The effect of non-punitive peer comparison and performance feedback on drivers' behavior using the telematics: The first randomized trial in Iran.

BACKGROUND: Aggressive driving is the leading behavior resulting in fatal or nonfatal disabling injuries. Therefore, programs with the main focus on driving behavior could reduce the risk of traffic injuries remarkably. We aimed to investigate the role of non-punitive performance feedback on drivers' behavior and evaluate the persistence of the altered behavior by using in-vehicle telematics. METHODS: This study was done as a randomized controlled trial by repeated-measures design to evaluate the non-punitive behavioral intervention's efficacy on the behavioral transition to safer driving for 1,289 bus and 104 taxi drivers. All participants were studied during 17 weeks through three stages: stage 0 (five weeks for collecting the baseline characteristics of the participants), stage 1 (nine weeks for randomizing the participants into intervention group or control group and sending the intervention group feedback via short message service), and stage 2 (three weeks for following-up the participants without sending feedback). The intervention group drivers received weekly text messages about the driving score and drivers' rank within their peer group.The study's primary outcome was the driver score changing pattern throughout the study calculated by a neuro-fuzzy scoring system composed of four factors: speed violation, harsh acceleration, harsh braking, and harsh turning. RESULTS: Among the bus drivers, a significant positive effect of the intervention was found in stage 1 (P<0.0001) and in stage 2 (P<0.0001) regarding the calculated scoring system. Among the taxi drivers, a significant positive effect of the intervention was found in stage 1 (P<0.0001), but the effect was not significant in stage 2 (P=0.15). CONCLUSION: The results of this study were in favor of using telematics and its positive effect on driving performance. The reformed behavior persisted even after the intervention ceased. PRACTICAL APPLICATION: Behavioral interventions could be considered a promising strategy to enhance and promote safe driving performance.

Burden of injury along the development spectrum: associations between the Socio-demographic Index and disability-adjusted life year estimates from the Global Burden of Disease Study 2017.

BACKGROUND: The epidemiological transition of non-communicable diseases replacing infectious diseases as the main contributors to disease burden has been well documented in global health literature. Less focus, however, has been given to the relationship between sociodemographic changes and injury. The aim of this study was to examine the association between disability-adjusted life years (DALYs) from injury for 195 countries and territories at different levels along the development spectrum between 1990 and 2017 based on the Global Burden of Disease (GBD) 2017 estimates. METHODS: Injury mortality was estimated using the GBD mortality database, corrections for garbage coding and CODEm-the cause of death ensemble modelling tool. Morbidity estimation was based on surveys and inpatient and outpatient data sets for 30 cause-of-injury with 47 nature-of-injury categories each. The Socio-demographic Index (SDI) is a composite indicator that includes lagged income per capita, average educational attainment over age 15 years and total fertility rate. RESULTS: For many causes of injury, age-standardised DALY rates declined with increasing SDI, although road injury, interpersonal violence and self-harm did not follow this pattern. Particularly for self-harm opposing patterns were observed in regions with similar SDI levels. For road injuries, this effect was less pronounced. CONCLUSIONS: The overall global pattern is that of declining injury burden with increasing SDI. However, not all injuries follow this pattern, which suggests multiple underlying mechanisms influencing injury DALYs. There is a need for a detailed understanding of these patterns to help to inform national and global efforts to address injury-related health outcomes across the development spectrum.

An Approach Towards Reducing Road Traffic Injuries and Improving Public Health Through Big Data Telematics: A Randomised Controlled Trial Protocol.

