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.     

The Contribution of Pre-impact Posture on Restrained Occupant Finite Element Model Response in Frontal Impact

Objective: The objective of this study was to discuss the influence of the pre-impact posture to the response of a finite element human body model (HBM) in frontal impacts.

Methods: This study uses previously published cadaveric tests (PMHS), which measured six realistic pre-impact postures. Seven postured models were created from the THUMS occupant model (v4.0): one matching the standard UMTRI driving posture as it was the target posture in the experiments, and six matching the measured pre-impact postures. The same measurements as those obtained during the cadaveric tests were calculated from the simulations, and biofidelity metrics based on signals correlation (CORA) were established to compare the response of the seven models to the experiments.

Results: The HBM responses showed good agreement with the PMHS responses for the reaction forces (CORA = 0.80 ± 0.05) and the kinematics of the lower part of the torso but only fair correlation was found with the head, the upper spine, rib strains (CORA= 0.50 ± 0.05) and chest deflections (CORA = 0.67 ± 0.08). All models sustained rib fractures, sternal fracture and clavicle fracture. The average number of rib fractures for all the models was 5.3 ± 1.0, lower than in the experiments (10.8 ± 9.0).

Variation in pre-impact posture greatly altered the time histories of the reaction forces, deflections and the rib strains, mainly in terms of time delay, but no definite improvement in HBM response or injury prediction was observed. By modifying only the posture of the HBM, the variability in the impact response was found to be equivalent to that observed in the experiments. The postured HBM sustained from 4 to 8 rib fractures, confirming that the pre-impact posture influenced the injury outcome predicted by the simulation.

Conclusions: This study tries to answer an important question: what is the effect of occupant posture on kinematics and kinetics. Significant differences in kinematics observed between HBM and PMHS suggesting more coupling between the pelvis and the spine for the models which makes the model response very sensitive to any variation in the spine posture. Consequently, the findings observed for the HBM cannot be extended to PMHS. Besides, pre-impact posture should be carefully quantified during experiments and the evaluation of HBM should take into account the variation in the predicted impact response due to the variation in the model posture.     

通用电气风险评估模式在我国中小企业干预中的应用及效果评估

为提高对职业危害的识别和控制能力,采用跨国企业风险评估模式帮助我国中小企业改善职业健康与安全管理。选用通用电气环境健康安全管理体系中的11个相关元素作为评估工具,对企业开展干预,并评估效果。结果表明,干预效果较好,工人接触有害物质的水平明显降低,个体防护用品使用率和正确使用率有较大提高,职业危害风险评估符合率有明显提高。应用风险评估模式干预的示范企业,职业卫生现状得到有效改善,为企业管理提供了借鉴。     

森林保险支付意愿及影响因素分析——基于异质性营林主体视角

基于期望效用函数理论分析了异质性营林主体的森林保险支付意愿及差异,并以传统小林农和新型林业经营主体为研究对象,以福建省382户传统小林农和88户新型林业经营主体的调研数据为基础,综合运用条件估值法、卡方检验及Cox比例风险模型,对异质性营林主体的森林保险支付意愿与差异及支付意愿影响因素进行对比与分析。研究表明：传统小林农和新型林业经营主体的森林保险意愿支付水平存在显著差异,在1000~2500元/亩保障水平下,传统小林农的意愿支付水平分别为1.911元/亩、2.941元/亩、3.532元/亩及3.979元/亩,新型林业经营主体为1.632元/亩、3.971元/亩、5.809元/亩及6.864元/亩;两类营林主体的支付意愿均随保额的提高而提高,但新型林业经营主体的提升幅度远高于小林农。异质性营林主体的森林保险支付意愿影响因素也存在明显差别,这与其在森林保险认知特征、林业生产经营特征、林业灾损特征、森林保险产品评价特征等方面存在显著差异有关。此外,林地面积对两类营林主体支付意愿均具有显著影响,规模化、集约化的林业生产经营可促进林业经营主体的森林保险愿意支付水平。     

Formation of Two Xylem Frost Injuries in One Annual Ring in Siberian Spruce under Conditions of Western Siberian Forest-Tundra

The phenomenon of the formation of two damaged xylem layers in one frost ring is described in Siberian spruce grown in western Siberian forest-tundra. Temperature conditions providing for the formation of pathological cell and tissue structures are determined. The relationship between the formation of double frost injuries and cold periods is demonstrated.     

