Search Results (506)

Background: Midfacial fractures are common outcomes of facial trauma. While younger individuals typically sustain these injuries through high-energy events like assaults and traffic or sports accidents, elderly patients increasingly present with fractures from low-energy mechanisms, primarily falls. Purpose: The aim of this study was to analyze age- and gender-specific patterns in midfacial fractures over a 10-year period, with emphasis on elderly individuals and low-energy trauma. Methods: A retrospective review was performed of proven midfacial fractures between 2013 and 2022 at the Department of Oral and Maxillofacial Surgery (University of Pécs, Hungary). The patients were stratified by age (<65 vs. ≥65 years) and gender. The variables included the injury mechanism, fracture localization, the dental status, hospitalization, and the presence of associated injuries. Bivariate analyses were performed, and the significance level was set to p < 0.05. Results: A total of 957 radiologically confirmed midfacial fracture cases were evaluated, of whom 344 (35.9%) were ≥65 years old. In the elderly group, females had a 19-fold higher risk for midfacial trauma than younger females (OR: 19.1, 95%CI: 9.30–39.21). In the older group, a fall was significantly the most frequent injury mechanism (OR: 14.5; 95%CI: 9.9–21.3), responsible for 89.5% of the cases, while hospitalization (OR: 0.36; 95%CI: 0.23–0.56) was less characteristic. Most of the fractures occurred in the zygomatic bone, in the zygomaticomaxillary complex, or in the anterior wall of the maxilla. Associated injuries in the elderly group included mostly lower limb injuries—particularly pertrochanteric femoral fractures in females—and upper limb injuries, with a slight male dominance. Conclusions: Low-energy falls are the primary cause of midfacial fractures in elderly patients, particularly in women. Tailored prevention and management strategies are essential for improving the outcomes in this growing demographic group. Full article

The paper provides an analysis of the causes of accidents in oil and gas pipeline systems. As part of a comprehensive overview of the topic, it also presents the historical development of pipeline systems, from the first commercial oil pipelines in the United States to modern infrastructure projects, with a particular focus on the role of regulatory requirements and measures (prevention, detection, and mitigation) to improve transport efficiency and pipeline safety. The research uses historical accident data from various databases to identify the main causes of accidents and analyse trends. The focus is on factors such as corrosion, third-party interference, and natural disasters that can lead to accidents. A comparison of the various accident databases shows that there are different practises and approaches to operation and reporting. As each database differs in terms of inclusion criteria, the categories are divided into five main groups to allow systematic interpretation of the data and cross-comparison of accident causes. Regional differences in the causes of accidents involving oil and gas pipelines in Europe, the USA, and Canada are visible. However, an integrated analysis shows that the number of accidents is declining in almost all categories. The majority of all recorded accidents are in the “Human factors and Operational disruption” and “Corrosion and Material damage” groups. It is recommended to use the database as required, as each category has its own specifics. Full article

This study developed and validated an integrated theoretical framework combining the Theory of Planned Behavior (TPB) and the Technology Acceptance Model (TAM) to investigate how driving assistance technologies (DATs) influence risky driving behaviors among young urban Chinese drivers. Based on this framework, we proposed and tested several hypotheses regarding the effects of psychological and technological factors on risky driving intentions and behaviors. A survey was conducted with 495 young drivers in Shaoguan, Guangdong Province, examining psychological factors, technology acceptance, and their influence on risky driving behaviors. Structural equation modeling revealed that the integrated TPB-TAM explained 58.3% of the variance in behavioral intentions and 42.6% of the variance in actual risky driving behaviors, significantly outperforming single-theory models. Attitudes toward risky driving (β = 0.287) emerged as the strongest TPB predictor of behavioral intentions, while perceived usefulness (β = −0.172) and perceived ease of use (β = −0.113) of driving assistance technologies negatively influenced risky driving intentions. Multi-group analysis identified significant gender and driving experience differences. Logistic regression analyses demonstrated that model constructs significantly predicted actual traffic violations and accidents. These findings provide theoretical insights into risky driving determinants and practical guidance for developing targeted interventions and effective traffic safety policies for young drivers in urban China. Full article

