Risk Of Injury Research Articles

How Accurate Are Surgeons at Assessing the Quality of Their Critical View of Safety During Laparoscopic Cholecystectomy?

IntroductionObtaining the critical view of safety (CVS) is considered an important step to reduce bile duct injuries during laparoscopic cholecystectomy (LC). However, existing literature suggests that few surgeons obtain adequate CVS when LC videos are directly evaluated by experts. This discrepancy calls for effective, standardized CVS teaching methods. While self-assessment (SA) remains the principal tool utilized by practicing surgeons for performance improvement, its effectiveness is controversial. The aim of this study was to compare surgeon SAs of repeated LC performance and attainment of the CVS with that of expert raters. MethodsMulti-institutional study of surgeon members from the Society of American Gastrointestinal and Endoscopic Surgeons who volunteered to participate. All surgeons were asked to submit an LC video and complete a SA of the CVS quality using the Strasberg scale (0-6 score with ≥5 score indicating appropriate CVS). The same videos were reviewed by two blinded expert raters, members of the Society of American Gastrointestinal and Endoscopic Surgeons safe cholecystectomy task force, who had received prior rater training. Surgeon self-ratings and expert ratings were compared with a Wilcoxon signed-rank test. ResultsTwenty-five surgeon-participants were recruited, 13 of whom submitted an LC video. Surgeons did not achieve adequate CVS in their first submitted video based on expert ratings. Surgeons in the SA group overestimated their performance across all four scales: Operative Performance Rating System (z = −0.36, P = 0.715), Global Operative Assessment of Laparoscopic Skills (z = −0.37, P = 0.712), Strasberg (z = −1.84, P = 0.066), and Competency Assessment Tool (z = −0.73, P = 0.465). Surgeons in the coaching group overestimated their performance on each scale as well: Operative Performance Rating System (z = −0.67, P = 0.500), Global Operative Assessment of Laparoscopic Skills (z = −1.48, P = 0.138), Strasberg (z = −1.07, P = 0.285), and Competency Assessment Tool (z = −1.21, P = 0.225). ConclusionsOur study confirms that an adequate CVS is infrequently obtained during LC in a small but national sample of general surgeons. It further adds to the existing body of literature that suggests that SA alone may be inadequate for performance improvement. Effective teaching methods such as expert or artificial intelligence coaching are needed to improve the use of appropriate CVS by surgeons that may help decrease bile duct injury risk.

Decreased isometric neck strength is a risk factor for head, neck and face injuries in professional rugby league players

ABSTRACT Head, neck and face injuries are a concern in contact sports. This exploratory study aimed to establish 1) injury risk factors for head, neck and face injuries and 2) clinical cut-off values related to strength, endurance and proprioception of the cervical spine in a team of professional rugby league players. Pre-season assessments of isometric strength of the flexor, extensor and lateral flexor muscles, endurance of the flexor muscles and joint position error were conducted. Injuries resulting in games missed were recorded. Cross-tabulations were used to determine the unadjusted odds ratios for the measures as risk factors for playing season injuries. The unadjusted odds ratio (OR) values indicated that if a player had weaker extensors of the neck (<36.4 kg, p = 0.014; <3.4N/kg, p = 0.014) or asymmetry of isometric strength of their lateral flexor muscles (left-to-right ratio <0.91, p = 0.005), their odds of games missed due to season head, neck and face injuries was increased (OR extensors = 8; 95% CI = 1.5-42.5 OR asymmetry of lateral flexor muscles OR = 12.6; 95% CI = 2.0-79.4). As muscle strength is modifiable, the clinical application of this study would involve targeting players in the team beneath the clinical cut-off value.