Biomechanics of Brain and Spinal-Cord Injury: Analysis of Neuropathologic and Neurophysiology Experiments

This study analyzes 46 brain and 48 spinal-cord impact experiments. The velocity of brain impact was 2.0-10.0 m/s and displacement, 0.75-5.0 mm (5.3-33% compression) using a controlled pneumatic impact. The velocity of spinal-cord impact was 1.5-6.0 m/s and displacement, 1.25-3.25 mm (25-65% compression). Brain injury varied from cortical contusion, diffuse axonal injury (DAI), to fatalities, and spinal-cord injury from temporary to complete loss of somatosensory-evoked potentials. Logist functions were determined for each injury severity and various biomechanical parameters, VC, C, V, and combinations. Brain and spinal-cord injury is most strongly correlated to VC, the viscous response. The goodness-of-fit was x² = 22.1, R-0.84 and p< 0.0000 for fatal brain injury, x² = 27.5, R = 0.96 and p< 0.0000 for cortical contusion, and x² = 17.7, R = 0.49 and p < 0.0001 for partial recovery of spinal-cord conduction. Neural tissue is viscoelastic, with a rate-dependent tolerance related to energy absorption. VC is a measure of energy absorption by impact deformation and is predictive of neural contusion, DAI, long-duration coma, spinal-cord dysfunction, and death. Tolerances for various severities of neural injury are presented. At the tissue level, VC is the product of strain and strain-rate, ε dε/dt. The research shows that strain is not a sufficient parameter of neural injury risk, and that the product of strain and strain-rate is a key biomechanical parameter for brain and spinal-cord injury.     

Theory and Model of Agricultural Insurance Subsidy

The issue of agricultural insurance subsidy is discussed in this paper aiming to make it provided more rationally and scientifically. It is started with the connection between agricultural insurance and financial subsidy. It is really necessary and crucial to implement the financial insurance due to the bad operational performance, especially in the developing countries. But the subsidy should be provided more rationally because financial subsidy has lots of negative effects. A model in competitive insurance markets developed by Ahsan et al （1982） and a farmers＇ decision model are developed to solve the optimal subsidized rate. Finally, the equation is got to calculate it. But a quantitative subsidized rate is not made here because the calculation should be under some restricted conditions, which are always absent in the developing countries. So the government should provide some subsidy for the ex ante research and preparation to get the scientific probability and premium rate.     

分洪区洪灾保险工作初探

本文从洪水过程的随机特点及防洪工作的实际需要等各个方面出发,阐述了在分洪区实行洪灾保险的必要性,结合国内外已有的实践经验,分析了这一工作得以顺利开展的可能性。并在此基础上,提出了二种洪灾保险费用计算方法,实例计算结果表明,这些方法是基本可行的。     

浅谈我国冰雹的分布规律及其保险对策

本文从冰雹灾害的分布规律着手,研究我国雹灾对策形式之一——雹灾保险,在对世界各国雹灾保险借鉴的基础上,选择我国雹灾保险的模式,建立适合我国国情的雹灾保险。     

Should 'Cyrus the Centipede' take a hike? Effects of exposure to a pedestrian safety program on children's safety knowledge and self-reported behaviors

INTRODUCTION: We report the first evaluation of the popular "Cyrus the Centipede" child pedestrian safety program. METHOD: A pre-test/post-test control versus experimental condition design was used to assess Cyrus' impact on third graders' pedestrian safety knowledge, and self-reported pedestrian behaviors. RESULTS: Although some beneficial effects were observed, the program was not reliably effective. In particular, the impact of exposure to Cyrus was strongly influenced by the individual teacher who delivered it, likely due to the highly unstructured nature of the curriculum. SUMMARY: We suggest that: (a) the effectiveness and reliability of such programs be demonstrated before they are widely adopted; and (b) programs that focus on training children in actual or simulated traffic environments may be more effective than those that primarily focus on teaching safety facts and rules.