The Impacts of Temporal Variation and Individual Differences in Driver Cognitive Workload on ECG-Based Detection.

OBJECTIVE: This paper aimed to investigate the robustness of driver cognitive workload detection based on electrocardiogram (ECG) when considering temporal variation and individual differences in cognitive workload. BACKGROUND: Cognitive workload is a critical component to be monitored for error prevention in human-machine systems. It may fluctuate instantaneously over time even in the same tasks and differ across individuals. METHOD: A driving simulation study was conducted to classify driver cognitive workload underlying four experimental conditions (baseline, N-back, texting, and N-back + texting distraction) in two repeated 1-hr blocks. Heart rate (HR) and heart rate variability (HRV) were compared among the experimental conditions and between the blocks. Random forests were built on HR and HRV to classify cognitive workload in different blocks and for different individuals. RESULTS: HR and HRV were significantly different between repeated blocks in the study, demonstrating the time-induced variation in cognitive workload. The performance of cognitive workload classification across blocks and across individuals was significantly improved after normalizing HR and HRV in each block by the corresponding baseline. CONCLUSION: The temporal variation and individual differences in cognitive workload affects ECG-based cognitive workload detection. But normalization approaches relying on the choice of appropriate baselines help compensate for the effects of temporal variation and individual differences. APPLICATION: The findings provide insight into the value and limitations of ECG-based driver cognitive workload monitoring during prolonged driving for individual drivers.

Thermal and cardiovascular strain imposed by motorcycle protective clothing under Australian summer conditions.

Motorcycle protective clothing can be uncomfortably hot during summer, and this experiment was designed to evaluate the physiological significance of that burden. Twelve males participated in four, 90-min trials (cycling 30 W) across three environments (25, 30, 35 °C [all 40% relative humidity]). Clothing was modified between full and minimal injury protection. Both ensembles were tested at 25 °C, with only the more protective ensemble investigated at 30 and 35 °C. At 35 °C, auditory canal temperature rose at 0.02 °C min(-1) (SD 0.005), deviating from all other trials (p < 0.05). The thresholds for moderate (>38.5 °C) and profound hyperthermia (>40.0 °C) were predicted to occur within 105 min (SD 20.6) and 180 min (SD 33.0), respectively. Profound hyperthermia might eventuate in ~10 h at 30 °C, but should not occur at 25 °C. These outcomes demonstrate a need to enhance the heat dissipation capabilities of motorcycle clothing designed for summer use in hot climates, but without compromising impact protection. Practitioner's Summary: Motorcycle protective clothing can be uncomfortably hot during summer. This experiment was designed to evaluate the physiological significance of this burden across climatic states. In the heat, moderate (>38.5 °C) and profound hyperthermia (>40.0 °C) were predicted to occur within 105 and 180 min, respectively.

Simulating the dynamic effect of land use and transport policies on the health of populations.

OBJECTIVES: We identified the features of a land use-transportation system that optimizes the health and well-being of the population. METHODS: We developed a quantitative system dynamics model to represent relationships among land use, transport, economic development, and population health. Simulation experiments were conducted over a 10-year simulation period to compare the effect of different baseline conditions and land use-transport policies on the number of motor vehicle crash deaths and disability-adjusted life years lost. RESULTS: Optimal reduction in the public health burden attributable to land transport was demonstrated when transport safety risk reduction policies were combined with land use and transport polices that minimized reliance on individual motorized transport and maximized use of active transport modes. The model's results were particularly sensitive to the level of development that characterized each city at the start of the simulation period. CONCLUSIONS: Local, national, and international decision-makers are encouraged to address transport, land use, and health as an integrated whole to achieve the desired societal benefits of traffic safety, population health, and social equity.

The association of social functioning, social relationships and the receipt of compensation with time to return to work following unintentional injuries to Victorian workers.