Background/Objectives: Providing appropriate treatment for pediatric patients after traffic accidents remains a significant challenge. Furthermore, limited studies have validated the long-term effectiveness and safety of integrative Korean medicine treatment (IKMT) based on follow-up periods of 6 months or longer for pediatric patients. Methods: A retrospective chart review was conducted, focused on children aged 0–6 years who visited one of seven Korean medicine hospitals after traffic accident injuries and received IKMT between 1 January 2019 and 30 June 2023. The primary outcome was the Numeric Rating Scale (NRS) scores of chief complaints, and the secondary outcomes were quality of life, adverse events, and satisfaction with IKMT. Statistical analyses were conducted using paired t-tests and descriptive statistics, with a significance level of 5%. Results: Sixty-four participants were included in the retrospective chart review, and fifty-seven guardians responded to the surveys (mean age: 4.84 ± 1.26 years; mean duration of treatment: 19.20 ± 25.38 days). Among the immediate symptoms after the accidents, flashbacks and intrusive symptoms as well as nightmares and crying were the most common (50.9%). Following treatment, the NRS scores for flashbacks and intrusive symptoms and for nightmares and crying showed meaningful improvements from the time right after the accidents to the survey period. Follow-up confirmed that quality of life scores on all dimensions corresponded with those of healthy children. Nine adverse events were reported, and the participants fully recovered without the need for additional treatment. Furthermore, 91.2% of the survey respondents were satisfied with IKMT. Conclusions: IKMT was effective and safe for alleviating the post-accident symptoms in infants and young children aged 0–6 years involved in traffic accidents. Full article

Background: Renal trauma accounts for approximately 3–5% of all trauma cases, predominantly affecting young males. The most common etiology is blunt trauma, particularly due to road traffic accidents, and it frequently occurs as part of polytrauma involving multiple organ systems. Management strategies are primarily dictated by hemodynamic stability, overall clinical condition, comorbidities, and injury severity graded according to the AAST classification. This study aimed to evaluate the effectiveness of non-operative management (NOM) in high-grade renal trauma (AAST grades III–V), beyond its established role in low-grade injuries (grades I–II). Secondary endpoints included the identification of independent prognostic factors for NOM failure and in-hospital mortality. Methods: We conducted a retrospective observational study including patients diagnosed with blunt renal trauma who presented to the Emergency Department of Policlinico Umberto I in Rome between 1 January 2013 and 30 April 2024. Collected data comprised demographics, trauma mechanism, vital signs, hemodynamic status (shock index), laboratory tests, blood gas analysis, hematuria, number of transfused RBC units in the first 24 h, AAST renal injury grade, ISS, associated injuries, treatment approach, hospital length of stay, and mortality. Statistical analyses, including multivariable logistic regression, were performed using SPSS v28.0. Results: A total of 244 patients were included. Low-grade injuries (AAST I–II) accounted for 43% (n = 105), while high-grade injuries (AAST III–V) represented 57% (n = 139). All patients with low-grade injuries were managed non-operatively. Among high-grade injuries, 124 patients (89%) were treated with NOM, including observation, angiography ± angioembolization, stenting, or nephrostomy. Only 15 patients (11%) required nephrectomy, primarily due to persistent hemodynamic instability. The overall mortality rate was 13.5% (33 patients) and was more closely associated with the overall injury burden than with renal injury severity. Multivariable analysis identified shock index and active bleeding on CT as independent predictors of NOM failure, whereas ISS and age were significant predictors of in-hospital mortality. Notably, AAST grade did not independently predict either outcome. Conclusions: In line with the current international literature, our study confirms that NOM is the treatment of choice not only for low-grade renal injuries but also for carefully selected hemodynamically stable patients with high-grade trauma. Our findings highlight the critical role of physiological parameters and overall ISS in guiding management decisions and underscore the need for individualized assessment to minimize unnecessary nephrectomies and optimize patient outcomes. Full article

(1) Background: The number of casualties due to car accidents in Europe is decreasing. However, there are still very large differences in the levels of road safety between countries, even within the European Union. Therefore, it is vital to conduct reliable international analyses to compare the effectiveness of actions taken to prevent road accidents. Information on the number of accidents, injuries, and fatalities can be found in various databases (e.g., Eurostat or OECD). In this paper, it is clearly shown that data on car accidents and the resulting injuries are not comparable between different countries, and any conclusions drawn using these data as their basis will be erroneous. (2) Methods: The indicators of the number of car accidents, injured people, and fatalities in relation to the number of inhabitants were determined, then their distribution and mutual correlations were examined for a group of selected European countries. (3) Results: There is no correlation between the indicators of the number of car accidents and injuries and the indicator of fatalities. An assessment of road safety based on these indicators would result in inconsistent and ambiguous conclusions. (4) Conclusions: It has been empirically shown that data on the number of car accidents and injured people from different countries are not comparable. These conclusions were verified by providing examples of the definitions of an injured person used in different countries. This paper clearly indicates that any international comparisons can only be made based on data regarding the number of road accident fatalities. Full article

