Improved Spatial Resolution in Modeling of Nitrogen Oxide Concentrations in the Los Angeles Basin.

The extent to which emission control technologies and policies have reduced anthropogenic NOx emissions from motor vehicles is large but uncertain. We evaluate a fuel-based emission inventory for southern California during the June 2021 period, coinciding with the Re-Evaluating the Chemistry of Air Pollutants in CAlifornia (RECAP-CA) field campaign. A modified version of the Fuel-based Inventory of Vehicle Emissions (FIVE) is presented, incorporating 1.3 km resolution gridding and a new light-/medium-duty diesel vehicle category. NOx concentrations and weekday-weekend differences were predicted using the WRF-Chem model and evaluated using satellite and aircraft observations. Model performance was similar on weekdays and weekends, indicating appropriate day-of-week scaling of NOx emissions and a reasonable distribution of emissions by sector. Large observed weekend decreases in NOx are mainly due to changes in on-road vehicle emissions. The inventory presented in this study suggests that on-road vehicles were responsible for 55-72% of the NOx emissions in the South Coast Air Basin, compared to the corresponding fraction (43%) in the planning inventory from the South Coast Air Quality Management District. This fuel-based inventory suggests on-road NOx emissions that are 1.5 ± 0.4, 2.8 ± 0.6, and 1.3 ± 0.7 times the reference EMFAC model estimates for on-road gasoline, light- and medium-duty diesel, and heavy-duty diesel, respectively.

Risk of permanent medical impairment after road traffic crashes: A systematic review.

PURPOSE: To systematically review the risk of permanent disability related to road traffic injuries (RTIs) and to determine the implications for future research regarding permanent impairment following road traffic crashes. METHODS: We conducted this systematic review according to the preferred reporting items for systematic reviews and meta-analysis statement. An extended search of the literature was carried out in 4 major electronic databases for scientific research papers published from January 1980 to February 2020. Two teams include 2 reviewers each, screened independently the titles/abstracts, and after that, reviewed the full text of the included studies. The quality of the studies was assessed using the strengthening the reporting of observational studies in epidemiology (STROBE) checklist. A third reviewer was assessed any discrepancy and all data of included studies were extracted. Finally, the data were systematically analyzed, and the related data were interpreted. RESULTS: Five out of 16 studies were evaluated as high-quality according to the STROBE checklist. Fifteen studies ranked the initial injuries according to the abbreviated injury scale 2005. Five studies reported the total risk of permanent medical impairment following RTIs which varied from 2% to 23% for car occupants and 2.8% to 46% for cyclists. Seven studies reported the risk of permanent medical impairment of the different body regions. Eleven studies stated the most common body region to develop permanent impairment, of which 6 studies demonstrated that injuries of the cervical spine and neck were at the highest risk of becoming permanent injured. CONCLUSION: The finding of this review revealed the necessity of providing a globally validated method to evaluate permanent medical impairment following RTIs across the world. This would facilitate decision-making about traffic injuries and efficient management to reduce the financial and psychological burdens for individuals and communities.

Ride-Hailing and Road Traffic Crashes: A Critical Review.

Ride-hailing businesses, including Uber and Lyft, have reshaped road traffic since they first began operating in the United States approximately a decade ago. It follows that ride-hailing may also alter the incidence and distribution of road traffic crash injuries and deaths. The available evidence relating ride-hailing to crashes is critically reviewed in this article. We present a theoretical model that synthesizes the hypothesized mechanisms, and we identify common methodological challenges and suggest priorities for future research. Mixed results have been reported for the overall incidence of road traffic crash injuries and deaths, likely due to heterogeneous impacts on vehicular traffic flow (e.g., increasing the volume of vehicles); on vehicle-, person-, and event-level characteristics (e.g., reducing alcohol-impaired driver crashes); on road-user types (e.g., increasing pedestrian crashes); and on environmental conditions (e.g., reducing crashes most substantially where public transit access is poorest). The lack of a well-developed theory of human mobility and methodological challenges that are common to many ecological studies impede exploration of these sources of moderation. Innovative solutions are required to explicate ride-hailing's heterogeneous impacts, to guide policy that can take advantage of the public health benefits of ride-hailing, and to ensure that research keeps pace with technological advances that continue to reshape road traffic use.

