Injury risk from popular childhood physical activities: results from an Australian primary school cohort

Background: Children engage in various physical activities that pose different injury risks. However, the lack of adequate data on exposure has meant that these risks have not been quantified or compared in young children aged 5-12 years. Objectives: To measure exposure to popular activities among Australian primary school children and to quantify the associated injury risks. Method: The Childhood Injury Prevention Study prospectively followed up a cohort of randomly selected Australian primary and preschool children aged 5-12 years. Time (min) engaged in various physical activities was measured using a parent-completed 7-day diary. All injuries over 12 months were reported to the study. All data on exposure and injuries were coded using the International classification of external causes of injury. Injury rates per 1000 h of exposure were calculated for the most popular activities. Results: Complete diaries and data on injuries were available for 744 children. Over 12 months, 314 injuries relating to physical activity outside of school were reported. The highest injury risks per exposure time occurred for tackle-style football (2.18/1000 h), wheeled activities (1.72/1000 h) and tennis (1.19/1000 h). Overall, boys were injured more often than girls; however, the differences were non-significant or reversed for some activities including soccer, trampolining and team ball sports. Conclusion: Although the overall injury rate was low in this prospective cohort, the safety of some popular childhood activities can be improved so that the benefits may be enjoyed with fewer negative consequences.

Investigation of the causes of serious injury and fatal crashes: An analysis using econometric models

The rate of fatal crashes in Florida has remained significantly higher than the national average for the last several years. The 2003 statistics from the National Highway Traffic Safety Administration (NHTSA), the latest available, show a fatality rate in Florida of 1.71 per 100 million vehicle-miles traveled compared to the national average of 1.48 per 100 million vehicle-miles traveled. The objective of this research is to better understand the driver, environmental, and roadway factors that affect the probability of injury severity in Florida. ^ In this research, the ordered logit model was used to develop six injury severity models; single-vehicle and two-vehicle crashes on urban freeways and urban principal arterials and two-vehicle crashes at urban signalized and unsignalized intersections. The data used in this research included all crashes that occurred on the state highway system for the period from 2001 to 2003 in the Southeast Florida region, which includes the Miami-Dade, Broward and Palm Beach Counties.^ The results of the analysis indicate that the age group and gender of the driver at fault were significant factors of injury severity risk across all models. The greatest risk of severe injury was observed for the age groups 55 to 65 and 66 and older. A positive association between injury severity and the race of the driver at fault was also found. Driver at fault of Hispanic origin was associated with a higher risk of severe injury for both freeway models and for the two-vehicle crash model on arterial roads. A higher risk of more severe injury crash involvement was also found when an African-American was the at fault driver on two-vehicle crashes on freeways. In addition, the arterial class was also found to be positively associated with a higher risk of severe crashes. Six-lane divided arterials exhibited the highest injury severity risk of all arterial classes. The lowest severe injury risk was found for one way roads. Alcohol involvement by the driver at fault was also found to be a significant risk of severe injury for the single-vehicle crash model on freeways. ^

The role of supraspinal excitability in the development of healthy-limb deficits following anterior cruciate ligament injury

In the current study, we examined how supraspinal and spinal excitability were altered bilaterally after unilateral anterior cruciate ligament reconstruction (ACLr). 7 participants with ACLr and 7 healthy controls underwent transcranial magnetic stimulation (TMS) and electrical stimulation. To evaluate supraspinal excitability, resting motor thresholds (RMT) and motor evoked potential (MEP) stimulus response curves (SRC) were used. To measure spinal excitability, H-reflex SRC gain was assessed. Mixed factorial ANOVAs were used to compare measures between limbs and between groups. Cohen’s d was used to assess effect sizes between groups. Data indicated no significant differences between subject groups or between limbs. However, large effect sizes were found between limbs for H-reflex gain and RMTs suggesting that ACLr can have an effect on some of the variables examined. This study identified decreases in strength in the injured limbs and that subjects with an ACL injury exhibited decreases in spinal and supraspinal excitability of the quadriceps compared to Healthy controls.

Bone morphology of the femur and tibia captured by statistical shape modelling predicts rapid bone loss in acute spinal cord injury patients

We would like to thank the study participants and the clinical and research staff at the Queen Elizabeth National Spinal Injury Unit, as without them this study would not have been possible. We are grateful for the funding received from Glasgow Research Partnership in Engineering for the employment of SC during data collection for this study. We would like to thank the Royal Society of Edinburgh's Scottish Crucible scheme for providing the opportunity for this collaboration to occur. We are also indebted to Maria Dumitrascuta for her time and effort in producing inter-repeatability results for the shape models.

