Evaluation of geometrically personalized THUMS pedestrian model response against sedan–pedestrian PMHS impact test data

Objective: Evaluating the biofidelity of pedestrian finite element models (PFEM) using postmortem human subjects (PMHS) is a challenge because differences in anthropometry between PMHS and PFEM could limit a model's capability to accurately capture cadaveric responses. Geometrical personalization via morphing can modify the PFEM geometry to match the specific PMHS anthropometry, which could alleviate this issue. In this study, the Total Human Model for Safety (THUMS) PFEM (Ver 4.01) was compared to the cadaveric response in vehicle–pedestrian impacts using geometrically personalized models.

Methods: The AM50 THUMS PFEM was used as the baseline model, and 2 morphed PFEM were created to the anthropometric specifications of 2 obese PMHS used in a previous pedestrian impact study with a mid-size sedan. The same measurements as those obtained during the PMHS tests were calculated from the simulations (kinematics, accelerations, strains), and biofidelity metrics based on signals correlation (correlation and analysis, CORA) were established to compare the response of the models to the experiments. Injury outcomes were predicted deterministically (through strain-based threshold) and probabilistically (with injury risk functions) and compared with the injuries reported in the necropsy.

Results: The baseline model could not accurately capture all aspects of the PMHS kinematics, strain, and injury risks, whereas the morphed models reproduced biofidelic response in terms of trajectory (CORA score = 0.927 ± 0.092), velocities (0.975 ± 0.027), accelerations (0.862 ± 0.072), and strains (0.707 ± 0.143). The personalized THUMS models also generally predicted injuries consistent with those identified during posttest autopsy.

Conclusions: The study highlights the need to control for pedestrian anthropometry when validating pedestrian human body models against PMHS data. The information provided in the current study could be useful for improving model biofidelity for vehicle–pedestrian impact scenarios.     

Transport company safety climate—The impact on truck driver behavior and crash involvement

Objective: The present study investigated the relationships between safety climate and driving behavior and crash involvement.

Methods: A total of 339 company-employed truck drivers completed a questionnaire that measured their perceptions of safety climate, crash record, speed choice, and aberrant driving behaviors (errors, lapses, and violations).

Results: Although there was no direct relationship between the drivers' perceptions of safety climate and crash involvement, safety climate was a significant predictor of engagement in risky driving behaviors, which were in turn predictive of crash involvement.

Conclusions: This research shows that safety climate may offer an important starting point for interventions aimed at reducing risky driving behavior and thus fewer vehicle collisions.     

Factors affecting conviction rates of intoxicated driver patients in two large trauma centers

Objective: Outcomes from previous studies report the driving under the influence (DUI) conviction rates for trauma patients in several cities within Canada and the United States over the last 2 decades. This study reports charge, conviction, and prosecution rates for trauma patients at 2 level I trauma centers servicing a large metropolitan city.

Methods: A retrospective review of the trauma databases was completed to identify patients meeting inclusion criteria. Four hundred sixty patients were identified and their records were compared with the district attorney's records for DUI charges and convictions.

Results: The conviction rate for this study was 8.7%, demonstrating continued low rates of conviction despite growing interest and public awareness of drinking and driving.

Conclusions: We discuss legal considerations that providers should consider when treating patients who have been drinking and driving.     

Identifying risky drivers with simulated driving

Objective: The present study aimed to examine whether high-risk drivers differ from low-risk drivers in driving behavior in a simulated environment.

Method: The 2 risk groups including 36 drivers (18 males and 18 females) performed driving tasks in a simulated environment. The simulated driving behaviors are compared between the 2 risk groups.

Results: The high-risk drivers drove much faster and exhibited larger offsets of the steering wheel than did the low-risk drivers in events without incidents. Additionally, the high-risk drivers used turn signals and horns less frequently than the low-risk drivers.

Conclusions: The present study revealed that the high-risk group differed from the low-risk group in driving behavior in a simulated environment. These results also suggest that simulated driving tasks might be useful tools for the evaluation of drivers’ potential risks.     

“Are you still driving?” Metasynthesis of patient preferences for communication with health care providers

Aim: The aim of this study was to synthesize published qualitative studies to identify older adults' preferences for communication about driving with health care providers.

Background: Health care providers play a key role in addressing driving safety and driving retirement with older adults, but conversations about driving can be difficult. Guides exist for family members and providers, but to date less is known about the types of communication and messages older drivers want from their health care providers.

