UNASSIGNED: This study aims to establish best practices and guidelines to ensure that experimental research utilizing Postmortem Human Subjects (PMHS) for injury prevention adheres to relevant ethical principles, which are also commonly accepted in research involving human tissues and living subjects. Furthermore, it reviews existing literature to underscore the pivotal role of PMHS testing in evaluating the efficacy of safety systems, with a particular focus on airbag performance.
UNASSIGNED: This paper conducts an examination of the primary ethical principles governing human subject research as outlined in the Declaration of Helsinki (1965) and traces their evolution up to the latest framework proposed by the Council for International Organizations of Medical Sciences (CIOMS) in 2002. Input was solicited from international experts and laboratories experienced in PMHS testing to understand how these ethical principles are implemented in practice. This is complemented by a comprehensive review of literature that assesses the contribution of PMHS testing to airbag performance enhancements in frontal impacts.
UNASSIGNED: The findings underscore the importance of informed consent from donors or their next-of-kin, as highlighted in CIOMS declarations, to ensure the ethical integrity of the donation process in line with international standards. The study also finds it customary for an independent review board to evaluate the research methodology and the necessity of employing PMHS tissue over alternative methods, such as computational models or crash test dummies. Despite various national regulations on human subject participation and living tissue research, no specific legal framework governing PMHS tissue use was identified. The systematic literature review revealed that PMHS testing has been crucial in identifying potential injury mechanisms not detected by Anthropomorphic Test Devices (ATD), significantly contributing to the enhancement of computer human body models and the biofidelity of crash test dummies.
UNASSIGNED: The International Council on the Biomechanics of Injury (IRCOBI) recognizes the need to provide guidance for research involving human cadaveric tissue to be conducted with the highest ethical standards. This study proposes five recommendations to ensure adherence to these ethical principles in PMHS testing, highlighting the paramount importance of obtaining informed consent and securing independent committee approval. Moreover, IRCOBI emphasizes that until a thorough understanding of tissue damage tolerance levels is achieved and human surrogates, such as ATDs or Human Body Models (HBM), reach full biofidelity, the use of human cadavers remains indispensable for developing effective injury prevention strategies and measures.

Few large studies have investigated the factors and outcomes related to concomitant injuries occurring alongside mild traumatic brain injury (mTBI) after motor vehicle collisions (MVCs). Thus, the objective of this study was to assess whether MVC characteristics predict which patients with mTBI will have concomitant whiplash injury, and whether concomitant whiplash injury affects care utilization for these patients.
This retrospective cohort study included 22,213 patients with mTBI after MVC identified from the American College of Surgeons Trauma Quality Programs dataset. A hierarchical logistic regression model was constructed to investigate patient and MVC factors associated with concomitant whiplash injury. Propensity score matching on whiplash status, in conjunction with a multivariable logistic regression model, assessed if concomitant whiplash affected odds of hospitalization. In the subgroup of patients who were hospitalized, associations with hospital length of stay (LOS) and discharge disposition were investigated.
The median (IQR) age was 34 (24-51) years, with a median Glasgow Coma Scale score at presentation of 15 (15-15). Patients with concomitant whiplash were older (median 36 years vs 34 years, p = 0.03) and had higher rates of hospitalization (75% vs 64%, p < 0.001). In the hierarchical model for associations with concomitant whiplash injury, patients with blood alcohol content (BAC) greater than the federal driving limit had lower odds of concomitant whiplash (OR 0.63, 95% CI 0.49-0.81) along with those who had airbag deployment (OR 0.80, 95% CI 0.68-0.95), but seatbelt use was associated with greater odds (OR 1.41, 95% CI 1.16-1.71). After matching, concomitant whiplash was independently associated with increased odds of hospitalization (OR 1.67, 95% CI 1.40-1.99) while seatbelt use was associated with decreased odds (OR 0.88, 95% CI 0.81-0.95). Among hospitalized patients, concomitant whiplash was not associated with hospital LOS or discharge disposition.
MVC characteristics such as alcohol consumption and airbag deployment were protective toward development of concomitant whiplash for mTBI patients, while seatbelt use was associated with higher risk. Concomitant whiplash increases the odds of hospitalization for mTBI patients but does not affect hospital LOS or discharge disposition, while seatbelt use is associated with lower rates of hospitalization and a more favorable hospital course. These findings provide context to injury patterns and care provision after a common mechanism of injury.