PURPOSE: Understanding individual factors associated with return to work (RTW) post-injury is an important goal of compensation systems research. The aim of the present study was to determine factors associated with time to return to work following acute unintentional injuries. METHODS: A prospective cohort study was conducted in Victoria, Australia. The cohort comprised 133 persons who were employed at the time they were admitted to one of three study hospitals. Baseline health status data was obtained retrospectively at one-week post-injury and participants were further surveyed at 1, 6, 12, 26 and 52 weeks post-injury to measure recovery. Multivariate Cox proportional hazards regression analysis was used to examine the association between potential prognostic factors and time to RTW during the 12 month study. RESULTS: At the end of 12 months follow-up, 81.2% of the study cohort had returned to work. Older age, increased injury severity, self reported symptomatic pain and poor mental health at 1 week post-injury were associated with extended time to RTW. A significant statistical interaction between the receipt of compensation and high social functioning as measured by the SF-36 or strong social relationships as measured by the Assessment of Quality of Life was associated with earlier RTW. Participants reporting strong social relationships and high social functioning at 1 week post-injury and entitled to injury compensation returned to work 2.05 and 3.66 times earlier respectively, than similar participants with no entitlement to compensation. CONCLUSIONS: Both injury-related and psychosocial factors were associated with the duration of time to RTW following acute unintentional injuries. This study replicated previously reported findings on social functioning and compensation from an independent acute trauma sample. Programs or policies to improve social functioning early post-injury may provide opportunities to improve the duration of time to RTW following injury.

The status of trauma registry systems in Chinese hospitals.

Injuries are a major source of mortality and morbidity in China with approximately 66 million citizens requiring emergency medical care. Trauma registries provide the basis for quality assurance processes and inform the treatment of the injured patient. Against the backdrop of the recently established Chinese National Injury Surveillance System, the feasibility of establishing a multicentre trauma registry in a limited number of hospitals was examined. Seven hospital directors reported on a range of hospital characteristics including patient volume information and the types of patient information routinely collected. The findings indicate significant numbers of patients presenting due to injury, though little comparability in the type of information collected both between hospitals and with international trauma registry systems. The development of multicentre trauma registry is suggested as a way to monitor trauma system performance. The integration of clinical indicators into the National Injury Surveillance System in the long term is also recommended.

Injury in China: a systematic review of injury surveillance studies conducted in Chinese hospital emergency departments.

BACKGROUND: Injuries represent a significant and growing public health concern in China. This Review was conducted to document the characteristics of injured patients presenting to the emergency department of Chinese hospitals and to assess of the nature of information collected and reported in published surveillance studies. METHODS: A systematic search of MEDLINE and China Academic Journals supplemented with a hand search of journals was performed. Studies published in the period 1997 to 2007 were included and research published in Chinese was the focus. Search terms included emergency, injury, medical care. RESULTS: Of the 268 studies identified, 13 were injury surveillance studies set in the emergency department. Nine were collaborative studies of which eight were prospective studies. Of the five single centre studies only one was of a prospective design. Transport, falls and industrial injuries were common mechanisms of injury. Study strengths were large patient sample sizes and for the collaborative studies a large number of participating hospitals. There was however limited use of internationally recognised injury classification and severity coding indices. CONCLUSION: Despite the limited number of studies identified, the scope of each highlights the willingness and the capacity to conduct surveillance studies in the emergency department. This Review highlights the need for the adoption of standardized injury coding indices in the collection and reporting of patient health data. While high level injury surveillance systems focus on population-based priority setting, this Review demonstrates the need to establish an internationally comparable trauma registry that would permit monitoring of the trauma system and would by extension facilitate the optimal care of the injured patient through the development of informed quality assurance programs and the implementation of evidence-based health policy.

The Whitehorse NoFalls trial: effects on fall rates and injurious fall rates.