Design: A qualitative metasynthesis of studies published on or before October 10, 2014, in databases (PubMed, CINAHL, PsycINFO, and Web of Science) and grey literature was performed.

Review Methods: Twenty-two published studies representing 518 older adult drivers met the following inclusion criteria: the study (1) was about driving; (2) involved older drivers; (3) was qualitative (rather than quantitative or mixed methods); and (4) contained information on older drivers' perspectives about communication with health care providers.

Results: We identified 5 major themes regarding older adults' communication preferences: (1) driving discussions are emotionally charged; (2) context matters; (3) providers are trusted and viewed as authority figures; (4) communication should occur over a period of time rather than suddenly; and (5) older adults desire agency in the decision to stop driving.

Conclusion: Various stakeholders involved in older driver safety should consider older drivers' perspectives regarding discussions about driving. Health care providers can respect and empower older drivers—and support their family members—through tactful communication about driving safety and mobility transitions during the life course.     

State helmet laws and helmet use among fatally injured moped riders in the United States, 2011–2015

Objective: Research has found that mandatory motorcycle helmet laws increase helmet use and reduce motorcycle-related fatalities. However, the association between state moped helmet laws and helmet use in the United States has not been examined. This study investigated this association among a census of fatally injured moped riders in the United States.

Methods: A logistic regression model was constructed to analyze data extracted from the Fatality Analysis Reporting System (FARS) to examine risk factors for helmet nonuse among 572 moped riders fatally injured between 2011 and 2015.

Results: Fatally injured moped riders in states with universal helmet laws had 69 times the odds of wearing a helmet (P < .001).

Conclusions: Findings suggest that universal moped helmet laws increase helmet use. However, additional research is needed to examine helmet laws and use among nonfatally injured moped riders.     

A new method to assess the deformations of internal organs of the abdomen during impact

Objectives: Due to limitations of classic imaging approaches, the internal response of abdominal organs is difficult to observe during an impact. Within the context of impact biomechanics for the protection of the occupant of transports, this could be an issue for human model validation and injury prediction.

Methods: In the current study, a previously developed technique (ultrafast ultrasound imaging) was used as the basis to develop a protocol to observe the internal response of abdominal organs in situ at high imaging rates. The protocol was applied to 3 postmortem human surrogates to observe the liver and the colon during impacts delivered to the abdomen.

Results: The results show the sensitivity of the liver motion to the impact location. Compression of the colon was also quantified and compared to the abdominal compression.

Conclusions: These results illustrate the feasibility of the approach. Further tests and comparisons with simulations are under preparation.     

How motorcycle helmets affect trauma mortality: Clinical and policy implications

Background: Motorcycles are the most popular vehicles in Taiwan, where more than 14.8 million motorcycles (1 motorcycle per 1.6 people) are in service. Despite the mandatory helmet law passed in 1997, less than 80% of motorcyclists in Taiwan wear helmets.

Objective: The objective of this study was to analyze the effect of using motorcycle helmets on fatality rates.

Methods: A clinical data set including 2,868 trauma patients was analyzed; the cross-sectional registration database was administered by a university medical center in Central Taiwan. A path analysis framework and multiple logistic regressions were used to estimate the marginal effect of helmet use on mortality.

Results: Using a helmet did not directly reduce the mortality rate but rather indirectly reduced the mortality rate through intervening variables such as the severity of head injuries, number of craniotomies, and complications during therapeutic processes. Wearing a helmet can reduce the fatality rate by 1.3%, the rate of severe head injury by 34.5%, the craniotomy rate by 7.8%, and the rate of complications during therapeutic processes by 1.5%. These rates comprise 33.3% of the mortality rate for people who do not wear helmets, 67.3% of the severe head injury rate, 60.0% of the craniotomy rate, and 12.2% of the rate of complications during therapeutic processes.

Discussion: Wearing a helmet and trauma system designation are crucial factors that reduce the fatality rate.     

Examining motorcyclists' postcrash impressions: A qualitative study

Objective: Motorcycle-related crashes and injuries continue to be of great concern in Iran. This study seeks to explore how motorcyclists' perspectives and impressions of a crash are shaped and influence their future riding behaviors.

Methods: This was a qualitative study conducted in 3 major cities in Iran between March 2011 and February 2012. Participants included 31 male motorcyclists, of whom 22 participated in 4 focus groups and 9 in in-depth interviews. Findings were derived through the thematic method of analysis.