Hit-and-run: a Swedish nationwide cohort study of serious transport accidents and convictions due to traffic offenses in obsessive-compulsive disorder.

PURPOSE: Individuals with obsessive-compulsive disorder (OCD) often report driving-related obsessions, such as fears of causing accidents, but the risk of transport accidents in OCD is unknown. We investigated whether individuals with OCD have an increased risk of serious transport accidents and convictions due to traffic offenses and explored the role of psychiatric comorbidities. METHODS: We included all individuals ≥ 18 years living in Sweden between 1997 and 2013 (N = 5,760,734). A total of 23,126 individuals had a diagnosis of OCD in the National Patient Register. We also identified 16,607 families with full siblings discordant for OCD. Cox proportional hazards regression models estimated hazard ratios (HRs) with 95% confidence intervals (CIs) for the risk of three outcomes in individuals with OCD, compared to unexposed individuals and their unexposed full siblings: injuries or deaths due to transport accidents, injuries or deaths due to motor vehicle accidents, and convictions related to traffic offenses. Psychiatric comorbidities were systematically adjusted for. RESULTS: Women, but not men, with OCD had a marginally increased risk of serious transport accidents (adjusted HR = 1.20 [95% CI 1.13-1.28]) and motor vehicle accidents (adjusted HR = 1.20 [95% CI 1.09-1.31]), compared to unaffected individuals. Neither women nor men with OCD had a significantly increased risk of convictions. The sibling comparisons showed no significant associations. When psychiatric comorbidities were adjusted for, several observed associations became non-significant or inversed (HRs and 95% CIs below one). CONCLUSION: The risks of serious transport accidents and driving-related criminal convictions in OCD are negligible and heavily influenced by psychiatric comorbidity.

Evaluation of vertical and multi-axial suspension seats for reducing vertical-dominant and multi-axial whole body vibration and associated neck and low back joint torque and muscle activity.

The primary aim of this laboratory-based human subject study was to evaluate the biomechanical loading associated with mining vehicles' multi-axial whole body vibration (WBV) by comparing joint torque and muscle activity in the neck and low back during three vibration conditions: mining vehicles' multi-axial, on-road vehicles' vertical-dominant, and no vibration. Moreover, the secondary aim was to determine the efficacy of a vertical passive air suspension and a prototype multi-axial active suspension seat in reducing WBV exposures and associated biomechanical loading measures. The peak joint torque and muscle activity in the neck and low back were higher when exposed to multi-axial vibration compared to the vertical-dominant or no vibration condition. When comparing the two suspension seats, there were limited differences in WBV, joint torque, and muscle activity. These results indicate that there is a need to develop more effective engineering controls to lower exposures to multi-axial WBV and related biomechanical loading. Practitioner Summary: This study found that mining vehicles' multi-axial WBV can increase biomechanical loading in the neck and back more so than on-road vehicles' vertical-dominant WBV. While a newly-developed multi-axial active suspension seat slightly reduced the overall WBV exposures, the results indicate that more effective engineering controls should be developed. Abbreviation: APDF: amplitude probability density function; Aw: weighted average vibration; BMI: body mass index; C7: The 7th cervical vertebra; EMG: electromyography; ES: erector spinae; IRB: institutional review board; ISO: International Organization for Standardization; L5/S1: the fifth lumbar vertebra (L5)/the first sacral vertebra(S1); MSDs: musculoskeletal disorders; MVC: maximum voluntary contraction; PSD: power spectral density; RVC: reference voluntary contraction; SCM: sternocleidomastoid; SD: standard deviation; SPL: splenius capitis; TRAP: trapezius; VDV: vibration dose value; WBV: whole body vibration.

Spectrum of hollow visceral injury due to isolated blunt trauma abdomen presented to a tertiary care trauma hospital of Pakistan.