BACKGROUND: the burden of falls and fall-related injuries among older adults is well established. Contention surrounds the effectiveness, and hence value, of multi-component fall prevention interventions delivered in the community. OBJECTIVE: using consensus-based analytic guidelines rather than time-to-first fall as the primary endpoint, the objective was to examine the effectiveness of the Whitehorse NoFalls trial on all falls, falls resulting in injury and falls requiring medical care to be sought. DESIGN, SETTING AND PARTICIPANTS: the study was a community-based randomised controlled trial, with 1,090 participants assigned to one of eight groups, these being a combination of one or more of exercise, vision and or home hazard reduction or alternatively assignment to the control group. METHODS: using negative binomial regression, the incidence of all falls, falls resulting in injury and those requiring medical care in the intervention groups were examined. Falls were reported using a monthly return calendar. RESULTS: exercise alone and in combination with vision and/or home hazard reduction was associated with fewer falls. For falls resulting in injury and the subset requiring medical care, the vision plus exercise intervention was associated with fewer falls. CONCLUSIONS: the findings confirm the effectiveness of exercise in preventing falls among community-dwelling older adults and supports contention that multi-component interventions do not prevent more falls than a single intervention. The results highlight the effectiveness of vision plus exercise in preventing more serious falls, a finding which warrants further consideration.

Crash characteristics and patterns of injury among hospitalized motorised two-wheeled vehicle users in urban India.

BACKGROUND: Traffic crashes and consequent injuries represent a growing public health concern in India, particularly in light of increasing motorization. Motorised two-wheeled vehicles (MTV) constitute a large portion of the vehicle fleet in India. We report the crash characteristics and injury patterns among a cohort of MTV riders and pillions presenting to hospital post-crash. METHODS: Consecutive MTV riders and pillions, whether alive or dead, injured in a road traffic crash presenting to the emergency departments of two government hospitals and three branches of a private hospital in urban Hyderabad, India, were recruited to this study. RESULTS: 378 MTV users were enrolled to the study of whom 333 (88.1%) were male, 252 (66.7%) were riders and median age was 31.3 years. A total of 223 (59%) MTV users were injured in multi-vehicle crashes while one-third had a frontal impact. The majority (77%) were assessed as having a Glasgow coma score (GCS) of 13-15, 12% a GCS of 9-12 and 11% a GCS of 3-8. No difference was seen in the severity distribution of injuries based on GCS among riders and pillions. Open wounds and superficial injuries to the head (69.3%) and upper extremity (27%) and lower extremity (24%) were the most common injuries. 43 (11%) sustained an intracranial injury, including 12 (28%) with associated fracture of the bones of the head. There were few differences in types of injuries sustained by riders and pillions though riders had a significantly lower risk of crush injuries of the lower extremity than pillions (relative risk, RR 0.25, 95% CI 0.08-0.81) and female pillions were at a significantly lower risk of sustaining fractures of the lower extremity than male pillions (RR 0.30, 95% CI 0.09 - 0.94). Overall, 42 (11%) MTV users died, of which 42.8% died before reaching the hospital. Only 74 (19.6%) MTV users had worn a helmet correctly and failure to wear a helmet was associated with a five times greater risk of intracranial injury (RR 4.99, 95% CI 1.23-20.1). Of the 19 pre-hospital deaths, 16 (84%) had not worn a helmet. CONCLUSION: Head injuries accounted for the major proportion of injuries sustained in MTV users. Non-helmet use was associated with increased risk of serious head injuries. The data presented on the nature and severity of injuries sustained by MTV users can assist with planning to deal with these consequences as well as prevention of these injuries given the high use of MTV in India.

Motorcycle active safety systems: Assessment of the function and applicability using a population-based crash data set.

