuries is a priority for both community and elite Australian football organizations. There is considerable literature available on exercise programmes aimed at reducing lower limb injuries in Australian football and other running-related sports. The quality and outcomes of these studies have varied considerably, but indicate that exercise protocols may be an effective means of preventing lower limb injuries. Despite this, there has been limited high-quality and systematic evaluation of these data. The aim of this literature review is to systematically evaluate the evidence about the benefits of lower limb injury prevention exercise protocols aimed at reducing the most common severe lower limb injuries in Australian football. The Cochrane Central Register of Controlled Trials, the Cochrane Bone Joint and Muscle Trauma Group Specialized Register, MEDLINE and other electronic databases were searched, from January 1990 to December 2010. Papers reporting the results of randomized controlled trials (RCTs), quasi-RCTs, cohort and case-control studies were extracted. Primary outcomes were injury reduction or risk factor identification and/or modification. Secondary outcomes were adherence to any trialled interventions, injury severity and adverse effects such as secondary injuries and muscle soreness. The methodological quality of extracted manuscripts was assessed and results were collated. Forty-seven papers were identified and reviewed of which 18 related to hamstring injury, eight related to knee or ankle ligament injury, five related to tendon injury and four were hip or groin injury related. Another 12 papers targeted general lower limb injuries. Most (n = 27 [57%]) were observational studies, investigating injury risk factors. Twenty reported the results of intervention trials. Of these, 15 were efficacy trials reporting the effects of an intervention in reducing injury rates, four were biomechanical interventions in which the impact of the intervention on a known injury risk factor was assessed and one reported changes in injury risk factors as well as injury rates. The strength of the evidence base for exercise programmes for lower limb injury prevention was found to be limited, primarily due to the research methods employed, low adherence to interventions by the study participants and a lack of statistical power. Limited evidence obtained from a small number of RCTs suggests that balance and control exercises might be efficacious in preventing ankle ligament injuries and a programme involving a combination of balance and control exercises, eccentric hamstring, plyometrics and strength exercises could be efficacious in preventing all lower limb injuries. Overall, the evidence for exercise programmes as an efficacious lower limb injury prevention strategy is predominantly restricted to studies addressing injury aetiology and mechanisms. The findings of this review highlight the need to develop and test interventions in well designed population-based trials with an emphasis on promoting intervention uptake and adherence and, hence, intervention effectiveness. The results of this review can inform the development of the components of a future lower limb injury prevention exercise protocol for community-level Australian football.

Home safety education and provision of safety equipment for injury prevention (Review)