Exploring the Relationship Between Foot Position and Reduced Risk of Knee-Related Injuries in Side-Cutting Movements

Background: Knee-related injuries often result from poor movement patterns that destabilize the joint and increase stress on knee structures. Understanding the influence of foot positioning on knee biomechanics is critical for identifying high-risk movement patterns and preventing injuries. Methods: Twenty healthy male participants performed side-cutting movements at three different foot progression angles. One participant’s data were used to develop and validate a knee finite element model with high-speed dual fluoroscopic imaging (DFIS). Combined with a musculoskeletal analysis, the model simulated internal knee loads under various foot-positioning conditions. Results: The analysis revealed that, as the external foot progression angle increased, the ankle plantarflexion decreased, while the ankle internal rotation and knee valgus moments increased. Higher stress concentrations were observed on the ACL, lateral meniscus, lateral tibial cartilage, and medial collateral ligament, particularly at the femoral–tibial ACL attachments. Conclusion: The findings suggest that a toe-out foot position elevates the risk of knee injuries by increasing stress on key structures, whereas a toe-in position may enhance joint stability, reduce the ACL injury risk, and promote favorable muscle activation patterns.

Postural Responses in Trauma-Experienced Individuals

Background: Balance and proprioception are essential elements in postural control and injury prevention. Proprioception, the body’s sense of position and movement, is closely tied to balance, which depends on input from the visual, vestibular, and somatosensory systems. This article explores the link between trauma experiences and proprioceptive dysfunction, emphasizing how heightened muscle tone, dissociation, and altered sensory processing contribute to balance issues and the risk of injury. Method: The study included 48 participants, aged 18–25. Participants completed the Emotional Regulation Scale, Dissociative Experiences Scale II, and Childhood Trauma Questionnaire, after which they had to stand on a BTrackS Balance Plate while being exposed to images that are designed to evoke emotions from the OASIS image set. The balance plate software calculated outcomes of the participants’ postural sway (total sway, sway area, root mean square (RMS) to the mediolateral (ML) and anteroposterior (AP) way, and excursion to ML and AP ways). Results: Dissociative experience shows significant correlation with RMS ML when viewing positive pictures (rτ = 0.207, p = 0.045) and when viewing negative pictures again; scores with RMS ML (rτ = 0.204, p = 0.049) but also with RMS AP (rτ = 0.209, p = 0.042) and with Excursion ML (rτ = 0.200, p = 0.049) were significant. Experiences of physical abuse affected certain indicators of postural sway when viewing positive images compared to participants with no such experience (sway area: U = 374.50, p = 0.027; RMS AP: U = 383.50, p = 0.016; Excursion ML: U = 397.00, p = 0.007). Similarly, physical neglect affected postural sway during viewing of negative images (sway area: U = 366.50, p = 0.003; RMS AP: U = 371.00, p = 0.004; Excursion ML: U = 347.00, p = 0.034; and Excursion AP: U = 353.00, p = 0.010). Conclusions: The study highlights that dissociation disrupts balance in trauma survivors, especially under emotional stress which highlights the potential for motor-based treatments.

Same Same but Different: Why Both Sport-Specific Cutting Tasks and Generic Change-Of-Direction Tasks Might Need to Be Considered to Prevent ACL Injury

OBJECTIVE: To compare knee abduction moment (KAM) magnitudes between a generic 180° pivot turn (modified 505 change-of-direction test; m505) and a handball-specific sidestep cut, and to assess ranking consistency. Additionally, to examine the resultant ground reaction force (GRF) and its frontal plane moment arm to the knee to comprehend their contributions to KAM. STUDY DESIGN: Observational laboratory study. METHODS: High-level female handball players (n = 45) performed the m505 and handball-specific sidestep cut. Resultant GRF, its frontal plane moment arm to the knee, and KAM were obtained and subsequently compared between the tasks. Rank correlation coefficients were employed to assess if variables of both tasks are related. RESULTS: Peak KAM was similar for the m505 and the sidestep cut (1.79 (0.95 – 3.53) Nm/kg vs. 1.64 (0.34 – 3.60) Nm/kg; rB = .25; p = .14). The ranking of the players' peak KAM differed substantially ( rS = 0.26, p = .084), suggesting that different tasks could classify the same player with different injury risk. The m505 generated lower resultant GRF (24 ± 4 N/kg, 95% CI [23, 24] vs. 33 ± 9 N/kg, 95% CI [31, 35]; d = 1.30; p &lt; .001) but longer frontal plane moment arms (7.8 ± 1.8 cm, 95% CI [7.3, 8.4] vs. 5.4 ± 1.5 cm, 95% CI: [5.0, 5.8]; d = 1.36; p &lt; .001) than the sidestep cut. CONCLUSION: A difference in individual ACL injury risk assessment depending on movement type was revealed. While KAM magnitudes were similar across direction-change tasks, player rankings differed. The contributions of resultant GRF and frontal plane moment arms to peak KAM varied between tasks, underscoring the importance of task-specific and individualized injury prevention.