OBJECTIVE: Deaths due to road traffic accidents (RTAs) are a major public health concern around the world. Developing countries are over-represented in these statistics. Punitive measures are traditionally employed to lower RTA related behavioural risk factors. These are, however, resource intensive and require infrastructure development. This is a randomised controlled study to investigate the effect of non-punitive behavioural intervention through peer-comparison feedback based on driver behaviour data gathered by an in-vehicle telematics device. DESIGN, SETTING, AND PARTICIPANTS: A randomised controlled trial using repeated measures design conducted in Iran on the drivers of 112 public transport taxis in Tehran province and 1309 inter-city busses operating nationwide. Driving data is captured by an in-vehicle telematics device and sent to a centrally located data centre using a mobile network. The telematics device is installed in all vehicles. Participants are males aged above 20 who have had the device operating in their vehicles for at least 3 months prior to the start of the trial. INTERVENTION: The study had three stages: 1- Driver performance was monitored for a 4-week period after which they were randomised into intervention and control groups. 2- Their performance was monitored for a 9-week period. At the end of each week, drivers in the intervention group received a scorecard and a note informing them of their weekly behaviour and ranking within their peer group. Drivers in the control group received no feedback via short messaging service (SMS). 3- Drivers did not receive further feedback and their behaviour was monitored for another 4 weeks. PRIMARY AND SECONDARY OUTCOME MEASURE: Primary outcome was changes in weekly driving score in intervention and control groups during stage 2 of intervention. Taxis and busses were analysed separately using generalised estimating equation analysis. FUNDING AND ETHICAL APPROVAL: This project was funded by the National Institute for Medical Research Development (Grant No.940576) and approved by its ethics committee (Code: IR.NIMAD.REC.1394.016). This trial was registered at www.irct.ir as IRCT20180708040391N1.

Erratum: This Article Corrects: "GLASS Clinical Decision Rule Applied to Thoracolumbar Spinal Fractures in Patients Involved in Motor Vehicle Crashes".

[This corrects the article on p. 1108 in vol. 18, PMID: 29085544.].

GLASS Clinical Decision Rule Applied to Thoracolumbar Spinal Fractures in Patients Involved in Motor Vehicle Crashes.

INTRODUCTION: There are established and validated clinical decision tools for cervical spine clearance. Almost all the rules include spinal tenderness on exam as an indication for imaging. Our goal was to apply GLASS, a previously derived clinical decision tool for cervical spine clearance, to thoracolumbar injuries. GLass intact Assures Safe Spine (GLASS) is a simple, objective method to evaluate those patients involved in motor vehicle collisions and determine which are at low risk for thoracolumbar injuries. METHODS: We performed a retrospective cohort study using the National Accident Sampling System-Crashworthiness Data System (NASS-CDS) over an 11-year period (1998-2008). Sampled occupant cases selected in this study included patients age 16-60 who were belt-restrained, front- seat occupants involved in a crash with no airbag deployment, and no glass damage prior to the crash. RESULTS: We evaluated 14,191 occupants involved in motor vehicle collisions in this analysis. GLASS had a sensitivity of 94.4% (95% CI [86.3-98.4%]), specificity of 54.1% (95% CI [53.2-54.9%]), and negative predictive value of 99.9% (95% CI [99.8-99.9%]) for thoracic injuries, and a sensitivity of 90.3% (95% CI [82.8-95.2%]), specificity of 54.2% (95% CI [53.3-54.9%]), and negative predictive value of 99.9% (95% CI [99.7-99.9%]) for lumbar injuries. CONCLUSION: The GLASS rule represents the possibility of a novel, more-objective thoracolumbar spine clearance tool. Prospective evaluation would be required to further evaluate the validity of this clinical decision rule.

Identification of characteristics and frequent scenarios of single-vehicle rollover crashes during pre-ballistic phase; part 1 - A descriptive study.

This study aimed to identify common patterns of pre-ballistic vehicle kinematics and roadway characteristics of real-world rollover crashes. Rollover crashes that were enrolled in the National Automotive Sampling System-Crashworthiness Data System (NASS-CDS) between the years 2000 and 2010 were analyzed. A descriptive analysis was performed to understand the characteristics of the pre-ballistic phase. Also, a frequency based pattern analysis was performed using a selection of NASS-CDS variables describing the pre-ballistic vehicle kinematics and roadway characteristics to rank common pathways of rollover crashes. Most case vehicles departed the road due to a loss of control/traction (LOC) (61%). The road departure with LOC was found to be 13.4 times more likely to occur with slippery road conditions compared to dry conditions. The vehicle was typically laterally skidding with yawing prior to a rollover (66%). Most case vehicles tripped over (82%) mostly at roadside/median (69%). The tripping force was applied to the wheels/tires (82%) from the ground (79%). The combination of these six most frequent attributes resulted in the most common scenario, which accounted for 26% of the entire cases. Large proportion of road departure with LOC (61%) implies electronic stability control (ESC) systems being an effective countermeasure for preventing single-vehicle rollover crashes. Furthermore, the correlation between the road departure with LOC and the reduced friction limit suggests the necessity of the performance evaluation of ESC under compromised road surface condition.

Impact of improving vehicle front design on the burden of pedestrian injuries in Germany, the United States, and India.