Results: Six delineated themes suggest different factors that influence riders' postcrash impressions. These include (1) opposing reactions from family and peers postcrash; (2) the motorcyclist's perception of his or her ability to handle risky road situations; (3) risk-taking attributes; (4) perceived responsibility in meeting family needs; (5) the severity of the crash-related injury; and (6) elapsed time from the crash experience.

Conclusions: Riders' postcrash impressions were formed by the opposing reactions of their family and peers to the crash experience (i.e., the index crash); the personality of riders, including being overconfident and a risk taker; familial obligations; feeling traumatized by the crash; and passage of time. These formed their perceptions, feelings, attitudes, and thoughts about the index crash.

These findings are an important step in understanding how perception and attitudes of motorcyclists are shaped and how these influence their future riding behavior. The needs for interventional studies to assess the effectiveness of road safety risk reduction programs aligned with the riders' degree of postcrash impressions are discussed.     

Spatial patterns of off-the-system traffic crashes in Miami–Dade County,Florida, during 2005–2010

Objective: The objective of this study is to analyze the spatial distribution of the vehicles involved in crashes in Miami–Dade County. In addition, we analyzed the role of time of day, day of the week, seasonality, drivers’ age in the distribution of traffic crashes.

Method: Off-the-system crash data acquired from the Florida Department of Transportation during 2005–2010 were divided into subcategories according to the risk factors age, time of day, day of the week, and travel season. Various spatial statistics methods, including nearest neighbor analysis, Getis-Ord hot spot analysis, and kernel density analysis revealed substantial spatial variations, depending on the subcategory in question.

Results: Downtown Miami and South Beach showed up consistently as hotspots of traffic crashes in all subcategories except fatal crashes. However, fatal crashes were concentrated in residential areas in inland areas.

Conclusion: This understanding of patterns can help the county target high-risk areas and help to reduce crash fatalities to create a safer environment for motorists and pedestrians.     

Analysis of posttraumatic stress disorder in children with road traffic injury in Wenzhou,China

Objective: Road traffic accidents are the leading health threat to children and cause significant long-term mental health problems. This study aimed to characterize posttraumatic stress disorder (PTSD) in children suffering from road traffic injuries (RTIs) in Wenzhou, China.

Methods: We conducted a retrospective study of 537 children (aged 1 to 13 years old) with RTIs. The epidemiological features, PTSD incidence, clinical manifestation, and risk factors were analyzed based on a customized PTSD risk factor questionnaire. The outcome factors were also evaluated by means of the logistic regression method.

Results: The PTSD incidence was 24.77% in children with RTIs. The incidence of PTSD was related to the personality, family environment, and family care of the children. It was found that early psychological intervention and reasonable family care from the family might promote physical and mental welfare as well as contribute to the development of more effective treatments to prevent PTSD.

Conclusion: For susceptible children, in addition to dealing with the somatic injury, psychological intervention and family care should be carried out as early as possible.     

Evaluating the Brazilian zero tolerance drinking and driving law: Time series analyses of traffic-related mortality in three major cities

Objective: A zero tolerance alcohol restriction law was adopted in Brazil in 2008. In order to assess the effectiveness of this intervention, the present study compares specific mortality in 2 time series: 1980–2007 and 2008–2013.

Methods: Data on mortality and population were gathered from official Brazilian Ministry of Health information systems. Segmented regression analyses were carried out separately for 3 major Brazilian capitals: Belo Horizonte, Rio de Janeiro, and São Paulo.

Results: In 2 cities (Belo Horizonte and Rio de Janeiro) there were no significant changes in mortality rate trends in 2 periods, 1980 to 2007 and 2008 to 2013, where the observed rates did not differ significantly from predicted rates. In São Paulo, a decreasing trend until 2007 unexpectedly assumed higher levels after implementation of the law.

Conclusion: There is no evidence of reduced traffic-related mortality in the 3 major Brazilian capitals 5.5 years after the zero tolerance drinking and driving law was adopted.     

Motorcycle fuel tanks and pelvic fractures: A motorcycle fuel tank syndrome

Objective: Pelvic injuries are a serious and commonly occurring injury to motorcycle riders involved in crashes, yet there has been limited research investigating the mechanisms involved in these injuries. This study aimed to investigate the mechanisms involved in pelvic injuries to crashed motorcyclists.

Method: This study involved in-depth crash investigation and 2 convenience-based data sets were used. These data sets investigated motorcycle crashes in the Sydney, Newcastle, and Adelaide regions. Participants included motorcycle riders who had crashed either on a public road or private property within the study areas. The mechanism of injury and the type of injuries were investigated.