Injuries in weightlifting and powerlifting: an updated systematic review

ObjectiveTo systematically review the literature on the incidence, prevalence, anatomical injury localisation and risk factors in Olympic weightlifting and powerlifting.DesignUpdated systematic review, PROSPERO registration (CRD42022382364).Data sourcesFour databases (PubMed, Embase, SPORTDiscus...

A fish-friendly axial flow pump turns out to be eel safe, roach unfriendly and bream unsafe

Additional and refurbished pumping stations are required to mitigate the intensifying occurrence of droughts and floodings. These installations negatively impact threatened freshwater fish populations due to the increased risk of injury and mortality when fish pass through them. Fish-friendly pumping installations have been proposed as a potential solution to reduce these risks. However, published assessments of these new types of pumps remains lacking, and the few available studies do not enable a cross-comparison with conventional pump types. The promising, yet understudied, Fairbank Nijhuis ‘fish-friendly’ axial flow pump has been assessed in previous works, however the results remain ambiguous due to low recapture rates, unconsidered parameters, fixed operating conditions, and the inability to identify the likely sources of injury and mortality. In this study, we address the limitations of previous works by implementing a standardized protocol for live fish in conjunction with passive barotrauma detection sensors. The major finding of this work is that safe passage of eel (100% survival) is confirmed, but that bream and roach had a much lower survival probability (24% and 70% survival respectively) than expected, albeit higher than for a conventional axial flow pump (roach survival: 13%). Furthermore, roach and bream passing at higher rpm suffered significantly higher mortalities. The impact of the impeller was found to be the most common source of severe injury for both pumps. These results are significant because they conclusively show that fish-friendly pumps may be considered safe for eel, but not for other endemic European fish species such as roach and bream.

Change in Spatiotemporal Parameters During Running at Different Degrees of Inclination: Systematic Review

Background:Running is one of the simplest and most popular forms of exercise. Biomechanical evaluation of running is one of the elements of evaluating running technique and, consequently, improving sports performance. Running uphill and downhill is one of the components of daily running but also an element of training used by recreational runners. The aim of this study is to optimize running training and minimize the risk of injury by identifying changes in the spatiotemporal structure of running at different inclinations. Methods: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. The protocol has been registered on the international platform INPLASY under the number INPLASY202430094U2. The search was conducted up to 30 March 2024 using the Scopus, PubMed, and Web of Science databases. Results: Spatiotemporal parameters were most frequently analyzed at 2.8–3.35 m/s velocities and inclinations in the range of −11% to 11%. Decreases in stride length (SL) and flight time (FT), and increases in step frequency (SF) were the most frequently reported changes from all parameters analyzed as a function of inclination and velocity. Significant increases or decreases in individual parameters were more often observed for positive inclination values than negative ones. Conclusions: The heterogeneous results of the study limit the possibility of determining the changes that occur in the spatiotemporal structure of the run under the impact of different inclinations. The variation in the results for negative inclination values indicates the different characteristics of running uphill and downhill. However, for uphill running, SF, SL, and FT are closely related to the increase in inclination.

Correlation Between CT Renal Angiography of Live Kidney Donors and Intraoperative Findings: A Cross-sectional Study.