Objective: Motorcycles and mopeds, often referred to as powered 2-wheelers (PTWs), play an important role in personal mobility worldwide. Despite their advantages, including low cost, space occupancy, and fuel efficiency, the risk of sustaining serious or fatal injuries is higher than that for occupants of passenger cars. The development of safety systems specific for PTWs represents a potential way to reduce casualties among riders. With the proliferation of new active and passive safety technologies, the question as to which might offer the most value is important. In this context, a prioritization process was applied to a set of PTW active safety systems to evaluate their applicability to crash scenarios alone and in combination. The systems included in the study were antilock braking (ABS), autonomous emergency braking (AEB), collision warning, curve warning, and curve assist. Methods: With the functional performance of the 5 safety systems established, the relevance of each system to specific crash configurations and vehicle movements defined by a standardized accident classification system used in Victoria, Australia, was rated by 2 independent reviewers, with a third reviewer acting as a moderator where disagreements occurred. Ratings ranged from 1 (definitely not applicable) to 4 (definitely applicable). Using population-based crash data, the number and percentage of crashes that each safety system could potentially influence, or be relevant for, was defined. Applying accepted injury costs permitted the derivation of the societal economic cost of PTW crashes and the potential reductions associated with each safety system given a theoretical crash avoidance effectiveness of 100%. Results: In the 12-year period 2000-2011, 23,955 PTW riders and 1292 pillion passengers were reported to have been involved in a road crash, with over 500 killed and more than 10,000 seriously injured; only 3.5% of riders/pillion passengers were uninjured. The total economic cost associated with these injured riders and pillion passengers was estimated to be AU$11.1 billion (US$7.70 billion; €6.67 billion). The 5 safety systems, as single solutions or in combination, were relevant to 57% of all crashes and to 74% of riders killed. Antilock braking was found to be relevant to the highest number of crashes, with incremental increases in coverage when combined with other safety systems. Conclusions: The findings demonstrate that ABS, alone and in combination with other safety systems, has the potential to mitigate or possibly prevent a high percentage of PTW crashes in the considered setting. Other safety systems can influence different crash scenarios and are also recommended. Given the high cost of motorcycle crashes and the increasing number of PTW safety technologies, the proposed approach can be used to inform the process of selection of the most suitable interventions to improve PTW safety.

How important is vehicle safety in the new vehicle purchase process?

Whilst there has been a significant increase in the amount of consumer interest in the safety performance of privately owned vehicles, the role that it plays in consumers' purchase decisions is poorly understood. The aims of the current study were to determine: how important vehicle safety is in the new vehicle purchase process; what importance consumers place on safety options/features relative to other convenience and comfort features, and how consumers conceptualise vehicle safety. In addition, the study aimed to investigate the key parameters associated with ranking 'vehicle safety' as the most important consideration in the new vehicle purchase. Participants recruited in Sweden and Spain completed a questionnaire about their new vehicle purchase. The findings from the questionnaire indicated that participants ranked safety-related factors (e.g., EuroNCAP (or other) safety ratings) as more important in the new vehicle purchase process than other vehicle factors (e.g., price, reliability etc.). Similarly, participants ranked safety-related features (e.g., advanced braking systems, front passenger airbags etc.) as more important than non-safety-related features (e.g., route navigation systems, air-conditioning etc.). Consistent with previous research, most participants equated vehicle safety with the presence of specific vehicle safety features or technologies rather than vehicle crash safety/test results or crashworthiness. The key parameters associated with ranking 'vehicle safety' as the most important consideration in the new vehicle purchase were: use of EuroNCAP, gender and education level, age, drivers' concern about crash involvement, first vehicle purchase, annual driving distance, person for whom the vehicle was purchased, and traffic infringement history. The findings from this study are important for policy makers, manufacturers and other stakeholders to assist in setting priorities with regard to the promotion and publicity of vehicle safety features for particular consumer groups (such as younger consumers) in order to increase their knowledge regarding vehicle safety and to encourage them to place highest priority on safety in the new vehicle purchase process.

Factors associated with the premature graduation of children into seatbelts.

This study investigated the factors associated with the premature graduation into seatbelts for Australian children aged 4-11 years. From 699 child restraint use questionnaires, 195 children were identified as meeting the booster seat height-weight criteria (height: 100-145 cm and weight: 14-26 kg). Of these children, 44% were correctly traveling in a booster seat, while 56% had been moved prematurely into a seatbelt. A multivariable logistic regression model showed that there were a number of key predictors associated with the premature graduation to seatbelts. For example, children who were moved prematurely into a seatbelt were more likely to be older, have other children travelling in the vehicle and have younger parents compared to children appropriately restrained in a booster seat. In addition, there was a significant interaction between vehicle type and parent's household income. Based on the findings of this study, a number of recommendations are made for strategies to enhance appropriate restraint use for this age group, as well as for future research.

