An Extended Neck Position is Likely to Produce Cervical Spine Injuries Through Buckling in Accidental Head-First Impacts During Rugby Tackling.

Catastrophic cervical spine injuries in rugby often occur during tackling. The underlying mechanisms leading to these injuries remain unclear, with neck hyperflexion and buckling both proposed as the causative factor in the injury prevention literature. The aim of this study was to evaluate the effect of pre-impact head-neck posture on intervertebral neck loads and motions during a head-first rugby tackle. Using a validated, subject-specific musculoskeletal model of a rugby player, and computer simulations driven by in vivo and in vitro data, we examined the dynamic response of the cervical spine under such impact conditions. The simulations demonstrated that the initial head-neck sagittal-plane posture affected intervertebral loads and kinematics, with an extended neck resulting in buckling and supraphysiologic intervertebral shear and flexion loads and motions, typical of bilateral facet dislocation injuries. In contrast, an initially flexed neck increased axial compression forces and flexion angles without exceeding intervertebral physiological limits. These findings provide objective evidence that can inform injury prevention strategies or rugby law changes to improve the safety of the game of rugby.

Pressure Injuries and Skin Failure.

Pressure injuries are a common chronic wound in the older adult. Care of pressure injuries is an interprofessional effort and involves physicians, nurses, registered dieticians, rehabilitation therapists, and surgical subspecialties. Numerous treatment modalities exist but have varying evidence to substantiate their efficacy. All primary and other care providers, particularly geriatricians, need to be aware of current evidence-based prevention and treatment standards. When healing is not expected, palliative care should be considered to avoid futile procedures and preserve dignity and quality of life.

Effect of changes in motor skill induced by educational video program to decrease lower-limb joint load during cutting maneuvers: based on musculoskeletal modeling.

BACKGROUND: This study investigated the effects of changes in motor skills from an educational video program on the kinematic and kinetic variables of the lower extremity joints and knee ligament load. METHODS: Twenty male participants (age: 22.2 ± 2.60 y; height: 1.70 ± 6.2 m; weight: 65.4 ± 7.01 kg; BMI: 23.32 ± 2.49 [Formula: see text]) were instructed to run at 4.5 ± 0.2 m/s from a 5 m distance posterior to the force plate, land their foot on the force plate, and perform the cutting maneuver on the left. The educational video program for cutting maneuvers consisted of preparatory posture, foot landing orientation, gaze and trunk directions, soft landing, and eversion angle. The measured variables were the angle, angular velocity of lower extremity joints, ground reaction force (GRF), moment, and anterior cruciate ligament (ACL) and medial collateral ligament (MCL) forces through musculoskeletal modeling. RESULTS: After the video feedback, the hip joint angles increased in flexion, abduction, and external rotation (p < 0.05), and the angular velocity increased in extension (p < 0.05). The ankle joint angles increased in dorsiflexion (p < 0.05), and the angular velocity decreased in dorsiflexion (p < 0.05) but increased in abduction (p < 0.05). The GRF increased in the anterior-posterior and medial-lateral directions and decreased vertically (p < 0.05). The hip joint moments decreased in extension and external rotation (p < 0.05) but increased in adduction (p < 0.05). The knee joint moments were decreased in extension, adduction, and external rotation (p < 0.05). The abduction moment of the ankle joint decreased (p < 0.001). There were differences in the support zone corresponding to 64‒87% of the hip frontal moment (p < 0.001) and 32‒100% of the hip horizontal moment (p < 0.001) and differences corresponding to 32‒100% of the knee frontal moment and 21‒100% of the knee horizontal moment (p < 0.001). The GRF varied in the support zone at 44‒95% in the medial-lateral direction and at 17‒43% and 73‒100% in the vertical direction (p < 0.001). CONCLUSIONS: Injury prevention feedback reduced the load on the lower extremity joints during cutting maneuvers, which reduced the knee ligament load, mainly on the MCL.

Effects of bench press technique variations on musculoskeletal shoulder loads and potential injury risk.