OBJECTIVE: To evaluate the spectrum of isolated hollow visceral perforations in patients presenting with abdominal blunt trauma. METHODS: The observational, analytical, cross-sectional study was conducted at the surgical ward of Mayo Hospital, Lahore, Pakistan from July 1, 2020, to June 31, 2021, and comprised patients who presented in the emergency department after blunt trauma to abdomen without any open wound. Findings of hollow visceral injury were confirmed on exploration laparotomy. Data was analysed using SPSS 26. RESULTS: Of the 216 patients, 173(80.9%) were male and 43(19.9%) were female. The overall mean age was 42±9.7 years. Most of the blunt trauma abdomen cases were caused by motor vehicle accidents 59(27.3%). The most common hollow viscus affected was jejunum 42(19.4%), followed by transverse colon 29(13.4%). The most common type of injury observed was single complete disruption of hollow viscus 74(34.2%). CONCLUSIONS: The most common hollow organ affected by blunt trauma to the abdomen was jejunum, followed by transverse colon, and motor vehicle accidents were the major cause of these injuries.

Risk factors of road traffic accidents in Rural and Urban areas of indonesia based on the national survey of year 2018.

Context: Indonesia has a large population with a large number of motorised vehicles, so it cannot be separated from traffic accidents. Aims: This study aimed to determine and analyse the advanced level risk factors for road traffic accidents (RTA) in rural and urban areas based on data from the Basic Health Research 2018 (Riskesdas). Methods: This study used Riskesdas data sourced from the National Institute of Health Research and Development, Ministry of Health, Indonesia, which was collected from 34 provinces in Indonesia using a cross-sectional method. The statistical data consisted of 59,423 respondents aged over 15 years old, who had experienced a road traffic injury and lived in rural or urban areas. The data variables analysis was socio-demographic, lifestyle, smoking status, alcohol consumption, mental disorders, nutritional status and use of helmets on motorcycle riders and passengers. Statistical Analysis: Multivariate logistic regression was used to analyse the most dominant risk factors related to RTA in rural and urban areas. Results: The prevalence of RTA in urban areas was 34.1%, while in rural areas was 28.2%. The factors related to traffic accidents in respondents from urban areas (P < 0.005) were sex (1.342 [1.217-1.480]), age (1.111 [1.067-1.156]) and use of helmets on motorcycle riders and passengers (0.662 [0.566-0.771]). Meanwhile, risk factors for respondents from rural areas (P < 0.005) were mental disorders (0.842 [0.743-0.955]), age (1.095 [1.040-1.154]) and use of helmets on motorcycle riders and passengers (0.682 [0.585-0.796]). Conclusions: We found that the prevalence of RTA in urban areas was higher than in rural areas. The dominant risk factors related to RTA in Indonesia were age, sex, mental disorders and the use of helmets on motorcycle riders and passengers. This finding supports the importance of road safety education and the prevention of RTA needs to be done both in urban and rural areas.

Distance From Home to Motor Vehicle Crash Location: Implications for License Restrictions Among Medically-At-Risk Older Drivers.

In 30 states, licensing agencies can restrict the distance from home that "medically-at-risk" drivers are permitted to drive. However, where older drivers crash relative to their home or how distance to crash varies by medical condition is unknown. Using geocoded crash locations and residential addresses linked to Medicare claims, we describe how the relationship between distance from home to crash varies by driver characteristics. We find that a majority of crashes occur within a few miles from home with little variation across driver demographics or medical conditions. Thus, distance restrictions may not reduce crash rates among older adults, and the tradeoff between safety and mobility warrants consideration.

Evaluation of Nitrogen Oxide Emission Inventories and Trends for On-Road Gasoline and Diesel Vehicles.

On-road vehicles continue to be a major source of nitrogen oxide (NOx) emissions in the United States and in other countries around the world. The goal of this study is to compare and evaluate emission inventories and long-term trends in vehicular NOx emissions. Taxable fuel sales data and in-use measurements of emission factors are combined to generate fuel-based NOx emission inventories for California and the US over the period 1990-2020. While gasoline and diesel fuel sales increased over the last three decades, total on-road NOx emissions declined by approximately 70% since 1990, with a steeper rate of decrease after 2004 when heavy-duty diesel NOx emission controls finally started to gain traction. In California, additional steps have been taken to accelerate the introduction of new heavy-duty engines equipped with selective catalytic reduction systems, resulting in a 48% decrease in diesel NOx emissions in California compared to a 32% decrease nationally since 2010. California EMFAC model predictions are in good agreement with fuel-based inventory results for gasoline engines and are higher than fuel-based estimates for diesel engines prior to the mid-2010s. Similar to the findings of recent observational and modeling studies, there are discrepancies between the fuel-based inventory and national MOVES model estimates. MOVES predicts a steeper decrease in NOx emissions and predicts higher NOx emissions from gasoline engines over the entire period from 1990 to 2020.