Near-miss crashes and other predictors of motorcycle crashes: Findings from a population-based survey.

OBJECTIVE: Crash and injury surveillance studies have identified a range of rider-related factors, including age, sex, licensure, training and experience, as being associated with motorcycle crash risk. The aim of this study was to establish whether these previously identified factors were associated with crash involvement in an Australian-based population. METHODS: Data obtained from motorcyclists recruited from road authority licensing offices in a population-based survey design were analyzed. In addition to descriptive analysis, survey logistic regression was used to examine predictors of self-reported motorcycle crashes. A statewide population prevalence study of motorcyclists in New South Wales, Australia, was conducted using a multistage stratified random sampling plan. Participants (n = 503) represented 47% of eligible riders invited to participate. The distribution of responses was weighted to represent the population based on motorcycle registrations as a proxy for active motorcyclists, adjusted for age, sex, and variations in sample size and population density between survey sites. RESULTS: This analysis investigated factors associated with having crashed in the past 12 months. The key predictors of increased crash risk included frequent near-crash experiences (6-10) in the past year (adjusted odds ratio [ORadj] = 5.3; 95% confidence interval [CI], 1.3-21.8), having 4 or more riding demerit points (ORadj = 4.1; 95% CI, 1.1-14.7), and motorcycle type and riding purpose. Sports (ORadj = 2.8; 95% CI, 1.1-7.3) and commuter motorcycles (ORadj = 4.0; 95% CI, 1.1-15.3) were associated with higher odds of crashes compared to cruiser/touring motorcycles. Those whose purpose for riding frequently involved commuting, high-speed roads, or motorcycle sports had higher odds of being involved in a crash compared to riders who rarely took part in such activities. Rider age, license type, and time holding a motorcycle license were not predictive of crash involvement when other factors were taken into account. CONCLUSIONS: These findings provide important population-level information and insights about risk exposure for motorcyclists. Taking a more tailored approach to data collection meant that factors associated with crash involvement were identified that are not commonly observed in studies relying on administrative data. In particular, the study highlights the importance of near-crash experiences as warnings to riders and the need to use such experiences as learning opportunities to improve their riding style and safety.

Using medico-legal data to investigate fatal older road user crash circumstances and risk factors.

OBJECTIVE: This study used medico-legal data to investigate fatal older road user (ORU, aged 65 years and older) crash circumstances and risk factors relating to 4 key components of the Safe System approach (e.g., roads and roadsides, vehicles, road users, and speeds) to identify areas of priority for targeted prevention activity. METHOD: The Coroners' Court of Victoria's (CCOV) Surveillance Database was searched to identify and describe the frequency and rate per 100,000 population of fatal ORU crashes in the Australian state of Victoria for 2013-2014. Information relating to the deceased ORU, crash characteristics and circumstances, and risk factors was extracted and analyzed. RESULTS: One hundred and thirty-eight unintentional fatal ORU crashes were identified in the CCOV Surveillance Database. Of these fatal ORU crashes, most involved older drivers (44%), followed by older pedestrians (32%), older passengers (17%), older pedal cyclists (4%), older motorcyclists (1%), and older mobility scooter users (1%). The average annual rate of fatal ORU crashes per 100,000 population was 8.1 (95% confidence interval [CI], 6.0-10.2). In terms of the crash characteristics and circumstances, most fatal ORU crashes involved a counterpart (98%), of which the majority were passenger cars (50%) or fixed/stationary objects (25%), including trees (46%) or embankments (23%). In addition, most fatal ORU crashes occurred close to home (73%), on-road (87%), on roads that were paved (94%), on roads with light traffic volume (37%), and during low-risk conditions: between 12 p.m. and 6 p.m. (44%), on weekdays (80%), during daylight (75%), and under dry/clear conditions (81%). Road user (RU) error was identified by the police and/or the coroner for the majority of fatal crashes (55%), with a significant proportion of deceased ORUs deemed to have failed to yield (54%) or misjudged (41%). CONCLUSIONS: RU error was the most significant factor identified in fatal ORU crashes, which suggests that there is a limited capacity of the road system to fully accommodate RU errors. Initiatives related to safer roads and roadsides, vehicles, speed zones, as well as behavioral approaches are key areas of priority for targeted activity to prevent fatal ORU crashes in the future.