In industrialised countries injuries (including burns, poisoning or drowning) are the leading cause of childhood death and steep social gradients exist in child injury mortality and morbidity. The majority of injuries in pre-school children occur at home but there is little meta-analytic evidence that child home safety interventions reduce injury rates or improve a range of safety practices, and little evidence on their effect by social group. We evaluated the effectiveness of home safety education, with or without the provision of low cost, discounted or free equipment (hereafter referred to as home safety interventions), in reducing child injury rates or increasing home safety practices and whether the effect varied by social group. We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (2009, Issue 2) in The Cochrane Library, MEDLINE (Ovid), EMBASE (Ovid), PsycINFO (Ovid), ISI Web of Science: Science Citation Index Expanded (SCI-EXPANDED), ISI Web of Science: Social Sciences Citation Index (SSCI), ISI Web of Science: Conference Proceedings Citation Index- Science (CPCI-S), CINAHL (EBSCO) and DARE (2009, Issue 2) in The Cochrane Library. We also searched websites and conference proceedings and searched the bibliographies of relevant studies and previously published reviews. We contacted authors of included studies as well as relevant organisations. The most recent search for trials was May 2009. Randomised controlled trials (RCTs), non-randomised controlled trials and controlled before and after (CBA) studies where home safety education with or without the provision of safety equipment was provided to those aged 19 years and under, and which reported injury, safety practices or possession of safety equipment. Two authors independently assessed study quality and extracted data. We attempted to obtain individual participant level data (IPD) for all included studies and summary data and IPD were simultaneously combined in meta-regressions by social and demographic variables. Pooled incidence rate ratios (IRR) were calculated for injuries which occurred during the studies, and pooled odds ratios were calculated for the uptake of safety equipment or safety practices, with 95% confidence intervals. Ninety-eight studies, involving 2,605,044 people, are included in this review. Fifty-four studies involving 812,705 people were comparable enough to be included in at least one meta-analysis. Thirty-five (65%) studies were RCTs. Nineteen (35%) of the studies included in the meta-analysis provided IPD. There was a lack of evidence that home safety interventions reduced rates of thermal injuries or poisoning. There was some evidence that interventions may reduce injury rates after adjusting CBA studies for baseline injury rates (IRR 0.89, 95% CI 0.78 to 1.01). Greater reductions in injury rates were found for interventions delivered in the home (IRR 0.75, 95% CI 0.62 to 0.91), and for those interventions not providing safety equipment (IRR 0.78, 95% CI 0.66 to 0.92). Home safety interventions were effective in increasing the proportion of families with safe hot tap water temperatures (OR 1.41, 95% CI 1.07 to 1.86), functional smoke alarms (OR 1.81, 95% CI 1.30 to 2.52), a fire escape plan (OR 2.01, 95% CI 1.45 to 2.77), storing medicines (OR 1.53, 95% CI 1.27 to 1.84) and cleaning products (OR 1.55, 95% CI 1.22 to 1.96) out of reach, having syrup of ipecac (OR 3.34, 95% CI 1.50 to 7.44) or poison control centre numbers accessible (OR 3.30, 95% CI 1.70 to 6.39), having fitted stair gates (OR 1.61, 95% CI 1.19 to 2.17), and having socket covers on unused sockets (OR 2.69, 95% CI 1.46 to 4.96). Interventions providing free, low cost or discounted safety equipment appeared to be more effective in improving some safety practices than those interventions not doing so. There was no consistent evidence that interventions were less effective in families whose children were at greater risk of injury. Home safety interventions most commonly provided as one-to-one, face-to-face education, especially with the provision of safety equipment, are effective in increasing a range of safety practices. There is some evidence that such interventions may reduce injury rates, particularly where interventions are provided at home. Conflicting findings regarding interventions providing safety equipment on safety practices and injury outcomes are likely to be explained by two large studies; one clinic-based study provided equipment but did not reduce injury rates and one school-based study did not provide equipment but did demonstrate a significant reduction in injury rates. There was no consistent evidence that home safety education, with or without the provision of safety equipment, was less effective in those participants at greater risk of injury. Further studies are still required to confirm these findings with respect to injury rates.

Effect of age and breed on cross sectional area of flexor tendons in the metacarpal region of the forelimbs of horses

Effect of age and breed on cross sectional area of flexor tendons in the metacarpal region of the forelimbs of horses

Are regulations effective in reducing construction injuries? An analysis of the Italian context

ObjectivesAt the end of the 1990s, as required by European Directive 92/57/EEC, two laws were enacted in Italy which laid down safety and health requirements for construction sites: Decree 494/96...

The potential effectiveness of young driver high-performance vehicle restrictions as used in Australia

Young drivers persistently have higher crash rates despite various countermeasures targeted at their risk factors and exposures. A potentially high risk situation for novice drivers may feasibly include the driving of high performance vehicles, which are subject to restrictions for probationary and restricted drivers in four Australian States. High performance vehicles are capable of high levels of acceleration and speed, which may encourage unsafe driving behaviours, particularly when driven by novice drivers, who may lack appropriate judgement and experience. This research sought to identify potential safety benefits of restrictions on certain vehicles for novice drivers using crash data from Australia and New Zealand, and vehicle licensing data from New Zealand.Data on crashed vehicles and their drivers were analysed to estimate the prevalence of the high performance vehicles in the fleets considered, particularly when driven by young people. By matching New Zealand licensing data with crash data, it was possible to estimate the risk of these high performance vehicles relative to other vehicles in the fleet. For owners aged under 25, a statistically significant 69% elevated injury crash involvement risk ratio was estimated for the high performance vehicles subject to restrictions in Australia in comparison with their risk with other vehicles controlling for other relevant factors (with 95% CI 30–123%, using owners aged 40–59 as a comparison group). Injuries in the vehicles of young owners of high performance vehicles were estimated to increase compared to their rate in other vehicles by 101% (with 95% confidence interval 69–171%, using owners aged 40–59 as a comparison group). Despite the higher relative risk for the high performance vehicles, they were relatively rare in the fleets studied, and the potential reduction in young driver injury rates from banning these vehicles was estimated to range from 0.4% in New Zealand to 2.5% in the Australian States of Queensland and Victoria. In addition, the potential reductions estimated here also depend on unrealistic assumptions of 100% compliance with regulation and the adoption of less risky driving behaviour in response to lower performance vehicles. Although these vehicles have a statistically significantly higher crash and injury risk than other vehicles when owned by young people, there are considerable costs of implementation and ongoing enforcement in imposing vehicle restrictions for young drivers that may not outweigh these potential safety benefits.

