Unintentional non-traffic injury and fatal events: Threats to children in and around vehicles

Objective: There have been substantial reductions in motor vehicle crash–related child fatalities due to advances in legislation, public safety campaigns, and engineering. Less is known about non-traffic injuries and fatalities to children in and around motor vehicles. The objective of this study was to describe the frequency of various non-traffic incidents, injuries, and fatalities to children using a unique surveillance system and database.

Methods: Instances of non-traffic injuries and fatalities in the United States to children 0–14 years were tracked from January 1990 to December 2014 using a compilation of sources including media reports, individual accounts from families of affected children, medical examiner reports, police reports, child death review teams, coroner reports, medical professionals, legal professionals, and other various modes of publication.

Results: Over the 25-year period, there were at least 11,759 events resulting in 3,396 deaths. The median age of the affected child was 3.7 years. The incident types included 3,115 children unattended in hot vehicles resulting in 729 deaths, 2,251 backovers resulting in 1,232 deaths, 1,439 frontovers resulting in 692 deaths, 777 vehicles knocked into motion resulting in 227 deaths, 415 underage drivers resulting in 203 deaths, 172 power window incidents resulting in 61 deaths, 134 falls resulting in 54 deaths, 79 fires resulting in 41 deaths, and 3,377 other incidents resulting in 157 deaths.

Conclusions: Non-traffic injuries and fatalities present an important threat to the safety and lives of very young children. Future efforts should consider complementary surveillance mechanisms to systematically and comprehensively capture all non-traffic incidents. Continued education, engineering modifications, advocacy, and legislation can help continue to prevent these incidents and must be incorporated in overall child vehicle safety initiatives.     

New Methodology for an Expert-Designed Map From International Classification of Diseases (ICD) to Abbreviated Injury Scale (AIS) 3+ Severity Injury

Objective: There has been a longstanding desire for a map to convert International Classification of Diseases (ICD) injury codes to Abbreviated Injury Scale (AIS) codes to reflect the severity of those diagnoses. The Association for the Advancement of Automotive Medicine (AAAM) was tasked by European Union representatives to create a categorical map classifying diagnoses codes as serious injury (Abbreviated Injury Scale [AIS] 3+), minor/moderate injury (AIS 1/2), or indeterminate. This study's objective was to map injury-related ICD-9-CM (clinical modification) and ICD-10-CM codes to these severity categories.

Methods: Approximately 19,000 ICD codes were mapped, including injuries from the following categories: amputations, blood vessel injury, burns, crushing injury, dislocations/sprains/strains, foreign body, fractures, internal organ, nerve/spinal cord injury, intracranial, laceration, open wounds, and superficial injury/contusion. Two parallel activities were completed to create the maps: (1) An in-person expert panel and (2) an electronic survey. The panel consisted of expert users of AIS and ICD from North America, the United Kingdom, and Australia. The panel met in person for 5 days, with follow-up virtual meetings to create and revise the maps. Additional qualitative data were documented to resolve potential discrepancies in mapping. The electronic survey was completed by 95 injury coding professionals from North America, Spain, Australia, and New Zealand over 12 weeks. ICD-to-AIS maps were created for: ICD-9-CM and ICD-10-CM. Both maps indicated whether the corresponding AIS 2005/Update 2008 severity score for each ICD code was AIS 3+, 1/2, or indeterminable. Though some ICD codes could be mapped to multiple AIS codes, the maximum severity of all potentially mapped injuries determined the final severity categorization.

Results: The in-person panel consisted of 13 experts, with 11 Certified AIS specialists (CAISS) with a median of 8 years and an average of 15 years of coding experience. Consensus was reached for AIS severity categorization for all injury-related ICD codes. There were 95 survey respondents, with a median of 8 years of injury coding experience. Approximately 15 survey responses were collected per ICD code. Results from the 2 activities were compared, and any discrepancies were resolved using additional qualitative and quantitative data from the in-person panel and survey results, respectively.

Conclusions: Robust maps of ICD-9-CM and ICD-10-CM injury codes to AIS severity categories (3+ versus <3) were successfully created from an in-person panel discussion and electronic survey. These maps provide a link between the common ICD diagnostic lexicons and the AIS severity coding system and are of value to injury researchers, public health scientists, and epidemiologists using large databases without available AIS coding.     

Toxic Effect of a Pesticide, Diflubenzuron on Freshwater Microinvertebrate (Tetrahymena pyriformis)

Harmful bugs affect food production,directly by the qualitativeor quantitative reduction of the harvests,or indirectly while servinglike vectors of several illnesses of the plants and human[1].Many chemical products are used by human for a long time inthe…     

Evaluating the Effect of a Mechanical Adjunct to Improve the Installation of Child Restraint Systems to Vehicles

Objectives: We explored if an alternative CRS design that utilized a mechanical adjunct to amplify the force applied to the adult seat belt (intervention CRS) results in more accurate and secure attachment between the CRS and the vehicle compared to similar CRS models that use LATCH or the existing adult seat belt. We conducted three separate studies to address this question and additionally explored: (1) the contribution of prior CRS installation experience (Study 1), (2) the value-added of CRS labeling (Study 2), and (3) paper-based vs. video instructions (Study 3).

Methods: In Studies 1 and 2 we assessed a forward facing combination CRS design (intervention CRS) compared to a commercially available LATCH equipped model (control CRS) and in Study 3 we conducted a similar study using a convertible model of both the intervention and control CRS. Participants installed both CRS in a contemporary minivan and could choose which type of attachment to use for the control CRS (LATCH or seat belt); order of installation was counter-balanced. Evaluators systematically examined installations for accuracy and security.