Introduction A comprehensive understanding of the renal vascular anatomy variations is paramount to a successful kidney transplant. This reduces vascular injury risks and minimizes ischemia duration, optimizing surgical outcomes. The current study aims to assess the accuracy of renal computed tomography angiography (CTA) findings of live renal donors by comparing them with intraoperative findings. Methods This prospective cross-sectional study was conducted between October 2018 and February 2020. It included all healthy donors with two kidneys of normal size, shape, and position who were deemed suitable for nephrectomy. The CTA examinations were performed with the same protocol, which combined the vascular-excretory phase. A specialized radiologist confirmed anatomical findings. The CTA results were compared with intraoperative findings, which were documented by the transplantation team. Results The study included 220 patients. The preoperative CTA was highly sensitive and accurate, reaching 99.5% and 98.6%, respectively, for single vessels and 100% sensitivity and accuracy for triple vessels, pelvicalyceal system, and ureter duplication. The sensitivity of CTA for double vessels (vein and artery) was 90% and 92.6%, respectively, while accuracy was 98.6% for both. Conclusion CTA can be used to assess renal arteries and veins for potential renal donors with high accuracy. Although the CTA's minor, statistically non-significant discordance with the surgical findings regarding double arteries and veins, no artery or vein was missed on the CTA. Therefore, the sensitivity of CTA can reach 100%.

Variability and clinical anatomy of the superior gluteal nerve-A systematic review and meta-analysis.

The superior gluteal nerve (SGN) is a mixed nerve of the sacral plexus that arises from the posterior divisions of the L4, L5, and S1 nerve roots. Its motor branch plays a crucial role in innervation of hip muscles, which allows for physiological gait or walk-pattern. As for its sensory branch, it provides innervation for the hip joint capsule, especially its superior part. The understanding of this nerve is crucial as it may be injured during many operations involving mostly pelvic surgery, both arthroscopic and open procedures. The risk of injury is especially high during total hip arthroplasty (THA). These lesions often result in the presentation of major walk-pattern abnormalities. The most classical and commonly known would be the Trendelenburg sign, which presents with pelvic instability characterized by having the patient standing on one leg whereby the pelvis on the contralateral side will be dropping, resulting in a positive sign. The aim of this meta-analysis was to obtain all relevant data on SGN and its variations, in order to emphasize its anatomical, physiological, as well as clinical implications. A large-scale search was conducted in all major databases (PubMed, Embase, Science Direct, Google Scholar, and Web of Science) in order to determine and pool all available and relevant SGN data. No restrictions were applied to date or language. The data collection was categorized by prevalence, branching, patterns, course, origin, and distance from anatomical landmarks. A total of 41 studies (n = 869 hemipelves) were included in our analysis. The most common branching pattern of SGN was a spray pattern, 70.4% (95% CI: 54.4-96.8; p < 0.001) of the general population. We found that the closest branch to the greater trochanter of the femur and concurrently the most at risk during surgery was a muscular branch to gluteus minimus muscle. As the trend of pelvic surgeries, especially THA continues to rise, SGN lesions are now more than ever at risk. Yet to the authors' knowledge, this does not seem to be reflected in the current literature thereby making this the first meta-analysis concerning this important anatomical structure. The authors believe it is paramount for surgeons, especially in the orthopedic specialty, to thoroughly understand the SGN with its anatomical variability and clinical tie-ins.

Prophylactic central lymph node dissection for low-risk papillary thyroid cancer-Impact on subsequent therapy.