Bone morphology of the femur and tibia captured by statistical shape modelling predicts rapid bone loss in acute spinal cord injury patients

We would like to thank the study participants and the clinical and research staff at the Queen Elizabeth National Spinal Injury Unit, as without them this study would not have been possible. We are grateful for the funding received from Glasgow Research Partnership in Engineering for the employment of SC during data collection for this study. We would like to thank the Royal Society of Edinburgh's Scottish Crucible scheme for providing the opportunity for this collaboration to occur. We are also indebted to Maria Dumitrascuta for her time and effort in producing inter-repeatability results for the shape models.

Machine learning and data decompositions for complex networked dynamical systems

Thesis (Ph.D.)--University of Washington, 2016-08

Older Adult Injury Risk Assessment in the Driving and Occupational Environments

Thesis (Ph.D.)--University of Washington, 2016-08

Is "football for all" safe for all? : Cross-Sectional Study of Disparities as Determinants of 1-Year Injury Prevalence in Youth Football Programs

Football (soccer) is endorsed as a health-promoting physical activity worldwide. When football programs are introduced as part of general health promotion programs, equal access and limitation of pre-participation disparities with regard to injury risk are important. The aim of this study was to explore if disparity with regard to parents' educational level, player body mass index (BMI), and self-reported health are determinants of football injury in community-based football programs, separately or in interaction with age or gender. Methodology/Principal Findings Four community football clubs with 1230 youth players agreed to participate in the cross-sectional study during the 2006 season. The study constructs (parents' educational level, player BMI, and self-reported health) were operationalized into questionnaire items. The 1-year prevalence of football injury was defined as the primary outcome measure. Data were collected via a postal survey and analyzed using a series of hierarchical statistical computations investigating associations with the primary outcome measure and interactions between the study variables. The survey was returned by 827 (67.2%) youth players. The 1-year injury prevalence increased with age. For youths with parents with higher formal education, boys reported more injuries and girls reported fewer injuries than expected; for youths with lower educated parents there was a tendency towards the opposite pattern. Youths reporting injuries had higher standardized BMI compared with youths not reporting injuries. Children not reporting full health were slightly overrepresented among those reporting injuries and underrepresented for those reporting no injury. Conclusion Pre-participation disparities in terms of parents' educational level, through interaction with gender, BMI, and self-reported general health are associated with increased injury risk in community-based youth football. When introduced as a general health promotion, football associations should adjust community-based youth programs to accommodate children and adolescents with increased pre-participation injury risk.

The links between head injury and homelessness: A qualitative study

Background and aims: Head injury (HI) is a cause of cognitive impairment within the homeless population (Hwang et al, 2008). One study reported that over a 30-year period, the prevalence of hospitalised HI was 5.4 times higher in the homeless than in the general population (McMillan et al, 2015). This study explores the perceptions of homeless adults who have sustained a HI and their views regarding the relevance of HI to their homeless status. Methods: Participants were seven homeless adults with a moderate or severe HI. They were asked to talk about their journey to homelessness and in particular, to reflect on any perceived links between HI and their homeless status. The data were analysed using Interpretative Phenomenological Analysis (IPA). Results and conclusions: Emerging themes included: impairment following HI; substance misuse, feeling let down by services and difficult relationships with family. Evidence for the role of HI in precipitating and maintaining homelessness was found. Despite this, co-morbid difficulties complicate the picture. Four out of seven participants viewed substance misuse as their primary difficulty. This illustrates the need for in-depth assessment within this population in order to ensure that difficulties are fully understood and that the correct supports/ interventions are offered.

Effect of remote ischaemic preconditioning in cardiac dysfunction and end-organ injury following cardiac surgery with cardiopulmonary bypass in children: A translational approach investigating clinical outcome and myocardial molecular biology