OBJECTIVE: European car design regulations and New Car Assessment Program (NCAP) ratings have led to reductions in pedestrian injuries. The aim of this study was to evaluate the impact of improving vehicle front design on mortality and morbidity due to pedestrian injuries in a European country (Germany) and 2 countries (the United States and India) that do not have pedestrian-focused NCAP testing or design regulations. METHODS: We used data from the International Road Traffic and Accident Database and the Global Burden of Disease project to estimate baseline pedestrian deaths and nonfatal injuries in each country in 2013. The effect of improved passenger car star ratings on probability of pedestrian injury was based on recent evaluations of pedestrian crash data from Germany. The effect of improved heavy motor vehicle (HMV) front end design on pedestrian injuries was based on estimates reported by simulation studies. We used burden of disease methods to estimate population health loss by combining the burden of morbidity and mortality in disability-adjusted life years (DALYs) lost. RESULTS: Extrapolating from evaluations in Germany suggests that improving front end design of cars can potentially reduce the burden of pedestrian injuries due to cars by up to 24% in the United States and 41% in India. In Germany, where cars comply with the United Nations regulation on pedestrian safety, additional improvements would have led to a 1% reduction. Similarly, improved HMV design would reduce DALYs lost by pedestrian victims hit by HMVs by 20% in each country. Overall, improved vehicle design would reduce DALYs lost to road traffic injuries (RTIs) by 0.8% in Germany, 4.1% in the United States, and 6.7% in India. CONCLUSIONS: Recent evaluations show a strong correlation between Euro NCAP pedestrian scores and real-life pedestrian injuries, suggesting that improved car front end design in Europe has led to substantial reductions in pedestrian injuries. Although the United States has fewer pedestrian crashes, it would nevertheless benefit substantially by adopting similar regulations and instituting pedestrian NCAP testing. The maximum benefit would be realized in low- and middle-income countries like India that have a high proportion of pedestrian crashes. Though crash avoidance technologies are being developed to protect pedestrians, supplemental protection through design regulations may significantly improve injury countermeasures for vulnerable road users.

Official government statistics of road traffic deaths in India under-represent pedestrians and motorised two wheeler riders.

BACKGROUND: Reliable data on traffic deaths are important for planning road safety programmes and evaluating progress. Although pedestrians comprise approximately 40% of traffic deaths in low-income and middle-income countries, official government statistics in India suggest that pedestrians comprise less than 10% of deaths. OBJECTIVE: To assess the accuracy of official tabulations of traffic deaths among various road users in India. METHOD: We reviewed police first information reports (FIRs) of traffic deaths in one district (Belgaum) in 2013 and 2014 and extracted information about crash victims. We validated the FIRs by linking with case files from four police stations in the district. Finally, we compared the information on types of road users killed based on FIRs with the district's official tabulations. RESULTS: We found that the distribution of deaths by types of road users reported in official tabulations differed substantially from the underlying police reports. While official tabulations reported that only 9% of deaths in 2013 were pedestrians and 37% were riders of motorised two wheelers, FIRs showed that these groups accounted for 21% and 49% of deaths, respectively. DISCUSSION: Official tabulations of traffic deaths in India do not correctly represent the types of roads users killed. Until the Indian National Crime Records Bureau has corrected the process of generating statistical tabulations from police reports, data on the types of road users killed in India should not be used for research and policy. In the interim, researchers and policy makers who need such information should extract it from police case files.

Epidemiology of moderate-to-severe injury patterns observed in rollover crashes.

BACKGROUND: Previous epidemiological studies have highlighted the high risk of injury to the head, thorax, and cervical spine in rollover crashes. However, such results provide limited information on whole-body injury distribution and multiple region injury patterns necessary for the improvement and prioritization of rollover-focused injury countermeasures. METHODS: Sampled cases representing approximately 133,000 U.S. adult occupants involved in rollover crashes (between 1995 and 2013) sustaining moderate-to-severe injuries were selected from the National Automotive Sampling System Crashworthiness Data System database. A retrospective cohort study, based on a survey of population-based data, was used to identify relevant whole body injury patterns. RESULTS: Among belted occupants injured in rollover crashes, 79.2% sustained injuries to only one body region. The three most frequently injured (AIS2+) body regions were head (42.1%), upper extremity (28.0%), and thorax (27.1%). The most frequent multi-region injury pattern involved the head and upper extremity, but this pattern only accounted for 2.3% of all of occupants with moderate or worse injuries. CONCLUSIONS: The results indicated that for rollover-dominated crashes, the frequently observed injury patterns involved isolated body regions. In contrast, multi-region injury patterns are more frequently observed in rollovers with significant planar impacts. Identification of region-specific injury patterns in pure rollover crashes is essential for clarifying injury mitigation targets and developing whole-body injury metrics specifically applicable to rollovers.