Mid-Thoracic Spinal Injuries during Horse Racing: Report of 3 Cases and Review of Causative Factors and Prevention Measurements

We report three cases of a rare pattern of mid-thoracic spine injuries after horse racing falls and discuss possible causative factors and prevention measurements to reduce injury rates in professional riding and racing. Three patients, 2 male and 1 female with a mean age of 28 years old, underwent surgical treatment for mid-thoracic fractures after professional equestrian activities. The ASIA scale was E in one patient, B in the other one and A in the third. Multilevel posterior fusion was used in two patients and somatectomy plus fusion in the other. Follow up evaluation included changing of the ASIA scale, functional outcome and participation in equestrian activities. One patient fully recovered after surgery. Two patients remained paraplegic despite early surgical treatment and prolonged rehabilitation therapy. All patients had ended their professional equestrian career. This report analyzes possible mechanisms of injury and the pattern of mid-thoracic spine fractures after professional horse riding injuries. Despite skill improvements and continued safety education for horse riding, prophylactic measures for both the head and the spine should be refined. According to our study, additional mid-thoracic spinal protection should be added.

Risk Factors for Lower Extremity Muscle Injury in Professional Soccer

Background: Muscle injury is the most common injury type in professional soccer players. Despite this, risk factors for common lower extremity injuries remain elusive. Purpose: To evaluate the effects of various player- and match-related risk factors on the occurrence of lower extremity muscle injury in male professional soccer. Study Design: Cohort study; Level of evidence, 2. Methods: Between 2001 and 2010, 26 soccer clubs (1401 players) from 10 European countries participated in the study. Individual player exposure and time loss muscle injuries in the lower extremity were registered prospectively by the club medical staffs during 9 consecutive seasons. Hazard ratios (HRs) were calculated for player-related factors from simple and multiple Cox regression, and odds ratios (ORs) were calculated for match-related variables from simple and multiple logistic regression, presented with 95% confidence intervals (CIs). Results: There were 2123 muscle injuries documented in the major lower extremity muscle groups: adductors (n = 523), hamstrings (n = 900), quadriceps (n = 394), and calf (n = 306). Injuries to the adductors (56%; P = .015) and quadriceps (63%; P< .001) were more frequent in the kicking leg. Multiple analysis indicated that having a previous identical injury in the preceding season increased injury rates significantly for adductor (HR, 1.40; 95% CI, 1.00-1.96), hamstring (HR, 1.40; 95% CI, 1.12-1.75), quadriceps (HR, 3.10; 95% CI, 2.21-4.36), and calf injuries (HR, 2.33; 95% CI, 1.52-3.57). Older players (above mean age) had an almost 2-fold increased rate of calf injury (HR, 1.93; 95% CI, 1.38-2.71), but no association was found in other muscle groups. Goalkeepers had reduced injury rates in all 4 muscle groups. Match play on away ground was associated with reduced rates of adductor (OR, 0.56; 95% CI, 0.43-0.73) and hamstring injuries (OR, 0.76; 95% CI, 0.63-0.92). Quadriceps injuries were more frequent during preseason, whereas adductor, hamstring, and calf injury rates increased during the competitive season. Conclusion: Intrinsic factors found to increase muscle injury rates in professional soccer were previous injury, older age, and kicking leg. Injury rates varied during different parts of the season and also depending on match location.

Effectiveness of interventions to reduce aggression and injuries among ice hockey players: a systematic review

The increasing incidence of injuries related to playing ice hockey is an important public health issue. We conducted a systematic review to evaluate the effectiveness of interventions designed to reduce injuries related to aggressive acts in ice hockey. We identified relevant articles by searching electronic databases from their inception through July 2012, by using Internet search engines, and by manually searching sports medicine journals, the book series Safety in Ice Hockey and reference lists of included articles. We included studies that evaluated interventions to reduce aggression-related injuries and reported ratings of aggressive behaviour or rates of penalties or injuries. We identified 18 eligible studies. Most involved players in minor hockey leagues. Of 13 studies that evaluated changes in mandatory rules intended to lessen aggression (most commonly the restriction of body-checking), 11 observed a reduction in penalty or injury rates associated with rule changes, and 9 of these showed a statistically significant decrease. The mean number of penalties decreased by 1.2-5.9 per game, and injury rates decreased 3- to 12-fold. All 3 studies of educational interventions showed a reduction in penalty rates, but they were not powered or designed to show a change in injury rates. In 2 studies of cognitive behavioural interventions, reductions in aggressive behaviours were observed. Changes to mandatory rules were associated with reductions in penalties for aggressive acts and in injuries related to aggression among ice hockey players. Effects of educational and cognitive behavioural interventions on injury rates are less clear. Well-designed studies of multifaceted strategies that combine such approaches are required.