Predictors of Seat-Belt Use among Bus Passengers in Ghana: An Application of the Theory of Planned Behaviour and Health Belief Model.

BACKGROUND: Seat-belt use is effective in preventing traffic fatalities and injuries yet its use is not universal. This study sought to determine the predictors of self-reported seat-belt use among bus passengers in Ghana based on the theory of planned behaviour and health belief model. METHODS: A quantitative cross-sectional study design with 633 randomly selected intercity bus passengers was conducted using a structured questionnaire in Kumasi, Ghana. The resulting data were analysed using SPSS version 23.0. Ordinal regression was employed to determine the predictors of self-reported seat-belt use. RESULTS: Majority of the respondents were male (61.5%) with a mean age of 32.2 (SD = 11.6). A third (33.0%) reported that they always wear their seat-belt as bus passengers. The results indicated that intention (OR = 1.49, 95% CI = 1.21-1.84, p = 0.001), subjective norm (OR = 1.57, 95% CI = 1.15-2.13, p = 0.004) and perceived behavioural control (OR = 1.53; 95% CI = 1.21-1.92, p = 0.001) variables from the theory of planned behaviour were significant independent predictors of seat-belt use. Among the health belief model variables, perceived severity (OR = 1.57, 95% CI = 1.15-2.16, p = 0.005) and perceived barriers (OR = 0.52, 95% CI = 0.39-0.67, p = 0.001) were the only significant independent predictors of self-reported seat-belt use. CONCLUSION: The findings suggest that intention, subjective norm, perceived behavioural control, perceived severity and perceived barriers play an important role in determining bus passengers' seat-belt use behaviour. Road safety programmes to increase seat-belt use will gain from giving serious attention to these factors in the design and implementation of such programmes.

Simulator Pre-Screening of Underprepared Drivers Prior to Licensing On-Road Examination: Clustering of Virtual Driving Test Time Series Data.

BACKGROUND: A large Midwestern state commissioned a virtual driving test (VDT) to assess driving skills preparedness before the on-road examination (ORE). Since July 2017, a pilot deployment of the VDT in state licensing centers (VDT pilot) has collected both VDT and ORE data from new license applicants with the aim of creating a scoring algorithm that could predict those who were underprepared. OBJECTIVE: Leveraging data collected from the VDT pilot, this study aimed to develop and conduct an initial evaluation of a novel machine learning (ML)-based classifier using limited domain knowledge and minimal feature engineering to reliably predict applicant pass/fail on the ORE. Such methods, if proven useful, could be applicable to the classification of other time series data collected within medical and other settings. METHODS: We analyzed an initial dataset that comprised 4308 drivers who completed both the VDT and the ORE, in which 1096 (25.4%) drivers went on to fail the ORE. We studied 2 different approaches to constructing feature sets to use as input to ML algorithms: the standard method of reducing the time series data to a set of manually defined variables that summarize driving behavior and a novel approach using time series clustering. We then fed these representations into different ML algorithms to compare their ability to predict a driver's ORE outcome (pass/fail). RESULTS: The new method using time series clustering performed similarly compared with the standard method in terms of overall accuracy for predicting pass or fail outcome (76.1% vs 76.2%) and area under the curve (0.656 vs 0.682). However, the time series clustering slightly outperformed the standard method in differentially predicting failure on the ORE. The novel clustering method yielded a risk ratio for failure of 3.07 (95% CI 2.75-3.43), whereas the standard variables method yielded a risk ratio for failure of 2.68 (95% CI 2.41-2.99). In addition, the time series clustering method with logistic regression produced the lowest ratio of false alarms (those who were predicted to fail but went on to pass the ORE; 27.2%). CONCLUSIONS: Our results provide initial evidence that the clustering method is useful for feature construction in classification tasks involving time series data when resources are limited to create multiple, domain-relevant variables.

National general truck drivers' strike and food security in a Brazilian metropolis.