UNASSIGNED: We studied the kinetic phenomenon of an airbag impact on eyes after trabeculectomy using finite element analysis (FEA), a computerized method for predicting how an object reacts to real-world physical effects and showing whether an object will break, to sequentially determine the responses at various airbag deployment velocities.
UNASSIGNED: A human eye model was used in the simulations using the FEA program PAM-GENERISTM (Nihon ESI, Tokyo, Japan). A half-thickness incised scleral flap was created on the limbus and the strength of its adhesion to the outer sclera was set at 30%, 50%, and 100%. The airbag was set to hit the surface of the post-trabeculectomy eye at various velocities in two directions: perpendicular to the corneal center or perpendicular to the scleral flap (30° gaze-down position), at initial velocities of 20, 30, 40, 50, and 60 m/s.
UNASSIGNED: When the airbag impacted at 20 m/s or 30 m/s, the strain on the cornea and sclera did not reach the mechanical threshold and globe rupture was not observed. Scleral flap lacerations were observed at 40 m/s or more in any eye position, and scleral rupture extending posteriorly from the scleral flap edge and rupture of the scleral flap resulting from extension of the corneal laceration through limbal damage were observed. Even in the case of 100% scleral flap adhesion strength, scleral flap rupture occurred at 50 m/s impact velocity in the 30° gaze-down position, whereas in eyes with 30% or 50% scleral flap adhesion strength, scleral rupture was observed at an impact velocity of 40 m/s or more in both eye positions.
UNASSIGNED: An airbag impact of ≥40 m/s might induce scleral flap rupture, indicating that current airbags may induce globe rupture in the eyes after trabeculectomy. The considerable damage caused by an airbag on the eyes of short-stature patients with glaucoma who have undergone trabeculectomy might indicate the necessity of ocular protection to avoid permanent eye damage.

Side and frontal airbag deployment represents the main injury mechanism to the upper extremity during automotive collisions. Previous dynamic injury limit research has been limited to testing the forearm at either the assumed most vulnerable location to fracture, the distal 1/3rd, or the midpoint. Studies have varied the surface to which impacts were applied, with no clear consensus on the site of greatest vulnerability. The unpredictability of airbag impact location, especially with altered hand positioning, limits the effectiveness of existing forearm injury limits determined from impacts at only one location. The current study quantified the effect of impacts at alternative locations on injury risk along the forearm using the THUMS FE model. Airbag-level impacts were simulated along the forearm on all four anatomical surfaces. Results showed the distal 1/3rd is not the most vulnerable location (for any side), indicating forearm fracture is not solely driven by area moment of inertia (as previously assumed). The posterior forearm was the weakest, suggesting that current test standards underestimate the fracture risk of the forearm. Linear regression models showed strong correlation between forearm fracture risk and bone geometry (cross-sectional area and area moment of inertia) as well as soft-tissue depth, potentially providing the ability to predict forearm injury tolerances for any location or forearm size. This study demonstrated the forearm\'s vulnerability to fracture from airbag deployments, indicating the need for safety systems to better address injury mechanisms for the upper limb to effectively protect drivers.