For small papillary thyroid cancers (PTCs) with no lateral nodal involvement, American Thyroid Association guidelines recommend performing prophylactic central lymph node dissection (pCLND) if it influences further management. Our cohort study explored to what extent performing pCLND for small PTCs can de-escalate subsequent therapy including completion thyroidectomy and adjuvant radioactive iodine (RAI) ablation. Adults with T1, T2, and cN0 PTCs were identified from 42 centers across the prospectively maintained Australian and New Zealand Thyroid Cancer Registry (ANZTCR) between 2017 and 2023. Patients were excluded if they had clinical nodal involvement or distant metastases. Subsequent therapy and complication rates were compared between patients with and without pCLND. Out of 1290 patients with T1, T2, and cN0 PTCs (78% female and median age 53years), 660 (51%) received a total thyroidectomy and 630 (49%) received a hemithyroidectomy. Prophylactic CLND was performed for 477 patients (37%) and 36% uncovered occult lymph node metastases. After adjusting for differences in age, sex, and tumor characteristics, absence of lymph node metastasis after pCLND was independently associated with fewer completion thyroidectomies (adjusted relative risk [aRR]=0.65 and p=0.008) and reduced RAI ablation (aRR 0.55 and p<0.001). Additionally, pCLND was not associated with higher risks of recurrent laryngeal nerve injury (p=0.33), temporary hypocalcemia (p=0.21), or permanent hypoparathyroidism (p=0.48). In specialized settings across Australia and New Zealand, identifying negative lymph nodes from pCLND is associated with reduced completion thyroidectomies and RAI ablation amongst low risk cN0 PTCs. There were no additional complications rates when performed by experienced thyroid surgeons.

The Impact of Environmental Factors on Eye Trauma in Children: A Retrospective Study in Albania

Eye trauma in children can lead to long-term visual impairment and significantly impact their quality of life. Environmental factors play a crucial role in the occurrence of such injuries. This retrospective study aims to investigate the influence of ambiental factors on eye trauma among children in Albania. A retrospective analysis was conducted using data obtained from the Albanian Statistical Center covering the period from January 2017 to December 2023. A total of 317 pediatric patients with eye trauma were included in the study. Data regarding demographics, types of trauma, mechanisms of injury, and environmental factors were collected and analyzed. The study found that environmental factors significantly contributed to eye trauma in children. The most common environmental factors associated with eye injuries included inadequate supervision during outdoor activities, presence of hazardous objects in the environment, and lack of protective eyewear. Seasonal variations were observed, with a higher incidence of eye trauma during the summer months when outdoor activities are more prevalent. This retrospective study highlights the significant impact of environmental factors on eye trauma in children in Albania. Strategies focusing on improving supervision during outdoor activities, implementing safety measures and promoting the use of protective eyewear could help reduce the risk of eye injuries among pediatric populations. Further research and targeted interventions are warranted to address this public health concern effectively. Received: 21 August 2024 / Accepted: 15 November 2024 / Published: 3 December 2024

Cystic plate approach in laparoscopic cholecystectomy: a consecutive retrospective analysis.

This study aimed to investigate the safety, feasibility, and possible advantages of the cystic plate approach during laparoscopic cholecystectomy in a retrospective cohort of surgical patients. We summarized the key points of the technical approach, retrospectively analyzed the clinical outcomes of 156 patients in the cystic plate approach group from July 2018 to July 2023, and compared the findings with those of 173 cases in the routine approach group from the same period. We observed no differences in the average stone size, operation time, postoperative hospital stay, conversion rate, complications, or Visual Analog Scale pain scores on the second day of surgery between the two groups (p = 0.076, 0.067, 0.278, 1.000, 0.633, and 0.131, respectively). However, intraoperative blood loss, number of clips used, volume of postoperative drainage fluid, and Visual Analog Scale pain scores on the day of surgery in the cystic plate approach group were significantly lower than those in the routine approach group (p = 0.000, 0.031, 0.027, and 0.021, respectively). The cystic plate approach is a safe, feasible, and effective approach that has the advantages of minimal invasiveness with less bleeding and seepage, reduced use of biological clips, and less pain, potentially minimizing the risk of iatrogenic biliary injury. This study was registered at the International Clinical Trial Registry (ChiCTR2100052860). Registration date: November 6, 2021.