Evaluation of alternative intersection treatments at rural crossroads using simulation software.

OBJECTIVE: Rural roads are characterized by hazardous roadsides and suboptimal geometry yet allow for high travel speeds and unfavorable impact angles. In Victoria, 25% of persons seriously injured and 52% of fatalities occur on rural roads, with 30% occurring at intersections. In the United States, almost twice the number of traffic fatalities occur in rural areas than in urban areas, while accounting for less than half of all vehicle miles traveled and 21% of the population. The choice of safety countermeasure is therefore paramount. Simulation software provides a cost-effective means of analyzing alternative intersection treatments with a view to identifying their effectiveness in mitigating crashes. The aim of this research was to assess the safety benefits of 4 alternative intersection treatments using in-depth crash data with an advanced crash reconstruction process. METHOD: Using a single serious injury real-world crash from the Monash University Accident Research Centre Enhanced Crash Investigation Study and crash reconstruction software, an exemplar rural crash was reconstructed and validated against real-world data. The crash involved a passenger vehicle (European New Car Assessment Programme 5-star) approaching from a minor road and failing to yield at a give-way sign; the posted speed limit was 80 km/h. The vehicle was struck on the right/driver side by a rigid truck (B-vehicle; 1990) traveling on the major approach (100 km/h). The driver of the case vehicle was seriously injured. Four alternative intersection treatments appropriate for the crash site were constructed in computer-aided design software (Rhinoceros Ver. 5): roundabout; rumble strips; a reduced speed limit; and the combination of lower speed limit and rumbles to determine the reduction in crash forces in the presence of the countermeasures. RESULTS: The hypothetical scenarios demonstrate substantial reductions in impact force and different points of impact, resulting in a significantly lower injury severity for the struck driver. Speed limit reduction to 80 km/h on the main approach (from 100 km/h) in combination with rumble strips on both intersection approaches had the most favorable outcome with the crash avoided entirely, assuming speed compliance. DISCUSSION: The findings have implications for understanding the role of speed in crashes and hence the design of effective countermeasures. Simulation software, validated using real-world data, provides a cost-effective means of evaluating alternative intersection treatments for rural intersections. Scaled up, implementing these treatments would have significant safety benefits and reduce the road trauma currently associated with rural roads.

Understanding fatal older road user crash circumstances and risk factors.

OBJECTIVE: This study used medicolegal data to investigate fatal older road user (ORU) crash circumstances and risk factors relating to four key components of the Safe System approach (e.g., roads and roadsides, vehicles, road users, and speeds) to identify areas of priority for targeted prevention activity. METHODS: The Coroners Court of Victoria's Surveillance Database was searched to identify coronial records with at least one deceased ORU in the state of Victoria, Australia, for 2013-2014. Information relating to the ORU, crash characteristics and circumstances, and risk factors was extracted and analyzed. RESULTS: The average rate of fatal ORU crashes per 100,000 population was 8.1 (95% confidence interval [CI] 6.0-10.2), which was more than double the average rate of fatal middle-aged road user crashes (3.6, 95% CI 2.5-4.6). There was a significant relationship between age group and deceased road user type (χ2(15, N = 226) = 3.56, p < 0.001). The proportion of deceased drivers decreased with age, whereas the proportion of deceased pedestrians increased with age. The majority of fatal ORU crashes involved a counterpart (another vehicle: 59.4%; fixed/stationary object: 25.4%), and occurred "on road" (87.0%), on roads that were paved (94.2%), dry (74.2%), and had light traffic volume (38.3%). Road user error was identified by the police and/or coroner for the majority of fatal ORU crashes (57.9%), with a significant proportion of deceased ORU deemed to have "misjudged" (40.9%) or "failed to yield" (37.9%). CONCLUSIONS: Road user error was the most significant risk factor identified in fatal ORU crashes, which suggests that there is a limited capacity of the Victorian road system to fully accommodate road user errors. Initiatives related to safer roads and roadsides, vehicles, and speed zones, as well as behavioral approaches, are key areas of priority for targeted activity to prevent fatal older road user crashes in the future.