Results: Study 1: A greater proportion of participants in both the experienced and inexperienced groups was able to securely install the intervention CRS compared to the control CRS: (45% vs. 16%, p =.0001 for experienced) and (37% vs. 6%, p =.003 for inexperienced). No differences between the CRS were observed for accuracy of installation in either user group. Study 2: A greater proportion of participants were able to securely install the enhanced intervention CRS compared to the control CRS: (62% vs. 9%, p =.001). The intervention CRS demonstrated reduced installation accuracy: (30% vs. 61%, p =.001). Study 3: A greater proportion of participants was able to securely install the intervention CRS compared to the control CRS: 79% vs. 66% p =.03, but this effect was smaller than in the previous studies. Participants were less likely to achieve an accurate installation with the intervention CRS compared to the control CRS: 54% vs. 79%, p =.004. Common accuracy errors in each study included twisting or misrouting the seatbelt when installing the intervention CRS.

Conclusions: Our results suggest that novel CRS designs that utilize mechanical advantage to facilitate attachment of the CRS to the vehicle result in a tighter installation compared to LATCH equipped models, but an increase in accuracy errors occurred.     

Analysis of polychlorobiphenyls from used transformers for polychlorodibenzofurans

The results of analyses for polychlorodibenzofuran (PCDF) content in two samples of polychlorobiphenyl (PCB) from used electrical transformers are presented and discussed. In neither sample was there evidence for enhanced PCDF concentrations even though one of them had been subjected to overheating while in service.     

Polychlorodibenzo-p-dioxins and dibenzofurans in technical pentachlorophenol - results of a collaborative analytical exercise

Results of analyses of eight samples of technical pentachlorophenol conducted by three different analytical methods are presented and discussed.     

Reasons for Child Passenger Nonrestraint in Motor Vehicles

Objective: Although child passenger restraint use in motor vehicles has increased, there is an important minority of children who remain unrestrained. The goal of this study was to identify the frequency of and under what circumstances parents keep their children unrestrained.

Methods: A cross-sectional, online survey was distributed to parents and caregivers of children 10 years old and younger. Survey participants were asked about child restraint practices, including frequency of and reasons for nonuse of restraints. Parents were specifically asked how acceptable it would be to keep their child unrestrained in certain situations.

Results: One thousand two hundred eighty-five parents and guardians responded to the survey and 1,002 completed it; 23.8% (95% confidence interval [CI], 21.3–26.6%) of respondents said they had driven with their child not fully restrained on at least one occasion. Approximately 1 in 5 parents strongly or somewhat agreed that it would be acceptable to keep their child unrestrained in certain situations, including a short drive, in a rush, an inadequate number of restraints, riding in a taxi, if somebody was holding the child, and as a reward for a child. Parents were more likely to agree that it was acceptable to keep their child unrestrained under nearly all circumstances listed if they were male, ages 18–29, with a graduate school education, in the $100,000+ income bracket, or Latino.

Conclusions: There are certain situations for which parents find it acceptable to leave their children unrestrained. This has implications for targeted child passenger safety efforts designed to maximize consistent restraint use.     

Long term changes in polychlorodibenzo-p-dioxin concentrations in wood treated with technical pentachlorophenol

Wood samples treated with technical pentachlorophenol (PCP), technical sodium pentachlorophenoxide (NaPCP) and octachlorodibenzo-p-dioxin have been exposed outdoors for periods up to $\text{2}\text{1}\text{2}$ years. Analysis of extracts from the samples show that photolytic reductive dechlorination of highly chlorinated dibenzo-p-dioxins to less chlorinated isomers occurs. However there is no discernible increase in polychlorodibenzo-p-dioxin concentrations in the technical PCP treated wood presumably because further photolytic reactions and volatilisation compete effectively with the photolytic formation. There is no evidence for formation of octachlorodibenzo-p-dioxin (OCDD) in technical PCP treated wood in this study, probably because photolytic destruction and volatilisation compete effectively with formation reactions when the initial OCDD concentration is relatively high.     

Diet of the northern fulmar Fulmarus glacialis: reliance on commercial fisheries?

The massive expansion in breeding numbers and range of the northern fulmar Fulmarus glacialis over the last two centuries is generally attributed to an increased availability of fish offal and discarded fishes from commercial fisheries. This implies that discards should be a major component in fulmar diets in the more recently colonised areas in the south of their range. This paper examines the contemporary diet of the northern fulmar at three major breeding sites, Fair Isle (Shetland, UK), Iceland and Disko Fjord (western Greenland). At Fair Isle, 89% of regurgitates contained fishes, with sandeels (Ammodytidae) recorded in 37%; 32% contained crustaceans (mainly decapods); 8% contained squid. There was also a temporal trend; sandeels declining and crustaceans increasing in the diet from July to August. In Iceland, fishes were also the main prey (47 to 93% of wet mass), with sandeels common in the south and west, and capelin (Mallotus villosus) in the north and east. Other fish species were mainly discards, and together with discarded decapods and fish offal formed 5 to 72% of the diet, depending on the sector. Euphausiids, amphipods and copepods constituted 3 to 13% of the diet. At Disko, 39% of samples contained fishes, 64% contained crustaceans (mainly amphipods), 22% contained squid, and 16% contained pteropods. There was a clear temporal trend, with the bulk of the samples made up of crustaceans in mid-June, capelin from late June to late July, and crustaceans and pteropods from late July to late August. An extensive review of published studies was also carried out. The general pattern was for birds in more southerly populations to consume more discarded fishes, fish offal and benthic invertebrates. However, a considerable proportion of their diet also consisted of juvenile gadids, sandeels, capelin and pelagic zooplankton, which fulmars catch for themselves, and we suggest that breeding adults in the south are less dependent on fishing waste than is generally assumed. Received: 25 September 1998 / Accepted: 7 May 1999