Ensuring the structural integrity of reinforced concrete (RC) components in nuclear facilities exposed to extreme conditions is essential for safe decommissioning. This study investigates the impact of high-temperature exposure on RC pedestal structures supported by steel ring-shaped shear connectors—critical elements for maintaining vertical and lateral load paths in containment systems. Scaled-down cyclic loading tests were performed on pedestal specimens with and without prior thermal exposure, simulating post-accident conditions observed at a damaged nuclear power plant. Experimental results show that thermal degradation significantly reduces lateral stiffness, with failure mechanisms concentrating at the interface between the concrete and the embedded steel skirt. Complementary finite element analyses, incorporating temperature-dependent material degradation, highlight the crucial role of load redistribution to steel components when concrete strength is compromised. Parametric studies reveal that while geometric variations in the inner skirt have limited influence, thermal history is the dominant factor affecting vertical capacity. Notably, even with substantial section loss in the concrete, the steel inner skirt maintained considerable load-bearing capacity. This study establishes a validated analytical framework for assessing structural performance under extreme conditions, offering critical insights for risk evaluation and retrofit strategies in the context of nuclear facility decommissioning. Full article

The backbone of maritime transportation has always been the successful execution of ship operations. However, the human factor has proven to be a weak point in the system. To reduce and mitigate it, a regulatory framework and consequently a safety system for ship barriers were created and implemented with this goal in mind. The expected result of these measures was the creation of a resilient maritime transport system. Nevertheless, the available statistics show that most of the reported accidents and incidents occurred during ship operation, with the human factor as the main cause. Therefore, it is useful to investigate whether the regulatory framework can influence the safety system of ship barriers. Therefore, the objectives of the study are as follows: (a) to investigate and determine the regulatory safety requirements and the elements related to the ship barrier system, and (b) to investigate the influence of the regulatory safety requirements on the elements related to the ship barrier system. From the data obtained and the analyses performed, seven factors emerged. Four of them were related to the regulatory requirements and three to the shipboard barrier system, a basis for the presented models. Several important findings were obtained that have theoretical and practical implications and further highlight the importance and potential undesirable side effects of the provisions of the current regulatory framework. Full article

Background/Objectives: Deceleration can cause liver ruptures via ligament traction, with a specific, little-known transverse rupture in segment II of the left lobe being a concern. This study aimed to provide a detailed morphological characterization of these segment II ruptures, analyse their formation mechanisms using autopsy material, and propose a systematic intraoperative assessment method to improve their detection. Methods: This study analysed the autopsy cases of 132 victims of sudden, violent deceleration (falls from height, traffic accidents) performed between 2011 and 2014. Liver injuries were meticulously described, focusing on the morphological characteristics of ruptures (course, shape, depth) and their location relative to hepatic ligaments. Cases with prior liver resection due to injuries were excluded. Results: Liver ruptures were found in 61 of the 132 analysed cases (46.2%). A “new location” for ruptures was identified on the diaphragmatic surface of the left lobe’s segment II, near and along the left coronary and triangular ligaments. This specific type of rupture was found in 14 cases. Overall, 40 cadavers had liver ruptures near ligaments, totalling 55 such distinct ruptures, indicating that some had multiple ligament-associated tears. The incidence of liver rupture at this newly described site was statistically significant. Conclusions: Transverse rupture of the left hepatic lobe’s segment II, in its subdiaphragmatic area, results from ligament “pulling” forces during deceleration and is a characteristic injury. Its presence should be considered following blunt abdominal trauma involving deceleration, and the subdiaphragmatic area of the left lateral lobe requires intraoperative inspection, especially if other ligament-associated liver ruptures are found. Full article