The global burden of injury: incidence, mortality, disability-adjusted life years and time trends from the Global Burden of Disease study 2013.

BACKGROUND: The Global Burden of Diseases (GBD), Injuries, and Risk Factors study used the disability-adjusted life year (DALY) to quantify the burden of diseases, injuries, and risk factors. This paper provides an overview of injury estimates from the 2013 update of GBD, with detailed information on incidence, mortality, DALYs and rates of change from 1990 to 2013 for 26 causes of injury, globally, by region and by country. METHODS: Injury mortality was estimated using the extensive GBD mortality database, corrections for ill-defined cause of death and the cause of death ensemble modelling tool. Morbidity estimation was based on inpatient and outpatient data sets, 26 cause-of-injury and 47 nature-of-injury categories, and seven follow-up studies with patient-reported long-term outcome measures. RESULTS: In 2013, 973 million (uncertainty interval (UI) 942 to 993) people sustained injuries that warranted some type of healthcare and 4.8 million (UI 4.5 to 5.1) people died from injuries. Between 1990 and 2013 the global age-standardised injury DALY rate decreased by 31% (UI 26% to 35%). The rate of decline in DALY rates was significant for 22 cause-of-injury categories, including all the major injuries. CONCLUSIONS: Injuries continue to be an important cause of morbidity and mortality in the developed and developing world. The decline in rates for almost all injuries is so prominent that it warrants a general statement that the world is becoming a safer place to live in. However, the patterns vary widely by cause, age, sex, region and time and there are still large improvements that need to be made.

Analysis of crash parameters and driver characteristics associated with lower limb injury.

This study aims to investigate changes in frequency, risk, and patterns of lower limb injuries due to vehicle and occupant parameters as a function of vehicle model year. From the National Automotive Sampling System-Crashworthiness Data System, 10,988 observations were sampled and analyzed, representing 4.7 million belted drivers involved in frontal crashes for the years 1998-2010. A logistic regression model was developed to understand the association of sustaining knee and below knee lower limb injuries of moderate or greater severity with motor vehicle crash characteristics such as vehicle type and model years, toepan and instrument panel intrusions in addition to the occupant's age, gender, height and weight. Toepan intrusion greater than 2cm was significantly associated with an increased likelihood of injury (odds ratio: 9.10, 95% confidence interval 1.82-45.42). Females sustained a higher likelihood of distal lower limb injuries (OR: 6.83, 1.56-29.93) as compared to males. Increased mass of the driver was also found to have a positive association with injury (OR: 1.04, 1.02-1.06), while age and height were not associated with injury likelihood. Relative to passenger cars, vans exhibited a protective effect against sustaining lower limb injury (OR: 0.24, 0.07-0.78), whereas no association was shown for light trucks (OR: 1.31, 0.69-2.49) or SUVs (OR: 0.76, 0.28-2.02). To examine whether current crash testing results are representative of real-world NASS-CDS findings, data from frontal offset crash tests performed by the Insurance Institute for Highway Safety (IIHS) were examined. IIHS data indicated a decreasing trend in vehicle foot well and toepan intrusion, foot accelerations, tibia axial forces and tibia index in relation to increasing vehicle model year between the year 1995 and 2013. Over 90% of vehicles received the highest IIHS rating, with steady improvement from the upper and lower tibia index, tibia axial force and the resultant foot acceleration considering both left and right extremities. Passenger cars received the highest rating followed by SUVs and light trucks, while vans attained the lowest rating. These results demonstrate that while there has been steady improvement in vehicle crash test performance, below-knee lower extremity injuries remain the most common AIS 2+ injury in real-world frontal crashes.

The tolerance of the human body to automobile collision impact - a systematic review of injury biomechanics research, 1990-2009.