Too small for concern? Public health and nanotechnology.

While advances in nanotechnology promise to deliver significant benefits to many aspects of health care, there is increasing concern that regulatory regimes do not adequately capture the potential risks associated with this new technology. Concerns have arisen due to preliminary evidence suggesting that some engineered nanoparticles may display undesirable toxicological properties, presenting potential risks to human and environmental health and safety. Within this context, the role of Australia's National Industrial Chemicals and Assessment Scheme and the Therapeutic Goods Administration in regulating nano-based substances is explored. Drawing on earlier regulatory failures, combined with the scientific uncertainty surrounding nanotechnology, this article recommends that Australia adopt a proactive regulatory approach to nanotechnology through amendments to present legislative regimes. The approach articulated in this article strikes a balance between the current approach and that of the European Union's comprehensive new chemicals regime. Immediate regulatory change is called for in order to ensure that the health of the Australian public is adequately protected over the coming years.

General health status and functional disability following injury in traffic crashes.

OBJECTIVE: With increasing rates of survival associated with traffic crashes, a shift to understand the consequences of injury has risen to prominence. This prospective cohort study set out to examine general health status and functional disability at 2 months and 6-8 months post-crash. METHODS: Participants were otherwise healthy adults aged 18-59 years admitted to hospitals, excluding those with moderate-severe head injury and spinal cord injury. Sixty-two adults completed interviews prior to discharge and at 2 months and 8 months post-discharge. RESULTS: By 8 months post-crash, 89 percent had resumed employment and or study, two thirds rated the resolution of their medical problems to be excellent (14.5 percent) or good (53 percent), and 82 percent were considered to be fully self-sufficient with respect to activities of daily living. Despite this, results from the SF-36 indicated significant reductions in health status at 2 and 8 months post-crash relative to pre-crash health, with domain scores up to 26 percent lower than pre-crash scores, while assessment of activities of daily living indicated residual functional disability at both follow-up times. Self-reported pain was higher for both males and females at both follow-up times compared with pre-crash self-reported pain. CONCLUSION: This study demonstrated significant, ongoing loss of health-related quality of life and impairment associated with injuries sustained in road crashes, highlighting the need for continuing care post-discharge to facilitate a rapid return to optimal health.

Associations between alcohol consumption patterns and attitudes towards alcohol interlocks.

BACKGROUND: Drink-driving and alcohol-related crashes are a significant problem globally. Alcohol interlocks are used to prevent drivers with a blood alcohol concentration above a pre-determined level from starting their vehicle, making the technology highly effective in preventing drink-drive episodes. While alcohol interlocks are commonly used in drink-drive offender groups, their broader use as a preventative road safety strategy is considered increasingly feasible. In this context it is important to understand attitudes towards the technology, and to investigate whether these attitudes vary according to alcohol consumption patterns as this influences the acceptability of a broad-based preventative alcohol interlock program. METHODS: A representative sample of 2994 Australian drivers participated in an online cross-sectional survey. Participants reported their alcohol consumption, drink-drive behaviour and attitudes towards the use of alcohol interlocks for personal use and for drink-drive offenders. RESULTS: Half of the sample stated that alcohol interlocks would be of use personally. Seventy-four percent of high-risk drinkers (defined by an AUDIT score ≥20) stated they would find the technology personally useful when compared to 49% of low-risk drinkers (AUDIT ≤7). Overwhelmingly, more than 80% of participants agreed with the mandatory instalment of alcohol interlocks and compulsory clinical interventions for drink-drive offenders, with more low-risk drinkers supporting this than the high-risk drinkers. CONCLUSIONS: While there were mixed opinions regarding the perceived personal usefulness of alcohol interlocks, higher-risk drinkers were most likely to perceive interlocks as being of use for themselves. This high-risk group however, was less likely to provide support for clinical interventions and additional re-licensing requirements aimed at eliciting changes in drinking behaviour. These findings have important implications for drink-drive offender relicensing and the likely success of drink-driver education, and interventions aimed at curbing risky alcohol consumption.