This study explores the use of Large Language Models (LLMs), specifically GPT, for different safety management applications in the construction industry. Many studies have explored the integration of GPT in construction safety for various applications; their primary focus has been on the feasibility of such integration, often using GPT models for specific applications rather than a thorough evaluation of GPT’s limitations and capabilities. In contrast, this study aims to provide a comprehensive assessment of GPT’s performance based on established key criteria. Using structured use cases, this study explores GPT’s strength and weaknesses in four construction safety areas: (1) delivering personalized safety training and educational content tailored to individual learner needs; (2) automatically analyzing post-accident reports to identify root causes and suggest preventive measures; (3) generating customized safety guidelines and checklists to support site compliance; and (4) providing real-time assistance for managing daily safety tasks and decision-making on construction sites. LLMs and NLP have already been employed in each of these four areas for improvement, making them suitable areas for further investigation. GPT demonstrated acceptable performance in delivering evidence-based, regulation-aligned responses, making it valuable for scaling personalized training, automating accident analyses, and developing safety protocols. Additionally, it provided real-time safety support through interactive dialogues. However, the model showed limitations in deeper critical analysis, extrapolating information, and adapting to dynamic environments. The study concludes that while GPT holds significant promise for enhancing construction safety, further refinement is necessary. This includes fine-tuning for more relevant safety-specific outcomes, integrating real-time data for contextual awareness, and developing a nuanced understanding of safety risks. These improvements, coupled with human oversight, could make GPT a robust tool for safety management. Full article

Background: Trauma-related injuries are among the most common reasons for paediatric hospital presentations and represent a substantial component of orthopaedic care. Their management poses unique challenges due to ongoing skeletal development in children. While most reported fractures occur at home or during sports, prior studies have primarily used data from urban European populations, limiting the relevance of their findings for rural and regional settings. Urban-centred research often informs public healthcare guidelines, treatment algorithms, and infrastructure planning, introducing a bias when findings are generalised outside of metropolitan populations. This study addresses that gap by analysing fracture data from two rural trauma centres in New South Wales, Australia. This study assesses paediatric fractures resulting from severe injury mechanisms in rural areas, identifying common fracture types, underlying mechanisms, and treatment approaches to highlight differences in demographics. These findings aim to cast a light on healthcare challenges that regional areas face and to improve the overall cultural safety of children who live and grow up outside of the metropolitan trauma networks. Methods: We analysed data from two major rural referral hospitals in New South Wales (NSW) for paediatric injuries presenting between 1 January 2018 and 31 December 2022. This study included 150 patients presenting with fractures following severe mechanisms of injury, triaged into Australasian Triage Scale (ATS) categories 1 and 2 upon initial presentation. Results: A total of 150 severe fractures were identified, primarily affecting the upper and lower limbs. Males presented more frequently than females, and children aged 10–14 years old were most commonly affected. High-energy trauma from motorcycle (dirt bike) accidents was the leading mechanism of injury among all patients, and accounted for >50% of injuries among 10–14-year-old patients. The most common fractures sustained in these events were upper limb fractures, notably of the clavicle (n = 26, 17.3%) and combined radius/ulna fractures (n = 26, 17.3%). Conclusions: Paediatric trauma in regional Australia presents a unique and under-reported challenge, with high-energy injuries frequently linked to unregulated underage dirt bike use. Unlike urban centres where low-energy mechanisms dominate, rural areas require targeted prevention strategies. While most cases were appropriately managed locally, some were transferred to tertiary centres. These findings lay the groundwork for multi-centre research, and support the need for region-specific policy reform in the form of improved formal injury surveillance, injury prevention initiatives, and the regulation of under-aged off-road vehicular usage. Full article

Background: Sleep is a fundamental component of health, and deprivation has been linked to numerous adverse outcomes, including reduced academic and occupational performance, greater risk of accidents, and increased susceptibility to chronic diseases and premature mortality. Dietary and lifestyle behaviors are increasingly recognized as key determinants of sleep quality. Women are particularly susceptible to sleep disturbances due to hormonal fluctuations and psychosocial factors. However, women remain underrepresented in sleep research. This study aims to examine the associations between sleep quality, nutrition, and lifestyle in a large cohort of Spanish women. Methods: A cross-sectional study was conducted with 785 women aged 18–64. Participants completed the Pittsburgh Sleep Quality Index (PSQI) and the NutSo-HH questionnaire on dietary and lifestyle behaviors. Descriptive analyses, correlation matrices, Gaussian Graphical Models, and Principal Component Analyses were used to assess relationships between variables. Results: More than half of the participants rated their sleep quality as good or very good, although over 30% experienced frequent nighttime awakenings. Poor sleep quality was significantly associated with higher alcohol consumption, lower vegetable and white fish intake, and lower levels of physical activity. Diets rich in ultra-processed foods correlated moderately with subjective poor sleep and daytime dysfunction. However, no strong associations were found between stimulant consumption, late meals, or dietary patterns (e.g., Mediterranean diet) and sleep. Self-perceived health emerged as a protective factor, while nocturnal lifestyles were linked to longer sleep latency and fragmented sleep. Conclusions: In adult women, better sleep quality is linked to healthy dietary choices, regular physical activity, and a positive perception of general health. In contrast, alcohol use and irregular lifestyles are associated with poor sleep. Individual variability and cultural adaptation may moderate the impact of some traditionally harmful behaviors. Personalized, multidimensional interventions are recommended for promoting sleep health in women. Full article