UNASSIGNED: We studied the kinetic phenomenon of an airbag impact on eyes with different axial lengths using finite element analysis (FEA) to sequentially determine the physical and mechanical responses of intraocular segments at various airbag deployment velocities.
UNASSIGNED: The human eye model we created was used in simulations with the FEA program PAM-GENERISTM. The airbag was set to impact eyes with axial lengths of 21.85 mm (hyperopia), 23.85 mm (emmetropia) and 25.85 mm (myopia), at initial velocities of 20, 30, 40, 50 and 60 m/s. The deformation rate was calculated as the ratio of the length of three segments, anterior chamber, lens and vitreous, to that at the baseline from 0.2 ms to 2.0 ms after the airbag impact.
UNASSIGNED: Deformation rate of the anterior chamber was greater than that of other segments, especially in the early phase, 0.2-0.4 ms after the impact (P < 0.001), and it reached its peak, 80%, at 0.8 ms. A higher deformation rate in the anterior chamber was found in hyperopia compared with other axial length eyes in the first half period, 0.2-0.8 ms, followed by the rate in emmetropia (P < 0.001). The lens deformation rate was low, its peak ranging from 40% to 75%, and exceeded that of the anterior chamber at 1.4 ms and 1.6 ms after the impact (P < 0.01). The vitreous deformation rate was lower throughout the simulation period than that of the other segments and ranged from a negative value (elongation) in the later phase.
UNASSIGNED: Airbag impact on the eyeball causes evident deformation, especially in the anterior chamber. The results obtained in this study, such as the time lag of the peak deformation between the anterior chamber and lens, suggest a clue to the pathophysiological mechanism of airbag ocular injury.

Motor vehicle accidents are a significant cause of morbidity and mortality worldwide. Airbags aim to reduce the severity of motor vehicle accidents, but their deployment is not without risks. This study presents five cases presenting with diverse forms of upper extremity injuries following airbag deployment. The presented cases highlight the variety of clinical presentations, the differences in diagnostics in terms of imaging modalities, as well as the spectrum of possible outcomes from complete healing to decreased range of motion to persistent neurological symptoms. Understanding the mechanisms and presentations of such injuries can only help in improving and creating new strategies for the prevention of such injuries, as well as their management.

Background and Objectives: Protective equipment, including seatbelts and airbags, have dramatically reduced the morbidity and mortality rates associated with motor vehicle collisions (MVCs). While generally associated with a reduced rate of injury, the effect of motor vehicle protective equipment on patterns of chest wall trauma is unknown. We hypothesized that protective equipment would affect the rate of flail chest after an MVC. Materials and Methods: This study was a retrospective analysis of the 2019 iteration of the American College of Surgeons Trauma Quality Program (ACS-TQIP) database. Rib fracture types were categorized as non-flail chest rib fractures and flail chest using ICD-10 diagnosis coding. The primary outcome was the occurrence of flail chests after motor vehicle collisions. The protective equipment evaluated were seatbelts and airbags. We performed bivariate and multivariate logistic regression to determine the association of flail chest with the utilization of vehicle protective equipment. Results: We identified 25,101 patients with rib fractures after motor vehicle collisions. In bivariate analysis, the severity of the rib fractures was associated with seatbelt type, airbag status, smoking history, and history of cerebrovascular accident (CVA). In multivariate analysis, seatbelt use and airbag deployment (OR 0.76 CI 0.65-0.89) were independently associated with a decreased rate of flail chest. In an interaction analysis, flail chest was only reduced when a lap belt was used in combination with the deployed airbag (OR 0.59 CI 0.43-0.80) when a shoulder belt was used without airbag deployment (0.69 CI 0.49-0.97), or when a shoulder belt was used with airbag deployment (0.57 CI 0.46-0.70). Conclusions: Although motor vehicle protective equipment is associated with a decreased rate of flail chest after a motor vehicle collision, the benefit is only observed when lap belts and airbags are used simultaneously or when a shoulder belt is used. These data highlight the importance of occupant seatbelt compliance and suggest the effect of motor vehicle restraint systems in reducing severe chest wall injuries.