OBJECTIVE: We analysed the impact of the national general truck drivers' strike on the availability, variety and price of foods sold by a food supply centre. DESIGN: Descriptive study using secondary data to examine the percentage change in the mean price of fruits, vegetables and eggs before, during and after the strike. The strike in Brazil lasted 10 d from 21 to 30 May 2018. The drivers were on strike in order to make diesel oil tax-free and to obtain better working conditions. SETTING: The food supply centre, named CEASA-Minas Grande BH, was located in the metropolitan area of a Brazilian city. PARTICIPANTS: We examined twenty types of foods. RESULTS: After 10 d, there was a ~30 % reduction in the availability of all types of foods and prices increased. Foods with the highest price increases included cabbage (233·3 %), potatoes (220·0 %), papaya (160·0 %) and oranges (78·6 %). At the end of the strike, we observed reductions in the price of eggs, fruits, vegetables, roots and tubers; however, some foods remained more expensive than before the strike, including chayote (203·2 % higher), cucumber (66·7 % higher) and potatoes (60·0 % higher). CONCLUSIONS: The general truck drivers' strike was correlated with a reduction in the availability of food and, consequently, increases in price and possibly restrictions on access. The strike demonstrated the dependence of metropolises on road transportation and the conventional market. We speculate that initiatives aiming to shorten the food supply chain and promote food sovereignty and resilience of the supply circuits could be important.

Characterization of all-terrain vehicle-related chest injury patterns in children.

PURPOSE: To evaluate chest injury patterns in pediatric patients involved in all-terrain vehicle (ATV) accidents. METHODS: Retrospective review of patients 0-18 years old admitted to a level I trauma institute following an ATV-related incident from 2004 to 2013 was performed. Chest injury type, accident mechanism, driver/passenger status, and demographic and clinical data were compared between patients with and without chest injury. RESULTS: Chest injury was present in 102 (22%) of total 455 patients. The most common chest injuries were pulmonary contusion (61%), pneumothorax (45%), and rib fracture (34%). There were no cardiac, esophageal, or tracheobronchial injuries. Pulmonary lacerations, hemothoraces, and scapular fractures were predominantly not detected on radiography and recognized on CT only (86-92%). Patients with chest injury had longer median hospital stays (3 days vs 2 days, p = 0.0054). There was no significant difference in admission to intensive care after controlling for injury severity scores in patients with chest injury compared to those without (17 vs 9). Eight patients with chest injury died (8%) compared to 2 patients without chest injury (0.6%) (p = 0.0002). CONCLUSIONS: Chest injuries are common in children following ATV accidents and may be a marker of more severe trauma. Increased public awareness of these potentially devastating injuries and continuing safety efforts are needed.

Ridesharing and Motor Vehicle Crashes in 4 US Cities: An Interrupted Time-Series Analysis.

Uber, the world's largest ridesharing company, has reportedly provided over 2 billion journeys globally since operations began in 2010; however, the impact on motor vehicle crashes is unclear. Theoretically, ridesharing could reduce alcohol-involved crashes in locations where other modes of transportation are less attractive than driving one's own vehicle while under the influence of alcohol. We conducted interrupted time-series analyses using weekly counts of injury crashes and the proportion that were alcohol-involved in 4 US cities (Las Vegas, Nevada; Reno, Nevada; Portland, Oregon; and San Antonio, Texas). We considered that a resumption of Uber operations after a temporary break would produce a more substantial change in ridership than an initial launch, so we selected cities where Uber launched, ceased, and then resumed operations (2013-2016). We hypothesized that Uber's resumption would be associated with fewer alcohol-involved crashes. Results partially supported this hypothesis. For example, in Portland, Uber's resumption was associated with a 61.8% reduction (95% confidence interval: 38.7, 86.4) in the alcohol-involved crash rate (an absolute decrease of 3.1 (95% confidence interval: 1.7, 4.4) alcohol-involved crashes per week); however, there was no concomitant change in all injury crashes. Relationships between ridesharing and motor vehicle crashes differ between cities over time and may depend on specific local characteristics.

Survey of physician attitudes towards psychogenic nonepileptic seizures and driving.