Background/Objectives: Venous thromboembolism (VTE) and major hemorrhagic events are significant complications in hospitalized leukemia patients, but contemporary analyses of their epidemiology, predictors, and impact on clinical outcomes remain limited. Methods: We conducted a cross-sectional study using the National Inpatient Sample (NIS) database from 2016 to 2020. Hospitalized leukemia patients were identified using ICD-10 codes. Trends in the incidence of venous thromboembolism (VTE) and bleeding were assessed across the years, and multivariable logistic regression models were used to evaluate the predictors of VTE and bleeding. We assessed the influence thromboembolic and hemorrhagic complications on length of stay, cost, and mortality outcomes. Results: Among 430,780 leukemia hospitalizations, the overall incidence of VTE was 5.4% and remained stable throughout the study period (p = 0.09), while hemorrhagic events = 5.6%) showed a significant upward trend (p = 0.01). Cerebrovascular accidents, central venous catheter insertion, and protein calorie malnutrition (PCM) were significant predictors of both VTE and hemorrhage. PCM demonstrated a dose-dependent relationship with both complications. VTE was associated with a 33.5% increase in length of stay (LOS) and a 35% increase in cost of care (COC). Hemorrhage was associated with 23.2% increase in LOS and 32.6% increase in COC. Only hemorrhagic events were independently associated with increased mortality (adjusted OR 2.88, p < 0.001). Conclusions: The incidence of VTE in hospitalized leukemia patients has remained stable while hemorrhagic complications have increased significantly. Nutritional status represents a potentially modifiable risk factor for both VTE and bleeding complications. The competing risk between thrombosis and hemorrhage varies with age and nutritional status, suggesting the need for nuanced thromboprophylaxis strategies in this vulnerable population. Full article

Background: Previous studies have pointed out the importance of having first aid knowledge to effectively tend to the victim of any accident. However, it is still a constant challenge to ascertain the level of first aid knowledge among students at different stages of education. Objectives: This study aimed to analyse differences in first aid knowledge and meaningful knowledge across stages of education, as well as the influence of gender, and to determine variations in the perceived importance of first aid by stage of education. Methods: To achieve this, the First Aid Knowledge Assessment Questionnaire was administered to a sample of 1088 students: 405 from compulsory secondary education, 298 from baccalaureate and vocational training, and 385 at the university level. Results: Both when the sample was analysed in general and when it was divided according to gender, significant differences according to level of education were found for all the analysed dimensions in both knowledge level and meaningful knowledge level (p = 0.010–<0.001; ES: 0.025–0.397), with university students generally showing the highest results and secondary school students the lowest, both in knowledge and meaningful knowledge (p = 0.040–<0.001). Secondary school students showed a significantly lower interest and knowledge in first aid and regarded it as less important for their personal and professional growth (p < 0.001). In contrast, university students rated first aid as highly important and showed a greater interest on the topic (p < 0.001). Conclusions: Differences were observed across academic levels in knowledge and meaningful knowledge in first aid, with university students scoring higher and being the ones who gave most importance to this content. The findings underscore the need to reinforce first aid education at all levels of education. Full article

Motorbike taxis are widely used in Yaoundé and Douala, despite their association with heightened accident risks and relatively high fares. This research combines qualitative methods, including 38 semi-structured interviews and direct field observations, with a quantitative survey of 280 motorbike taxi passengers (customers). It employs a dynamic risk approach to analyse both the factors motivating individuals to choose motorbike taxis and the strategies adopted by drivers and passengers to mitigate and prevent accidents. The findings reveal that speed, cost-effectiveness, and the limited accessibility of certain neighbourhoods to other transport options are key factors driving regular motorbike taxi use. Moreover, strategies for managing accident risks include regulating passenger positions based on gender, perceived age, or physical stature; invoking deities for protection; and passengers’ verbal interactions with drivers to ensure safer behaviour. This research also explores how overloading, a collectively tolerated deviance, is managed to avoid or minimize the impact of accidents. By addressing both risk acceptance and prevention strategies, this study provides new insights into passengers’ social perceptions, which are often overlooked in motorbike taxi research. It expands the understanding of motorbike taxi use in urban Global South transport contexts, particularly in terms of users’ risk management behaviours. Full article