Results: The most frequent cause of pelvic injuries in crashed motorcyclists was due to contact with the motorcycle fuel tank during the crash (85%). For riders who had come into contact with the fuel tank, the injury types were able to be grouped into 3 categories based on the complexity of the injury. The complexity of the injury appeared to increase with impact speed but this was a nonsignificant trend. The pelvic injuries that did not occur from contact with the fuel tank in this sample differed in asymmetry of loading and did not commonly involve injury to the bladder. They were commonly one-sided injuries but this differed based on the point of loading; however, a larger sample of these injuries needs to be investigated.

Conclusion: Overall improvements in road safety have not been replicated in the amelioration of pelvic injuries in motorcyclists and improvements in the design of crashworthy motorcycle fuel tanks appear to be required.     

Child restraint use and parental perceptions of comfort

Objective: Suboptimal child restraint use includes incorrect and/or inappropriate restraint use and increases the risk of injury. Comfort has been suggested as an important factor impacting on optimal use of restraints by children. This article aims to examine the relationships between parent reported comfort and restraint misuse and age-appropriate restraint choice.

Methods: This is an analysis of data from a cross sectional observation study of child restraint use in New South Wales. Logistic regression was used to model the relationship between parent-reported comfort and restraint misuse and age-appropriate restraint choice.

Results: There was no significant relationship between either parent-reported comfort and restraint misuse or parent-reported comfort and age-appropriate restraint choice.

Conclusions: Parent perceptions of comfort of children in child restraints do not appear to be associated with incorrect child restraint use or age appropriate restraint choice. It is possible that the actual comfort of the child may be related to incorrect use but this remains to be tested. Further investigation of the relationship between parent-perceived comfort and the actual comfort of the child, as well as the impact of child comfort on optimal child restraint use is warranted.     

Analyzing pedestrian crash injury severity under different weather conditions

Objective: Pedestrians are the most vulnerable road users due to the lack of mass, speed, and protection compared to other types of road users. Adverse weather conditions may reduce road friction and visibility and thus increase crash risk. There is limited evidence and considerable discrepancy with regard to impacts of weather conditions on injury severity in the literature. This article investigated factors affecting pedestrian injury severity level under different weather conditions based on a publicly available accident database in Great Britain.

Method: Accident data from Great Britain that are publicly available through the STATS19 database were analyzed. Factors associated with pedestrian, driver, and environment were investigated using a novel approach that combines a classification and regression tree with random forest approach.

Results: Significant severity predictors under fine weather conditions from the models included speed limits, pedestrian age, light conditions, and vehicle maneuver. Under adverse weather conditions, the significant predictors were pedestrian age, vehicle maneuver, and speed limit.

Conclusions: Elderly pedestrians are associated with higher pedestrian injury severities. Higher speed limits increase pedestrian injury severity. Based on the research findings, recommendations are provided to improve pedestrian safety.     

The combined effects of on-road and simulator training with feedback on older drivers' on-road performance: Evidence from a randomized controlled trial

Objective: A number of training programs that seek to improve driving performance among older drivers are available accompanied by a growing interest in their effectiveness. The purpose of the present investigation was to examine the combined effect of (1) basic in-class training (BT); (2) on-road training with individualized feedback (OR); and (3) training on a driving simulator (S).

Methods: Using a randomized controlled trial study design, 78 older drivers were randomly assigned to one of 3 groups (BT, BT + OR, or BT + OR + S). All participants completed a pre- and postintervention on-road driving evaluation on a standardized route. The driving evaluations were recorded using video and Global Positioning System (GPS) equipment and were scored by a blind assessor.

Results: The results indicated a significant reduction of approximately 30% in overall number of driving errors/omissions among participants in the BT + OR and the BT + OR + S groups in comparison to participants in the BT group.

Conclusions: This study adds to the mounting evidence demonstrating the effectiveness of individualized driver training in improving safe driving among older adults.     

Risk factors affecting the severity of traffic accidents at Shanghai river-crossing tunnel

Objective: With increasing traffic volume and urban development, increasing numbers of underground tunnels have been constructed to relieve conflict between strained land and heavy traffic. However, as more long tunnels are constructed, tunnel traffic safety is becoming increasingly serious. Thus, it is necessary to acquire their implications and impacts. This study examined 4,539 traffic accidents that have occurred in 14 Shanghai river-crossing tunnels for the period 2011–2012 and analyze the correlation between potential factors and accident injury severity.

Methods: An ordered logit model was developed to examine the correlation between potential factors and accident injury severity.