BACKGROUND: Physicians from various disciplines encounter patients presenting with psychogenic nonepileptic seizures (PNES) as part of their routine clinical practice. Recommendations towards assessing fitness to drive and reporting are clearer for conditions such as neurocognitive disorders and epilepsy, but such guidelines do not exist for patients with PNES. Here, we assess physicians' attitudes towards driving for patients diagnosed with PNES. METHODS: Electronic questionnaires were sent to Neurology and Family Medicine physicians practicing at Creighton University Medical Center and Psychiatry physicians practicing at Creighton-Nebraska Psychiatry Residency Program to assess their opinion regarding driving risk when encountering PNES. RESULTS: The survey request was sent to 125 physicians, of which close to 60% completed the survey. Eighty-eight percent of participants encountered PNES in their clinical practice, and 69.1% agreed it was a difficult problem to assess, with only 8.3% endorsing a belief that these patients should drive without restrictions. Ninety-three percent felt having guidelines would help them assess the driving risk in this population. CONCLUSION: Psychogenic nonepileptic seizures are common across neurology, psychiatry, and primary care, and most physicians find assessing driving risk in such individuals highly warranted yet difficult. Developing such assessment guidelines and recommendations is of great need for clinicians.

Penetrating cervical traumatic spinal cord injury due to lawn mowing: an unusual case report.

We present a case of a 55-year-old farmer who suddenly experienced an electric sensation in the left half of his body during lawn mowing. Neurological examination discovered neurological deficits corresponding to an incomplete spinal cord injury. Magnetic resonance imaging displayed an artifact in the cervical region. Following, a computer tomography imaging showed a metal object, located intramedullary, in the cervical spinal cord. The conclusion was a traumatic lesion from the metal object obtained during lawn mowing. The object was evacuated surgically. Three years postoperatively, the patient was improved. Caution in diagnostics following usage of heavy machinery is advised.

Blunt Abdominal Trauma from Motor Vehicle Collisions from 2007 to 2011: Renal Injury Probability and Severity in Children versus Adults.

PURPOSE: There are sparse data directly comparing the probability of renal injury in children and adults. The kidney of the child is believed to be more susceptible to blunt injury for a variety of anatomical reasons. In a large cohort we tested the hypothesis that the pediatric kidney is more susceptible to any renal injury and to higher grade injury. MATERIALS AND METHODS: We queried the NTDB® (National Trauma Data Bank®) on all hospital admissions following motor vehicle collisions in a pediatric population (age less than 21 years) and a referent adult population (age 30 to 50 years). Of 111,172 children who were admitted after motor vehicle collisions 1,093 had renal injury. RESULTS: Of the 111,172 children admitted to the hospital following motor vehicle collisions 59,385 had abdominal trauma and 1,093 had renal injury. In a multivariate logistic model adjusting for overall ISS (Injury Severity Score), region, year, driver/passenger status, presence of restraint or an airbag, we found that children had 48% higher odds of renal injury compared to adults ages 30 to 50 years (OR 1.48, 95% CI 1.32-1.66, p <0.001). Furthermore, children were at 33% higher risk for high grade renal injury (OR 1.33, 95% CI 1.05-1.69, p = 0.919). The effect remained when restricting analysis to patients with concomitant liver and spleen injuries (p <0.001). CONCLUSIONS: In a large national cohort of children, blunt renal injury following motor vehicle collisions is rare but substantially more common than in adults. The odds of high grade renal injury are approximately 50% higher in children. A greater index of suspicion and a lower threshold for renal imaging is prudent for children with blunt abdominal trauma from motor vehicle collisions.

Fine and ultrafine particle exposures on 73 trips by car to 65 non-smoking restaurants in the San Francisco Bay Area.

A number of studies indicate cooking is a major source of exposure to particulate matter, but few studies have measured indoor air pollution in restaurants, where cooking predominates. We made 73 visits by car to 65 different non-smoking restaurants in 10 Northern California towns while carrying portable continuous monitors that unobtrusively measured ultrafine (down to 10 nm) and fine (PM2.5 ) particles to characterize indoor restaurant exposures, comparing them with exposures in the car. The mean ultrafine number concentrations in the restaurants on dinner visits averaging 1.4 h was 71 600 particles/cm3 , or 4.3 times the mean concentration on car trips, and 12.3 times the mean background concentration in the residence. Restaurants that cooked dinner in the same room as the patrons had higher ultrafine concentrations than restaurants with separate kitchens. Restaurant PM2.5 mass concentrations averaged 36.3 µg/m3 , ranging from 1.5 to 454 µg/m3 , but were relatively low on most visits: 43% of the indoor means were below 10 µg/m3 and 66% were below 20 µg/m3 , with 5.5% above 100 µg/m3 . Exposure to fine and ultrafine particles when visiting a restaurant exceeded the exposure a person received while traveling by car to and from the restaurant.