Congenital heart disease (CHD) is the most common birth defect, causing an important rate of morbidity and mortality. Treatment of CHD requires surgical correction in a significant percentage of cases which exposes patients to cardiac and end organ injury. Cardiac surgical procedures often require the utilisation of cardiopulmonary bypass (CPB), a system that replaces heart and lungs function by diverting circulation into an external circuit. The use of CPB can initiate potent inflammatory responses, in addition a proportion of procedures require a period of aortic cross clamp during which the heart is rendered ischaemic and is exposed to injury. High O2 concentrations are used during cardiac procedures and when circulation is re-established to the heart which had adjusted metabolically to ischaemia, further injury is caused in a process known as ischaemic reperfusion injury (IRI). Several strategies are in place in order to protect the heart during surgery, however injury is still caused, having detrimental effects in patients at short and long term. Remote ischaemic preconditioning (RIPC) is a technique proposed as a potential cardioprotective measure. It consists of exposing a remote tissue bed to brief episodes of ischaemia prior to surgery in order to activate protective pathways that would act during CPB, ischaemia and reperfusion. This study aimed to assess RIPC in paediatric patients requiring CHD surgical correction with a translational approach, integrating clinical outcome, marker analysis, cardiac function parameters and molecular mechanisms within the cardiac tissue. A prospective, single blinded, randomized, controlled trial was conducted applying a RIPC protocol to randomised patients through episodes of limb ischaemia on the day before surgery which was repeated right before the surgery started, after anaesthesia induction. Blood samples were obtained before surgery and at three post-operative time points from venous lines, additional pre and post-bypass blood samples were obtained from the right atrium. Myocardial tissue was resected during the ischaemic period of surgery. Echocardiographic images were obtained before the surgery started after anaesthetic induction and the day after surgery, images were stored for later off line analysis. PICU surveillance data was collected including ventilation parameters, inotrope use, standard laboratory analysis and six hourly blood gas analysis. Pre and post-operative quantitation of markers in blood specimens included cardiac troponin I (cTnI) and B-type natriuretic peptide (BNP), inflammatory mediators including interleukins IL-6, IL-8, IL-10, tumour necrosis factor (TNF-α), and the adhesion molecules ICAM-1 and VCAM-1; the renal marker Cystatin C and the cardiovascular markers asymmetric dymethylarginine (ADMA) and symmetric dymethylarginine (SDMA). Nitric oxide (NO) metabolites and cyclic guanosine monophosphate (cGMP) were measured before and after bypass. Myocardial tissue was processed at baseline and after incubation at hyperoxic concentration during four hours in order to mimic surgical conditions. Expression of genes involved in IRI and RIPC pathways was analysed including heat shock proteins (HSPs), toll like receptors (TLRs), transcription factors nuclear factor κ-B (NF- κ-B) and hypoxia inducible factor 1 (HIF-1). The participation of hydrogen sulfide enzymatic genes, apelin and its receptor were explored. There was no significant difference according to group allocation in any of the echocardiographic parameters. There was a tendency for higher cTnI values and inotropic score in control patients post-operatively, however this was not statistically significant. BNP presented no significant difference according to group allocation. Inflammatory parameters tended to be higher in the control group, however only TNF- α was significantly higher. There was no difference in levels of Cystatin C, NO metabolites, cGMP, ADMA or SDMA. RIPC patients required shorter PICU stay, all other clinical and laboratory analysis presented no difference related to the intervention. Gene expression analysis revealed interesting patterns before and after incubation. HSP-60 presented a lower expression at baseline in tissue corresponding to RIPC patients, no other differences were found. This study provided with valuable descriptive information on previously known and newly explored parameters in the study population. Demographic characteristics and the presence of cyanosis before surgery influenced patterns of activity in several parameters, numerous indicators were linked to the degree of injury suffered by the myocardium. RIPC did not reduce markers of cardiac injury or improved echocardiographic parameters and it did not have an effect on end organ function; some effects were seen in inflammatory responses and gene expression analysis. Nevertheless, an important clinical outcome indicator, PICU length of stay was reduced suggesting benefit from the intervention. Larger studies with more statistical power could determine if the tendency of lower injury and inflammatory markers linked to RIPC is real. The present results mostly support findings of larger multicentre trials which have reported no cardiac benefit from RIPC in paediatric cardiac surgery.

A review of risk factors for hamstring injury in soccer: a biomechanical approach

The aim has been to review the literature about the risk factors of hamstring injury in soccer from a biomechanical point of view. METHODOLOGY. Data bases of bibliography references were Medline, Scopus and SportDiscuss. RESULTS AND DISCUSSION. Many prospective studies have shown that the previous injury is the greatest risk factor of sustaining the injury. However the primary causes of the injury are unclear in soccer. A lack of hamstring flexibility has been one of the main injury risk factors with controversies on the results. Imbalance of isokinetic force is a risk factor but electrical coactivation of all muscles participating during knee flexion and extension are unknown in football. While the importance of lumbopelvic-hamstrings muscles synchronization during running seems to be crucial for understanding the risk of injury, no research has been developed in this topic in football. CONCLUSIONS. More research using new data recording procedures as Dynamic Scanners, Surface EMG, Inverse Dynamic Analysis are needed. The analysis of more specific movements as running, kicking or jumping is clearly required. Managers, coaches, physical trainers, physiotherapists, sport physicians and researchers should work together in order to improve the injury prevention and rehabilitation programs of football players. Key Words: sports biomechanics, soccer, hamstring injury, risk factors

Efficacy of ACL injury risk screening methods in identifying high-risk landing patterns during a sport-specific task

Screening methods sensitive to movement strategies that increase anterior cruciate ligament (ACL) loads are likely to be effective in identifying athletes at-risk of ACL injury. Current ACL injury risk screening methods are yet to be evaluated for their ability to identify athletes' who exhibit high-risk lower limb mechanics during sport-specific maneuvers associated with ACL injury occurrences. The purpose of this study was to examine the efficacy of two ACL injury risk screening methods in identifying high-risk lower limb mechanics during a sport-specific landing task. Thirty-two female athletes were screened using the Landing Error Scoring System (LESS) and Tuck Jump Assessment. Participants' also completed a sport-specific landing task, during which three-dimensional kinematic and kinetic data were collected. One-dimensional statistical parametric mapping was used to examine the relationships between screening method scores, and the three-dimensional hip and knee joint rotation and moment data from the sport-specific landing. Higher LESS scores were associated with reduced knee flexion from 30 to 57 ms after initial contact (P = 0.003) during the sport-specific landing; however, no additional relationships were found. These findings suggest the LESS and Tuck Jump Assessment may have minimal applicability in identifying athletes' who exhibit high-risk landing postures in the sport-specific task examined.