Results: Results show that increased injury severity is associated with male drivers, drivers aged 65 years or older, accident time from midnight to dawn, weekends, wet road surface, goods vehicles, 3 or more vehicles, 4 or more lanes, middle speed limits (50–79 km/h), zone 3, extra-long tunnels (over 3,000 m), and maximum longitudinal gradient.

Conclusions: This article aims to provide useful information for engineers to develop interventions and countermeasures to improve tunnel safety in China.     

A new approach to managing work-related road traffic injury: The development of a health investment framework

Objective: Statistics indicate that employees commuting or traveling as part of their work are overrepresented in workplace injury and death. Despite this, many organizations are unaware of the factors within their organizations that are likely to influence potential reductions in work-related road traffic injury.

Methods: This article presents a multilevel conceptual framework that identifies health investment as the central feature in reducing work-related road traffic injury. Within this framework, we explore factors operating at the individual driver, workgroup supervisor, and organizational senior management levels that create a mutually reinforcing system of safety.

Results: The health investment framework identifies key factors at the senior manager, supervisor, and driver levels to cultivating a safe working environment. These factors are high-performance workplace systems, leader–member exchange and autonomy, trust and empowerment, respectively. The framework demonstrates the important interactions between these factors and how they create a self-sustaining organizational safety system.

Conclusions: The framework aims to provide insight into the future development of interventions that are strategically aligned with the organization and target elements that facilitate and enhance driver safety and ultimately reduce work-related road traffic injury and death.     

Prevention of railway trespassing by automatic sound warning—A pilot study

Objective: The objective of this study was to investigate the effects of a sound warning system on the frequency of trespassing at 2 pilot test sites in Finland.

Methods: The effect of automatic prerecorded sound warning on the prevention of railway trespassing was evaluated based on observations at 2 test sites in Finland. At both sites an illegal footpath crossed the railway, and the average daily number of trespassers before implementation of the measures was about 18 at both sites.

Results: The results showed that trespassing was reduced at these sites by 18 and 44%, respectively. Because of the lack of proper control sites, it is possible that the real effects of the measure are somewhat smaller.

Conclusions: The current study concludes that automatic sound warning may be efficient and cost effective at locations where fencing is not a viable option. However, it is not likely to be a cost-effective panacea for all kinds of sites where trespassing occurs, especially in countries like Finland where trespassing is scattered along the railway network rather than concentrated to a limited number of sites.     

Survey regarding the 0.05 blood alcohol concentration limit for driving in the United States

Background: On May 14, 2013, the National Transportation Safety Board (NTSB) proposed that states lower the blood alcohol concentration (BAC) illegal limit from 0.08 to 0.05 g/dL (also referred to as the 0.08 law and the 0.05 limit, respectively). In March 2017, this recommendation was signed into law in the State of Utah.

Objective: The objective of this survey is to investigate perceptions regarding enforcement of the 0.05 g/dL BAC limit.

Method: Opinions of law enforcement officers, prosecutors, and defense attorneys were obtained through a series of questionnaires and focus groups.

Results: Survey data were collected from 32 law enforcement officers, 20 prosecutors, and 4 defense attorneys. The participants rated the usefulness of the NHTSA's driving while intoxicated (DWI) driving cues lower for the 0.05 limit than for the 0.08 law. Some of the participants believed that training would be needed in regard to sobriety testing under the 0.05 limit. Participants also stated that adequately preparing for prosecution of drunk drivers would be more difficult under the 0.05 limit. In addition, it was believed that drunk driving cases are more likely to be withdrawn and fewer plea agreements and guilty pleas are likely under the 0.05 limit. Prosecutors were concerned that the 0.05 limit would result in poorly investigated cases and overburden the court system. Defense attorneys were concerned about the social and economic costs of a 0.05 limit.

Discussion: Overall, it appears that the 0.05 limit is viewed as enforceable and it will save lives; however, the usefulness of the NHTSA DWI Detection Guide and of the standardized field sobriety tests need to be established for lower BACs, and efforts must be made to educate people regarding the relationship between BAC and impairment and impairment and driving with the risk of injury and death.

Conclusion: Though the 0.05 limit offers promise in saving lives, the following issues associated with changing the limit to 0.05 need to be resolved prior to implementation: Validating the sobriety tests for the 0.05 limit; if needed, modifying the sobriety tests to make them effective and valid at the 0.05 limit; and training law enforcement personnel and educating the public regarding the 0.05 limit.