Road traffic injuries account for 1.3 million deaths per year world-wide. Mitigating both fatalities and injuries requires a detailed understanding of the tolerance of the human body to external load. To identify research priorities, it is necessary to periodically compare trends in injury tolerance research to the characteristics of injuries occurring in the field. This study sought to perform a systematic review on the last twenty years of experimental injury tolerance research, and to evaluate those results relative to available epidemiologic data. Four hundred and eight experimental injury tolerance studies from 1990-2009 were identified from a reference index of over 68,000 papers. Examined variables included the body regions, ages, and genders studied; and the experimental models used. Most (20%) of the publications studied injury to the spine. There has also been a substantial volume of biomechanical research focused on upper and lower extremity injury, thoracic injury, and injury to the elderly - although these injury types still occur with regularity in the field. In contrast, information on pediatric injury and physiological injury (especially in the central nervous system) remains lacking. Given their frequency of injury in the field, future efforts should also include improving our understanding of tolerances and protection of vulnerable road users (e.g., motorcyclists, pedestrians).

Increased risk of driver fatality due to unrestrained rear-seat passengers in severe frontal crashes.

While belt usage among rear-seat passengers is disproportionately lower than their front-seat counterpart, this may have serious consequences in the event of a crash not only for the unbelted rear-seat passenger but also for the front-seat passengers as well. To quantify that effect, the objective of the study is to evaluate the increased likelihood of driver fatality in the presence of unrestrained rear-seat passengers in a severe frontal collision. U.S.-based census data from 2001 to 2009 fatal motor vehicle crashes was used to enroll frontal crashes which involved 1998 or later year vehicle models with belted drivers and at least one adult passenger in the rear left seat behind the driver. Results using multivariate logistic regression analysis indicated that the odds of a belt restrained driver sustaining a fatal injury was 137% (95% CI=95%, 189%) higher when the passenger behind the driver was unbelted in comparison to a belted case while the effects of driver age, sex, speed limit, vehicle body type, airbag deployment and driver ejection were controlled in the model. The likelihood of driver fatality due to an unrestrained rear left passenger increased further (119-197%) in the presence of additional unrestrained rear seat passengers in the rear middle or right seats. The results from the study highlight the fact that future advances to front row passive safety systems (e.g. multi-stage airbag deployment) must be adapted to take into account the effect of unrestrained rear-seat passengers.

GLass intact Assures Safe cervical Spine protocol.

BACKGROUND: Selective cervical spine immobilization performed by Emergency Medical Services (EMS) is being utilized with increasing frequency. These protocols, although very sensitive, still include subjective data such as "mild cervical discomfort." The aim of this study is to create an objective clinical decision rule that would enhance the selective approach for cervical spine immobilization in patients aged 16-60 years. STUDY OBJECTIVE: It is hypothesized that, in a motor vehicle crash, the integrity of the involved vehicle's glass window and airbag status is an excellent objective measure for the amount of energy a vehicle occupant has experienced during the crash. GLass intact Assures Safe Spine (GLASS) is an easy and objective method for evaluation of the need for prehospital cervical spine immobilization. METHODS: A retrospective cohort study was performed with sample motor vehicle crash cases to evaluate the performance of the GLASS rule. The National Accident Sampling System-Crashworthiness Data System (NASS-CDS) was utilized to investigate tow-away motor vehicle crashes, including their glass damage characteristics and occupant injury outcomes, over an 11-year period (1998-2008). Sample occupant cases selected for this study were patients aged 16-60 years, who were belt-restrained front seat occupants involved in a crash with no airbag deployment, and no glass damage before the crash. RESULTS: A total of 14,191 occupants involved in motor vehicle crashes were evaluated in this analysis. The results showed that the sensitivity of the GLASS rule was 95.20% (95% confidence interval [CI] 91.45-98.95%), the specificity was 54.27% (95% CI 53.44-55.09%), and the negative predictive value was 99.92% (95% CI 99.86-99.98%). CONCLUSION: The GLASS rule presents the possibility of a novel, more objective tool for cervical spine clearance. Prospective evaluation is required to further evaluate the validity of this clinical decision rule.

Effect of seat belt pretensioners on human abdomen and thorax: Biomechanical response and risk of injuries.