Ageing, chronic disease and injury: a study in western Victoria (Australia)

Background : An increasing burden of chronic disease and associated health service delivery is expected due to the ageing Australian population. Injuries also affect health and wellbeing and have a long-term impact on health service utilisation. There is a lack of comprehensive data on disease and injury in rural and regional areas of Australia. The aim of the Ageing, Chronic Disease and Injury study is to compile data from various sources to better describe the patterns of chronic disease and injury across western Victoria.

Design : Ecological study.

Methods : Information on demographics, socioeconomic indicators and lifestyle factors are obtained from health surveys and government departments. Data concerning chronic diseases and injuries will be sourced from various registers, health and emergency services, local community health centres and administrative databases and compiled to generate profiles for the study region and for sub-populations within the region.

Expected impact for public health: This information is vital to establish current and projected population needs to inform policy and improve targeted health services delivery, care transition needs and infrastructure development. This study provides a model that can be replicated in other geographical settings.

User centric design, data analysis and performance of snowboard bindings

This study focuses on soft boot snowboard bindings by looking at how users interact with their binding and proposes a possible solution to overcome such issues. Snowboarding is a multibillion-dollar sport that has only reached mainstream in the last 30 years its levels of progression in technology have evolved in that time. However, snowboard bindings for the most part still consist of the same basic architecture in the last 20 years. This study was aimed at taking a user centric point of view and using additive manufacturing technologies to be able to generate a new snowboard binding that is completely adaptable to the user. The initial part of the study was a survey of 280 snowboarders focussing on preferences, style and habits. This survey was generated from over 15 nations with the vast majority of boarders on the snow for five to fifty days a year. Significant emphasis was placed on the relationship between boarder binding set-up and occurrence of pain and/or injury. From the detailed survey it was found that boarder's experienced pain in the front foot/toe area as a result from the toe strap being too tight. However boarders wanted tighter bindings to increase responsiveness. Survey data was compared to ankle and foot biomechanics to build a relationship to assess the problem of pain versus responsiveness. The design stage of the study was to develop a binding that overcame the over-tightening of the binding but still maintain equivalent or better responsiveness compared to traditional bindings. The resulting design integrated the snowboard boot much more into the design, by using the sole as a "semi-rigid" platform and locking it in laterally between the heel cup and the new toe strap arrangement. The new design developed using additive manufacturing techniques was tested via qualitative and quantitative measures in the snow and in the lab. It was found that using the new arrangement in a system resulted in no loss of performance or responsiveness to the user. Due to the design and manufacturing approach users have the ability to customise the design to their specific needs.

MEASURING HEAD IMPACT CONTACT PRESSURE IN COLLEGIATE FOOTBALL GAMES TO CORRELATE HEAD KINEMATICS TO BRAIN KINETICS ELUCIDATING BRAIN INJURY DYNAMICS

Does a brain store thoughts and memories the way a computer saves its files? How can a single hit or a fall erase all those memories? Brain Mapping and traumatic brain injuries (TBIs) have become widely researched fields today. Many researchers have been studying TBIs caused to adult American football players however youth athletes have been rarely considered for these studies, contradicting to the fact that American football enrolls highest number of collegiate and high-school children than adults. This research is an attempt to contribute to the field of youth TBIs. Earlier studies have related head kinematics (linear and angular accelerations) to TBIs. However, fewer studies have dealt with brain kinetics (impact pressures and stresses) occurring during head-on collisions. The National Operating Committee on Standards for Athletic Equipment (NOCSAE) drop tests were conducted for linear impact accelerations and the Head Impact Contact Pressures (HICP) calculated from them were applied to a validated FE model. The results showed lateral region of the head as the most vulnerable region to damage from any drop height or impact distance followed by posterior region. The TBI tolerance levels in terms of Von-Mises and Maximum Principal Stresses deduced for lateral impact were 30 MPa and 18 MPa respectively. These levels were corresponding to 2.625 feet drop height. The drop heights beyond this value will result in TBI causing stress concentrations in human head without any detectable structural damage to the brain tissue. This data can be utilized for designing helmets that provide cushioning to brain along with providing a resistance to shear.