The relative importance of real-time in-cab and external feedback in managing fatigue in real-world commercial transport operations.

OBJECTIVE: Real-time driver monitoring systems represent a solution to address key behavioral risks as they occur, particularly distraction and fatigue. The efficacy of these systems in real-world settings is largely unknown. This article has three objectives: (1) to document the incidence and duration of fatigue in real-world commercial truck-driving operations, (2) to determine the reduction, if any, in the incidence of fatigue episodes associated with providing feedback, and (3) to tease apart the relative contribution of in-cab warnings from 24/7 monitoring and feedback to employers. METHODS: Data collected from a commercially available in-vehicle camera-based driver monitoring system installed in a commercial truck fleet operating in Australia were analyzed. The real-time driver monitoring system makes continuous assessments of driver drowsiness based on eyelid position and other factors. Data were collected in a baseline period where no feedback was provided to drivers. Real-time feedback to drivers then occurred via in-cab auditory and haptic warnings, which were further enhanced by direct feedback by company management when fatigue events were detected by external 24/7 monitors. Fatigue incidence rates and their timing of occurrence across the three time periods were compared. RESULTS: Relative to no feedback being provided to drivers when fatigue events were detected, in-cab warnings resulted in a 66% reduction in fatigue events, with a 95% reduction achieved by the real-time provision of direct feedback in addition to in-cab warnings (p < 0.01). With feedback, fatigue events were shorter in duration a d occurred later in the trip, and fewer drivers had more than one verified fatigue event per trip. CONCLUSIONS: That the provision of feedback to the company on driver fatigue events in real time provides greater benefit than feedback to the driver alone has implications for companies seeking to mitigate risks associated with fatigue. Having fewer fatigue events is likely a reflection of the device itself and the accompanying safety culture of the company in terms of how the information is used. Data were analysed on a per-truck trip basis, and the findings are indicative of fatigue events in a large-scale commercial transport fleet. Future research ought to account for individual driver performance, which was not possible with the available data in this retrospective analysis. Evidence that real-time driver monitoring feedback is effective in reducing fatigue events is invaluable in the development of fleet safety policies, and of future national policy and vehicle safety regulations. Implications for automotive driver monitoring are discussed.

Validation of the abrasion resistance test protocols and performance criteria of EN13595: The probability of soft tissue injury to motorcycle riders by abrasion resistance of their clothing.

INTRODUCTION: Motorcyclists represent an increasing proportion of road users globally and are increasingly represented in crash statistics. Soft tissue injuries are the most common type of injuries to crashed motorcyclists. These injuries can be prevented through the use of protective clothing designed for motorcycle use. However, the quality of such clothing is not controlled in many countries around the world. A European Standard was developed to assess the performance of clothing but as this is not mandatory, clothing certified to this Standard is difficult to obtain. Given the importance of this Standard, and that it has been validated only once, further validation work is required. METHODS: In-depth crash investigation data were used to investigate the relationship between the abrasion resistance performance of clothing and real-world injury outcome. Clothing was collected from riders who crashed on public roads in Sydney and Newcastle, Australia. This clothing was tested according to the EU Standard and the time to hole was recorded. Hospital medical records were reviewed and the association between a rider suffering a soft tissue injury and the time-to-hole for the garment was examined. RESULTS: The probability of soft tissue injury for Level 1 Standard garments was between 40-60%, but more than 60% of garments tested failed to meet the minimum requirement. CONCLUSIONS: The findings of this study provide qualified support for the Standard, with a marginal association between time-to-hole and injury being found. PRACTICAL IMPLICATIONS: This work supports the need for improved safety performance and an increased number of high performing garments being available to motorcyclists.