Prevalence of active transportation among adults in Latin America and the Caribbean: a systematic review of population-based studies.

OBJECTIVE: To describe the prevalence of "active" (self-propelled, human-powered) transportation in the Latin America and Caribbean (LAC) region over the past decade. METHODS: MEDLINE, Excerpta Medica (Embase), SportDiscus, Lilacs, MediCarib, Web of Science, OVID, CINAHL, Scopus, Google Scholar, National Transportation Library, and TRIS/TRID were searched for articles on active transportation published between January 2003 and December 2014 with (at least) a title and abstract in English, Portuguese, or Spanish. Research was included in the study if the two reviewing authors agreed it 1) was conducted in an adult sample (≥ 18 years old), 2) was designed to be representative of any LAC area, and 3) reported at least one measure of active transportation. Reference lists of included papers and retrieved reviews were also checked. A total of 129 key informants (87 scientific experts and 42 government authorities) were contacted to identify additional candidate publications. Two other authors extracted the data independently. RESULTS: A total of 10 459 unique records were found; the full texts of 143 were reviewed; and a total of 45 studies were included in the study, yielding estimates for 72 LAC settings, most of which were in Argentina, Brazil, and Colombia. No eligible studies were found for the years 2003-2004, resulting in a 10-year study time frame. Estimates were available for walking, cycling, or the combination of both, with a high degree of heterogeneity (heterogeneity index (I2) ≥ 99%). The median prevalence of active transportation (combining walking and cycling) was 12.0%, ranging from 5.1% (in Palmas, Brazil) to 58.9% (in Rio Claro, Brazil). Men cycled more than women in all regions for which information was available. The opposite was true for walking. CONCLUSIONS: Prevalence of active transportation in LAC varied widely, with great heterogeneity and uneven distribution of studies across countries, indicating the need for efforts to build comprehensive surveillance systems with standardized, timely, and detailed estimates of active transportation in order to support policy planning and evaluation.

Seatbelt paths of the pregnant women sitting in the rear seat of a motor vehicle.

PURPOSE: Seatbelt use during pregnancy is important to improve maternal and fetal survival after motor vehicle collisions. However, because the rear seatbelt of a motor vehicle tends to make contact with the neck, even if it is adequately used, some pregnant women sitting in the rear seat opt not to fasten the belt. The purpose of this study is to explore seatbelt-neck contact for pregnant women sitting in the rear seat of a motor vehicle. METHODS: We carried out an anthropometric study. Japanese women who were ≥30 weeks pregnant (n = 12) sat in the left side of the rear seat of a typical mid-size passenger sedan and fastened the seatbelt. Seating posture was investigated by measuring the coordinates of the anthropometric data points of the pregnant women (head, shoulder, hip joint, and knee joint). The belt path was analyzed by measuring the clearance between the belt and the sternum or navel. RESULTS: Among the 12 pregnant women at 33.9 week ± 3.3 week gestation, the shoulder belt deviated to the right side and subsequently contacted to the neck in four pregnant women (Contact group). The height of the Contact group was significantly shorter than that of Non-contact group (152.3 cm ± 3.0 cm vs. 159.0 cm ± 3.3 cm, p = 0.008). Regarding the relative position of the seatbelt to the subject's body, the distances from the top of the sternum to the center of the shoulder belt were significantly shorter in Contact group (3.9 cm ± 3.5 cm) than that in the Non-contact group (8.0 cm ± 1.6 cm, p = 0.03). However, no significant difference was found for the distance from the umbilicus to the center of the lap belt. CONCLUSION: Our findings show that because of short height and late term of pregnancy with protrusion of the abdomen, the shoulder belt deviates to the right or left, avoiding the protruded uterus, and subsequently makes contact with the neck. Seatbelt systems for rear seats need to be developed to improve passenger safety, especially for pregnant women.