BACKGROUND: A better coupling of the occupant to the car seat in the early phase of a frontal or far side impacts using pretensioner systems may reduce the likelihood of the submarining effect or increases the likelihood of seat belt engaging the shoulder, respectively. However, the high belt forces may also increase the risk of upper body injuries to the vehicle occupant (especially in abdominal region). It was hypothesized that human body characteristics, such as body mass index (BMI) influence the biomechanical response and injury outcome to the abdominal regions during static pretensioning deployment tests. METHODS: Four postmortem human specimens (PMHS), in a BMI range from 15.6 to 31.2, were positioned in production seats in a normal passenger position and were restrained using a standard three-point belt system. The pretension forces in the belts were generated at two points (retractor and right anchorage) or at all three locations (retractor, left anchorage, and right anchorage). An optical motion capture system and acceleration cubes mounted to the lumbar spine were used to measure the abdomen deformation during testing. RESULTS: The normalized deflections of the thorax recorded at the level of fourth rib were under 10% (noninjury level). Two different patterns were observed in the time histories of abdominal penetration rate in the four PMHSs associated with lower and higher BMI. Abdominal injuries (spleen lacerations) were observed only in the two PMHS with highest BMI. CONCLUSION: Based on data from this study and similar data from the literature, belt velocity and FmaxCmax were shown to be the best injury predictors for injury risk analysis for Abbreviated Injury Scale 2+ and for Abbreviated Injury Scale 3+ injuries, respectively.

Planar impacts in rollover crashes: significance, distribution and injury epidemiology.

While one third of all fatal motor vehicle crashes involve rollover of the vehicle, a substantially large portion of these rollover crashes involve planar impacts (e.g., frontal, side or rear impact) that influence the crash kinematics and subsequently the injury outcome. The objective of the study was to evaluate the distribution of planar impacts in rollover crashes, and in particular, to describe the differences in the underlying crash kinematics, injury severity and the regional distribution of injuries when compared to the rollover-dominated crashes without significant planar impact (i.e., primary rollovers). Sampled cases (n=6,900) from the U.S. National Automotive Sampling System - Crashworthiness Data System, representing approximately 3.3 million belted drivers involved in a rollover crash in years 1998-2008, were analyzed. Single vehicle rollover crashes with significant planar impact (21% of all rollover crashes) were in general more likely to result in occupant fatality and involved higher incidence of moderate to severe injuries compared to single vehicle primary rollovers (p<0.05). A substantial proportion of the planar impact rollovers ended in single quarter turn crashes (30%), mostly resulting from a frontal impact (59%). While chest was the most frequently injured body region among all rollover victims sustaining severe injuries, severe injuries sustained in primary rollovers were more isolated (single body region) in comparison to the ones sustained in rollovers with planar impacts. The results emphasize the higher risk of rollover victims sustaining an injury and the differences in distribution of injuries sustained when a planar impact is associated with the rollover crash.

Vulnerability of female drivers involved in motor vehicle crashes: an analysis of US population at risk.

OBJECTIVES: Motor vehicle trauma has been effectively reduced over the past decades; however, it is unclear whether the benefits are equally realized by the vehicle users of either sex. With increases in the number of female drivers involved in fatal crashes and similarity in driving patterns and risk behavior, we sought to evaluate if advances in occupant safety technology provide equal injury protection for drivers of either sex involved in a serious or fatal crash. METHODS: We performed a retrospective cohort study with national crash data between 1998 and 2008 to determine the role of driver sex as a predictor of injury outcome when involved in a crash. RESULTS: The odds for a belt-restrained female driver to sustain severe injuries were 47% (95% confidence interval = 28%, 70%) higher than those for a belt-restrained male driver involved in a comparable crash. CONCLUSIONS: To address the sex-specific disparity demonstrated in this study, health policies and vehicle regulations must focus on effective safety designs specifically tailored toward the female population for equity in injury reduction.

Response of the sternum under dynamic 3-point bending - biomed 2010.

The goal of this study was to investigate the response and failure properties of the human sternum under bending loading. Nine sternum specimens from post mortem human surrogates (n=7 male, n=2 female, age: 62.7 +/- 10.9 years) were extracted and potted in a three point bending test setup. Specimens were loaded to failure at their center points in bending at 1100 mm/s, with some specimens previously loaded in a non-failure quasi-static loading test. In two cases, the non-failure test was repeated to show that specimens were not damaged during non-failure testing. The sternum specimens were found generally to be unable to support shear forces in the anterior-posterior direction and as a result had relatively low failure moments (24.1 Nm +/- 20.1 Nm). While two of the specimens did fail in bending, the remaining specimens failed as a result of the high tensile forces introduced by the bending loads. These specimens first experienced compressive loads, and then, as the potted ends continued to rotate, tensile loads, which resulted in failure of the specimens (400-800 N).