Autopsy-Based Cross-Sectional Observational Study On Carotid Artery Injury In Non-Penetrative Neck Trauma

Background: Non-penetrative neck trauma poses a significant risk of carotid artery injury, which can lead to severe consequences. Diagnosis of carotid artery injury in non-penetrative trauma remains challenging due to delayed clinical presentation. Research on non-penetrative mechanisms of injury is relatively less common compared to penetrating trauma. This study aims to analyse patterns of vascular injuries in compression injuries to the neck, focusing on non-penetrative trauma. Materials and Methods: A cross-sectional study was conducted in a Forensic Medicine Department of Government Stanley medical college, Chennai, over a one-year period, analysing 150 cases of non-penetrative neck trauma. Post-mortem data, including gross and histopathological findings, were collected and analysed. Results &amp; Discussion: Among the 150 cases studied, hanging was the most prevalent cause of blunt cervical trauma. The majority of cases affected individuals were between the age group 21 and 40 years, with male preponderance. Gross examination revealed intimal tears in a proportion of cases, with histopathological examination identifying a higher prevalence of injuries. Posterior knot ligatures were predominant in both complete and partial hanging cases, correlating with a higher incidence of carotid body hemorrhage. The association between posterior knot position and carotid body hemorrhage emphasizes specific vulnerabilities in hanging cases. Conclusion: The findings of the study emphasize the importance of forensic investigations in identifying vascular injuries, guiding injury prevention strategies, and informing medicolegal proceedings. Further research is needed to enhance diagnostic and management approaches in clinical and forensic practice.

Fatigue and recovery in ballet: Exploring the experiences of professional South African ballet dancers

BackgroundProfessional South African ballet dancers face a higher risk of overuse injuries and overtraining syndrome as compared to dancers from other countries; especially towards the end of a ballet season. Fatigue is a major factor leading to overtraining syndrome and injuries in professional ballet dancers. The study aimed to explore the fatigue and recovery experiences of South African ballet dancers, highlighting how they navigate these aspects and the strategies they employ for recovery.MethodsSnowball sampling was employed to recruit ten professional South African ballet dancers. Between March and June 2023, individual semi-structured interviews were conducted online using Microsoft Teams. The interview schedule, informed by previous research, delved into the dancers’ fatigue and recovery experiences. Interviews were recorded, transcribed, and analysed using inductive thematic analysis.ResultsSeven main themes were developed from the data. Participants distinguished between mental and physical fatigue, highlighting the impact of mental fatigue on their well-being. They identified factors contributing to fatigue, including high external pressure, motivated behaviours, and expectations from audiences and management. These contributors often resulted in injuries, mandatory breaks, and sub-optimal performance. Participants accepted fatigue as inherent to their profession, emphasising mental resilience. Recovery practices included psychological, nutritional, and active strategies. The COVID-19 lockdown provided a respite from external pressures, allowing for improved recovery, but participants faced challenges upon returning to work. Gradually increasing practice time and exposure to external pressures assisted ballet dancers in effectively managing fatigue and enhancing their recovery as they returned to work.ConclusionThis study offers a perspective of fatigue and recovery in a sample of professional ballet dancers in South Africa. It emphasises the ongoing significance of fatigue and recovery and the necessity for effective strategies by arts organisations, mental health professionals, and academic researchers to support artists. The insights gained from this research could be crucial in redesigning training programs for dancers, adjusting training intensity and volume to enhance performance, and promoting recovery. Furthermore, this information serves as a strong rationale for adopting a holistic approach to fatigue and recovery, emphasising the importance of a collaborative effort to address these aspects effectively.

Ankle proprioception and functional performance in patients with Achilles tendinopathy.