Systematic review and meta-analysis evaluating the effectiveness of home safety interventions (education and provision of safety equipment) for child injury prevention

BackgroundInjuries are the leading cause of childhood death in industrialised countries with steep social gradients in morbidity and mortality. Most injuries in pre-school children occur at home, however there is...

EFFECT OF DRUG TESTING PROGRAMMES ON INJURY RATE AND SEVERITY IN SMALL AND MEDIUM SIZED CONSTRUCTION COMPANIES

BackgroundConstruction work is hazardous and workers consistently rank in the top of all occupations and industries for illicit drug and heavy alcohol use.ObjectiveDetermine the associations between active company drug testing...

Understanding accident causation in led outdoor activities: development of an accident analysis framework

BackgroundIn Australia, injury-causing accidents during led outdoor activities are currently problematic; however, the industry's understanding of accidents is limited and the surveillance systems required to enhance it do not exist....

Home safety education and provision of safety equipment for injury prevention.

In industrialised countries injuries (including burns, poisoning or drowning) are the leading cause of childhood death and steep social gradients exist in child injury mortality and morbidity. The majority of injuries in pre-school children occur at home but there is little meta-analytic evidence that child home safety interventions reduce injury rates or improve a range of safety practices, and little evidence on their effect by social group. We evaluated the effectiveness of home safety education, with or without the provision of low cost, discounted or free equipment (hereafter referred to as home safety interventions), in reducing child injury rates or increasing home safety practices and whether the effect varied by social group. We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (2009, Issue 2) in The Cochrane Library, MEDLINE (Ovid), EMBASE (Ovid), PsycINFO (Ovid), ISI Web of Science: Science Citation Index Expanded (SCI-EXPANDED), ISI Web of Science: Social Sciences Citation Index (SSCI), ISI Web of Science: Conference Proceedings Citation Index- Science (CPCI-S),CINAHL (EBSCO) and DARE (2009, Issue 2) in The Cochrane Library. We also searched websites and conference proceedings and searched the bibliographies of relevant studies and previously published reviews. We contacted authors of included studies as well as relevant organisations. The most recent search for trials was May 2009. Randomised controlled trials (RCTs), non-randomised controlled trials and controlled before and after (CBA) studies where home safety education with or without the provision of safety equipment was provided to those aged 19 years and under, and which reported injury, safety practices or possession of safety equipment. Two authors independently assessed study quality and extracted data. We attempted to obtain individual participant level data (IPD) for all included studies and summary data and IPD were simultaneously combined in meta-regressions by social and demographic variables. Pooled incidence rate ratios (IRR) were calculated for injuries which occurred during the studies, and pooled odds ratios were calculated for the uptake of safety equipment or safety practices, with 95% confidence intervals. Ninety-eight studies, involving 2,605,044 people, are included in this review. Fifty-four studies involving 812,705 people were comparable enough to be included in at least one meta-analysis. Thirty-five (65%) studies were RCTs. Nineteen (35%) of the studies included in the meta-analysis provided IPD.There was a lack of evidence that home safety interventions reduced rates of thermal injuries or poisoning. There was some evidence that interventions may reduce injury rates after adjusting CBA studies for baseline injury rates (IRR 0.89, 95% CI 0.78 to 1.01). Greater reductions in injury rates were found for interventions delivered in the home (IRR 0.75, 95% CI 0.62 to 0.91), and for those interventions not providing safety equipment (IRR 0.78, 95% CI 0.66 to 0.92).Home safety interventions were effective in increasing the proportion of families with safe hot tap water temperatures (OR 1.41, 95% CI 1.07 to 1.86), functional smoke alarms (OR 1.81, 95% CI 1.30 to 2.52), a fire escape plan (OR 2.01, 95% CI 1.45 to 2.77), storing medicines (OR 1.53, 95% CI 1.27 to 1.84) and cleaning products (OR 1.55, 95% CI 1.22 to 1.96) out of reach, having syrup of ipecac (OR 3.34, 95% CI 1.50 to 7.44) or poison control centre numbers accessible (OR 3.30, 95% CI 1.70 to 6.39), having fitted stair gates (OR 1.61, 95% CI 1.19 to 2.17), and having socket covers on unused sockets (OR 2.69, 95% CI 1.46 to 4.96).Interventions providing free, low cost or discounted safety equipment appeared to be more effective in improving some safety practices than those interventions not doing so. There was no consistent evidence that interventions were less effective in families whose children were at greater risk of injury. Home safety interventions most commonly provided as one-to-one, face-to-face education, especially with the provision of safety equipment, are effective in increasing a range of safety practices. There is some evidence that such interventions may reduce injury rates, particularly where interventions are provided at home. Conflicting findings regarding interventions providing safety equipment on safety practices and injury outcomes are likely to be explained by two large studies; one clinic-based study provided equipment but did not reduce injury rates and one school-based study did not provide equipment but did demonstrate a significant reduction in injury rates. There was no consistent evidence that home safety education, with or without the provision of safety equipment, was less effective in those participants at greater risk of injury. Further studies are still required to confirm these findings with respect to injury rates.