Injuries due to automobile safety devices have been reported and we report a rare fatality due to a defective airbag system. A compact hybrid car driven by a 37-year-old male at moderate speed had crashed through an unprotected manhole. The car had moved around 200 m before it came to a halt. The passers-by had noticed that the driver was unconscious, partly leaning forward with an inflated airbag. He was pronounced dead on admission. The car had sustained minor indentation on front bumper. Autopsy revealed a circular perforated laceration on the neck associated with completely transected right carotid artery and partially transected jugular vein. There was a 2 × 2-cm cylindrical metal object lodged at C4-C5 vertebrae level, and the remaining part of this was retrieved during scene investigation and identified as a part of a metal canister in the inflator component of the airbag system. There was a perforation in the airbag which was similar in size to the retrieved foreign body. The cause of death was ascertained as hemorrhagic shock due to bleeding from ruptured neck vessels caused by primary shrapnel projected from the faulty airbag system. Following the incident, the manufacturers replaced faulty airbag systems in similar models. If abnormally fatal injuries are observed, a scene visit along with automotive expert opinion would provide valuable insight into the incident. Such information would alert the general public on regular screening of safety measures and prompt manufacturers to recall faulty products.

OBJECTIVE: The advent of automated vehicles (AVs) provides an opportunity to design integrated wheelchair seating stations that provide an equivalent level of safety for occupants using wheelchairs as those using vehicle seating. This study designed a frontal occupant protection system for an integrated second-row wheelchair seating station that includes optimized airbags and seatbelt systems.
METHODS: MADYMO models were used to optimize belt geometry for a midsized male ATD seated in a surrogate wheelchair fixture, with and without inclusion of a Self Conforming Rearseat Air Bag (SCaRAB). Sled tests were performed to confirm the benefits of airbag use and optimized belt geometry. Additional modeling was performed with commercial manual and power wheelchairs, to identify the effects of wheelchair design and forward clear space on occupant kinematics and injury measures. Additional sled tests were performed with manual and power wheelchairs to demonstrate effectiveness of the restraint system with commercial products.
RESULTS: Simulations and tests both showed improved kinematics using an optimized seatbelt system geometry compared to a commonly used suboptimal D-ring location that places the shoulder belt at a more outboard location. Use of the SCaRAB helped compensate for suboptimal geometry. Results include specific recommendations for belt geometry relative to the wheelchair seating station and airbag parameters suitable for protecting occupants seated in wheelchairs. Restraint systems initially optimized using the surrogate wheelchair also performed well with the two commercial wheelchairs. The clear space required for maneuvering a wheelchair will likely prevent injurious head contact in frontal crashes.
CONCLUSIONS: This study is the first to design a frontal optimal occupant protection system for an integrated second-row wheelchair seating station, demonstrating that it should be feasible once integrated wheelchair seating stations are included in AVs.

Although various soft pneumatic actuators have been studied, their performance, including load capacity, has not been satisfied yet. Enhancing their actuation capability and using them to develop soft robots with high performance is still an open and challenging issue. In this study, we developed novel pneumatic actuators based on fiber-reinforced airbags as a solution to this problem, of which the maximum pressure reaches more than 100 kPa. Through cellular rearrangement, the developed actuators could bend uni- or bidirectionally, achieving large driving force, large deformation, and high conformability. Hence, they could be used to develop soft manipulators with relatively large payload (up to 10 kg, about 50 times the body self-weight) and soft climbing robots with high mobility. In this article, we first present the design of the airbag-based actuators and then model the airbag to obtain the relationship between the pneumatic pressure, external force, and deformation. Subsequently, we validate the models by comparing the simulated and measured results and test the load capacity of the bending actuators. Afterward, we present the development of a soft pneumatic robot that can rapidly climb horizontal, inclined, and vertical poles with different cross-sectional shapes and even outdoor natural objects, like bamboos, at a speed of 12.6 mm/s generally. In particular, it can dexterously transition between poles at any angle, which, to the best of our knowledge, has not been achieved before.