The purpose of this study was to investigate differences in ankle plantar flexion proprioception and lower extremity function between Achilles tendinopathy (AT) patients and healthy controls. 17 patients with midportion AT (age 22.0±3.0, 7 females, and 10 males) and 17 healthy controls (age 21.5±2.1, 7 females, and 10 males) were recruited. The following tests were performed randomly: the ankle plantar flexion active movement extent discrimination assessment (AMEDA), weight-bearing lunge test (WBLT), single leg hop test, figure-of-eight hop test, Y Balance Test (YBT), and lower extremity functional test (LEFT). Group comparisons were made between the AT and healthy groups, and receiver operator characteristic (ROC) curves were used to analyze the ability of tests to differentiate between participants with and without AT. Results showed that the AT group performed significantly worse in the ankle proprioception test (p=0.016), single leg hop test (p=0.001), figure-of-eight hop test (p<0.001), unilateral LEFT (p=0.001), and LEFT injury risk score (p=0.001) than healthy controls. No significant between group difference was found in WBLT and YBT. Diagnostic analysis showed that the AMEDA (p=0.018), single leg hop test (p=0.003), figure-of-eight hop test (p=0.002), and LEFT (p=0.001) could differentiate between patients with AT and the healthy individuals. The current study demonstrated that ankle proprioception and functional performance involving explosive jump are impaired in patients with AT, suggesting poorer dynamic neuromuscular function and a higher risk of lower limb injury in this population, and furthermore, these tests should be considered in the assessment for AT.

Surgical Anatomy of the Retrosigmoid Approach with Endoscopic-Assisted Reverse Anterior Petrosectomy: Optimizing Meckel's Cave Access from the Posterior Fossa

Abstract Objectives We investigated the extent of access to Meckel's cave (MC) and the middle cranial fossa (MCF) protecting the internal carotid artery (ICA) using the retrosigmoid approach with endoscopic-assisted reverse anterior petrosectomy (EA-RAP). Methods Five specimens were dissected using the limited and extended EA-RAP. Based on the bone removal of the internal acoustic meatus (IAM) and subarcuate fossa, exposure of the MC and ICA were statistically compared. Results The limited and extended EA-RAP allowed access to the medial and anterior MC (4 mm posterior to the first genu of the cavernous ICA, and 20 mm posterior to foramen rotundum [FR]). The access to the lateral MC varied with distance of 12 and 8 mm medial to the foramen ovale for the limited and extended EA-RAP, respectively.In the extended EA-RAP, the exposure of the ICA was gained by drilling with the 0-degree endoscope (3 mm) versus 45-degree endoscope (9 mm). The working distances from the midpoint of the IAM to the most medial point of the exposed ICA was 24 mm. The most lateral point of the exposed ICA varied between 0- and 45-degree endoscopes with a distance of 21 and 13 mm, respectively. Conclusion A coronal plane from the posterior genu of the cavernous ICA and a sagittal plane to the common crus of the semicircular canals can define the area of MCF accessed by the EA-RAP. Drilling of the temporal bone should be carefully customized according to the patient and can be aided by endoscopic assistance for direct visualization to minimize the risk of injuries to ICA.

Optimal Timing for Safe Bivalving of Fiberglass Casts Is Before the Exothermic Peak.

Cast saw injury is a notable source of medicolegal risk. Previous work with plaster casts demonstrated that cast saw injury was minimized by waiting 12 minutes before removal. In this study, we evaluate the safety parameters of fiberglass casting materials. Eight-ply plaster and fiberglass casts were applied to a pediatric forearm model at variable dip-water temperatures, and the mean time to reach their exothermic peak was determined. Fiberglass casts were then maintained at the manufacturer's recommended dip-water temperature and removed at intervals of 2 (before exothermic peak), 6 (approximately fiberglass's exothermic peak), or 12 (after exothermic peak) minutes. All casts were removed by a pediatric orthopaedic surgeon blinded to the cast set time. Cast/blade temperature, saw force, blade-to-skin contact, bivalve time, cast spreading force, and cut completeness were assessed individually and as short (<6-minutes) or long (≥6-minutes) set times. Fiberglass casts exothermically peaked markedly earlier (5.2 [IQR = 5-5.4] minutes) than plaster (14.8 [IQR=13.7-15.3] minutes), P < 0.0001, at maximum temperatures, which did not markedly differ. Downward force applied during fiberglass cast removal was markedly lower in the short versus long set time groups [average forces of 8.3 (IQR=6.4-10.4) versus 12.9 (IQR=11.1-14.5) Newtons, P < 0.0001, as were maximum forces: 23.2 (IQR=18.9-26.6) versus 43.8 (IQR=38.6-48.5) Newtons, P < 0.0001]. Bivalve time and maximum cast spreading force were decreased in short set times with 40.5 (IQR=39.2-44.7) versus 44.4 (IQR=40.6-47.3) seconds (P = 0.06) and 15.5 (IQR=14-18.5) versus 21.5 (IQR=18-26.5) N (P = 0.07), respectively. Maximum saw blade temperature was markedly lower in the short (99.6°C [IQR=98.2-105.6°C]) versus long (130.6°C [IQR=121.9-141°C]) set times (P = 0.04). No notable differences in blade-to-skin touches or touch duration were detected. Unlike plaster, fiberglass casts cut before exothermically peaking were associated with less downward force, faster bivalve times, and decreased spread force without increased blade temperature or skin contacts. This suggests that fiberglass casts can be bivalved markedly earlier without increased risk of injury.