Anterior Cruciate Ligament Injury Prevention and Primary Prevention of Knee Osteoarthritis

A fter decades of epidemiologic and mechanistic research, anterior cruciate ligament (ACL) injuries are clearly a growing problem among active youth and adults. On average each year, there are approximately 113 000 ambulatory health care visits for initial care of cruciate ligament injuries and about 75 000 outpatient surgical reconstructions. Assuming that the average surgical cost of reconstruction is $25 000, then surgical costs over a 10-year period exceed $18.7 billion. However, these simple estimates do not take into account either the physical pain, lost school and work days, activity limitations, and disability associated with ACL injuries or the possible long-term sequelae of a major joint injury, such as posttraumatic osteoarthritis. Prior knee injury is one of the strongest risk factors for the development of osteoarthritis: 1 in 2 adults with a serious knee injury will develop knee osteoarthritis over his or her lifetime. In fact, more than 50% of ACL-injured knees will develop osteoarthritis in as few as 10 years. This figure is alarming given the numbers of ACL injuries occurring every year, most in adolescents and young adults during sport and recreation activities. A teenage soccer player who injures a knee at age 16 may develop osteoarthritis by his or her early 30s. With the average annual cost (both direct and indirect) of knee osteoarthritis among primary care patients older than age 55 at $5700, this young adult may expend more than $285 000 over a lifetime. In addition, a proportion of patients will develop knee osteoarthritis severe enough to require total knee replacement. In 2009, 679 260 total knee replacements for osteoarthritis were performed at an average cost of $47 179 per procedure, totaling more than $34 million. Clearly, the human and financial costs of both ACL injury and knee osteoarthritis are staggering. The take-home message from ACL Research Retreat VI is that the mechanisms of ACL injury are multidimensional and complex. Considerable work remains to be done to both identify specific mechanisms of injury and refine current neuromuscular injury-prevention training programs for the greatest cost effectiveness. The challenge to the ACL research community over the next few years is to begin translating and disseminating neuromuscular training programs that have been proven to prevent lower extremity injuries in general and ACL injuries specifically. Waiting to implement effective programs until we know more about specific mechanisms or about which specific components of these programs are responsible for reducing injury rates does a significant disservice to the millions of adolescents and young adults who may have to live with the pain and disability of ACL injury and posttraumatic osteoarthritis. As we move forward from ACL Research Retreat VI, we must begin to implement and widely disseminate effective neuromuscular training programs in community-based, scholastic, and collegiate sports. To do this, ACL researchers may have to venture out of their comfort zones. They will need to develop the skills to effectively plan, translate, and implement programs that are acceptable to athletes, coaches, parents, and sports organization administrators and feasible in the community setting using available resources. The ACL research community also needs to initiate and nurture partnerships with other organizations that can help raise awareness and disseminate effective injury-prevention interventions. The Arthritis Foundation’s Osteoarthritis Action Alliance (OAAA) is a group of more than 35 stakeholder organizations with the goal of ‘‘promoting action to prevent and control osteoarthritis.’’ Groups interested in injury prevention are welcome to join the OAAA Injury Prevention Workgroup; information is available at www. oaactionalliance.org. The Injury Prevention Workgroup of the OAAA is in the initial stages of developing a research agenda that will identify gaps in the scientific knowledge related to injury prevention for the primary prevention of osteoarthritis. Long-term activities will include collecting and marketing best practices in injury prevention and identifying and addressing barriers and facilitators related to dissemination of effective programs.

Safety risk management for electrical transmission and distribution line construction

Prior research has established that electrical contractors involved in the construction and maintenance of electrical transmission and distribution (T&D) lines are at extremely high risk of electrocution. The result of inadvertent contact with T&D lines often is death or severe injury that involves damage to internal organs, musculoskeletal disorders, neurological damages and severe burns. The Electrical Safety Foundation International has demonstrated that contact with overhead power lines has been the single largest cause of electrical fatalities over the last decade. To reduce this disproportionate injury rate, electrical contractors implement many strategies such as the use of rubber insulating equipment, and locking devices. Unfortunately, these strategies are often cost-prohibitive in certain construction and maintenance scenarios. Therefore, electrical contractors are faced with complex decisions that involve comparing the cost of injury prevention with the expected safety benefit. This paper presents research that objectively evaluated the risk associated with common T&D construction tasks and the effectiveness of specific injury prevention techniques. The research team then developed a decision support framework that provides electrical contractors with objective safety and cost feedback given specific project characteristics. The results indicate that many of the effective strategies implemented to reduce T&D electrical injuries are very costly (e.g., de-energizing lines). Consequently, under most conditions, the costs of injury prevention far outweigh the cost savings associated with the reduction of injury rates. The implication of these findings is that T&D electrical contractors must highly value the non-monetary benefits of injury prevention in order to improve safety in their sector.

An Anterior Cruciate Ligament Injury Prevention Framework: Incorporating the Recent Evidence

Anterior cruciate ligament (ACL) injury rates have increased by ∼50% over the last 10 years. These figures suggest that ACL focused research has not been effective in reducing injury rates among community level athletes. Training protocols designed to reduce ACL injury rates have been both effective (n = 3) and ineffective (n = 7). Although a rationale for the use of exercise to reduce ACL injuries is established, the mechanisms by which they act are relatively unknown. This article provides an injury prevention framework specific to noncontact ACL injuries and the design of prophylactic training protocols. It is also apparent that feedback within this framework is needed to determine how biomechanically relevant risk factors like peak joint loading and muscular support are influenced following training. It is by identifying these links that more effective ACL injury prevention training programs can be developed, and, in turn, lead to reduced ACL injury rates in the future.

The Effectiveness of Injury-Prevention Programs in Reducing the Incidence of Anterior Cruciate Ligament Sprains in Adolescent Athletes

There is a high incidence of anterior cruciate ligament (ACL) injury in adolescents participating in pivoting sports such as soccer, basketball, and handball. Most ACL injuries in athletes are noncontact injuries, with a mechanism of sudden deceleration, change in direction, or landing from a jump. These mechanisms coupled with an increase in contraction of the quadriceps have been shown as risk factors for ACL injuries. Injuries to the ACL may require surgery, a long rehabilitation, and the potential for reinjury. Studies have shown reductions in lower extremity injury rates using training protocols that focus on landing mechanics, balance training, strength training, and/or agility training. There has been some thought that starting preventive training programs with adolescent athletes may be the most effective approach to reducing adolescent ACL injuries. Can lower extremity injury-prevention programs effectively reduce ACL injury rates in adolescent athletes?

Attitudes of Teenagers Towards Workplace Safety Training

More than 70 % of teenagers are employed before graduating high school. Every 10 min, in the United States, a young worker is injured on the job. Safety training has been suggested as a way to prevent injuries, yet little is known about the methods of safety training and the effectiveness of training that teens receive at work. This study is the first to assess the attitudes teens hold towards safety training and what they believe would help them stay safe on the job. In 2010, focus groups and interviews were conducted with 42 teens from public high schools in Jefferson County, Kentucky. Participating teens were aged 15-19 years old, 43 % male, 69 % African-American, and 56 % worked either in the restaurant/food industry or in retail jobs. Most teens reported receiving safety training. Although the majority believed that safety training was important, many felt that they personally did not need safety training; that it was "common sense." However, 52 % of teens reported workplace injuries. Many viewed injury lightly and as part of the job, even those that sustained severe injuries. Most teens were trained by methods that seem at best "boring" and at worst, ineffective. Little interaction, action, or repetition is used. Training is not geared towards teens' developmental levels or interest, as in most cases all workers received the same type of training. Safety training may be a powerful way to reduce injury rates among working teenagers, but it is essential that training methods which are geared towards teens are utilized.