A game-theoretic driver steering model with individual risk perception field generation

Driver-automation shared steering control (SSC) has emerged as a promising technology for enhancing vehicle safety, but desire to achieve seamless collaboration between the driver and automation requires an in-depth understanding of driver steering behavior in interaction with automation. In this paper, we introduce a game-theoretic driver steering model with individual risk perception field generation. Firstly, a driver risk perception field is developed based on a novel concept of potential injury risk (PIR) to provide a quantitative estimation of the driver’s perceived driving risk. This approach offers an explicit and physically meaningful structure for simulating the driver’s risk perception process and elucidating the reasons for discrepancies in risk perception. Then, this driver risk perception field is integrated into the framework of non-cooperative Nash game to model the steering interaction between the driver and automation, and the analytical expression of Nash equilibrium is derived in detail. The resulting combined driver model effectively captures the driver adaptation at both the control and planning levels. Next, the key parameters of the combined driver model and its comparators are identified using measured driver steering behavior data from thirty subjects in a series of driving simulator experiments. Finally, the effectiveness and superiority of the combined driver model is validated through a comprehensive comparative analysis. The results demonstrate that the combined driver model achieves the lowest prediction errors compared to its comparators and effectively captures the individual differences in risk perception and steering behavior.

Quality Issues in Kinematic Traces from Three Head Impact Sensors in Boxing: Prevalence, Effects, and Implications for Exposure Assessment.

When used in-vivo or in biofidelic environments, many head impact sensors have shown limitations related to the quality and validity of the kinematics measured. The objectives were to assess the quality of kinematic traces from three head impact sensors, determine the effects of signal quality on peak accelerations, and compare measurements across sensors. Head impacts were collected with instrumented mouthguards, skin patches, and headgear patches during boxing sparring. The quality of the raw kinematic traces for 442 events for each sensor was categorized using pre-defined objective criteria into high, questionable, and low-quality classes. The proportion of high-quality recordings was analyzed by participant, type of impact, and impact location. Associations between signal quality and peak kinematics were assessed within each sensor, and peak kinematics (resolved to the head center of gravity) were compared between sensors. High-quality criteria were met in 53%, 20%, and 26% of events for the mouthguard, skin patch, and headgear patch, respectively. High-quality recordings were less frequent for impacts occurring close to the sensor (e.g., 30% vs. 61% for the mouthguard) and showed lower peak kinematics than low-quality recordings (p < 0.001). Despite careful selection of high-quality simultaneous recordings, there was little to no association between the sensors' measurements (Spearman's p ≥ 0.043). The kinematic data often reflected the motion of the sensor itself rather than the motion of the head, overestimating head impact magnitude. Researchers should evaluate data quality prior to analyzing kinematics or injury severity metrics. Comparison of data across studies or in relation to injury risk functions needs to be done with caution when data were acquired from different sensors.