While shoulder injuries resulting from the bench press exercise are commonly reported, no biomechanical evidence for lowering injury risk is currently available. Therefore, the aim of the present study was to compare musculoskeletal shoulder loads and potential injury risk during several bench press variations. Ten experienced strength athletes performed 21 technical variations of the barbell bench press, including variations in grip width of 1,1.5 and 2 bi-acromial widths (BAW), shoulder abduction angles of 45°, 70° and 90°, and scapula poses including neutral, retracted, and released conditions. Motions and forces were recorded by an opto-electronic measurement system and an instrumented barbell. An OpenSim musculoskeletal shoulder model was employed to estimate joint reaction forces in the glenohumeral and acromioclavicular joints. Time-series of joint reaction forces were compared between techniques by statistical non-parametric mapping. Results showed that narrower grip widths of < 1.5 BAW decreased acromioclavicular compression (p < 0.05), which may decrease the risk for distal clavicular osteolysis. Moreover, scapula retraction, as well as a grip width of < 1.5 BAW (p < 0.05), decreased glenohumeral posterior shear force components and rotator cuff activity and may decrease the risk for glenohumeral instability and rotator cuff injuries. Furthermore, results showed that mediolaterally exerted barbell force components varied considerably between athletes and largely affected shoulder reaction forces. It can be concluded that the grip width, scapula pose and mediolateral exerted barbell forces during the bench press influence musculoskeletal shoulder loads and the potential injury risk. Results of this study can contribute to safer bench press training guidelines.

Neuromuscular Training Effects on Athletes' Jumping and Lower Limb Injury: A Systematic Review.

This study assessed the impact of integrated neuromuscular training (INT) on athletes' jumping performance and lower limb injury prevention. A thorough search across multiple databases, including PubMed, Web of Science, Science Direct, and the Cochrane Library, identified a sample of 19,805 athletes aged between 8.5 and 27.7 years. Results showed that INT led to a significant improvement in jumping ability (SMD = 0.45, 95% CI 0.30-0.60, P = 0.000) and a reduction in lower limb injuries (SMD = 0.68, 95% CI 0.62-0.74, P = 0.000). The most effective interventions lasted at least 25 minutes, conducted 2-5 times per week, for a minimum of 9 weeks. This approach was particularly beneficial for children and adolescents, as it enhanced their countermovement jump (CMJ) ability and helped in the prevention of injuries.

Strength and clinical test combinations enhance predictions of sagittal and frontal plane biomechanics in single-leg landing.

OBJECTIVES: To determine whether clinical screening tests can predict lower limb joint kinematics and kinetics outcomes eliciting anterior cruciate ligament (ACL) injury risk in single-leg landings. DESIGN: Cross-sectional study. SETTING: Laboratory research. PARTICIPANTS: Twenty-six professional male futsal athletes. MAIN OUTCOME MEASURES: Participants completed the Modified Star Excursion Balance Test (mSEBT), Lateral Step Down (LSD), Lunge, Hop tests, and isometric strength tests for clinical screening of lower extremity injury risk and performed single-leg landings to assess lower extremity 3D kinematics and kinetics outcomes. RESULTS: mSEBT, LSD, and isometric strength were the more important tests when constructing the prediction models. The predictive power of clinical tests for screening injury risk significantly increases when combined with strength measurements (p = 0.005, f2 = 0.595). We discerned 11 biomechanical predictions, six explicitly related to the sagittal plane's biomechanics. Some predictions were leg-dependent, with muscle strength tests predominantly predicting biomechanical outcomes of the preferred leg. CONCLUSION: Combining clinical screening tests with strength measures enhances ACL injury risk factors prediction during single-leg landings. Clustering at least two tests improves prediction accuracy, aiding injury prevention planning and decision-making.

Suicides among construction workers in the United States, 2021.

BACKGROUND: Construction workers have the second highest suicide death rate; despite this, there is limited literature examining suicides in the industry, which is necessary to identify those at higher risk of death by suicide. The objective of this study was to examine the characteristics of those who died by suicide in construction to address this knowledge gap. METHODS: Data from the National Center for Health Statistics National Vital Statistics System 2021 public use Mortality Multiple Cause-of-Death file were used to identify deaths by suicide, while denominator data for rates come from the 2021 Current Population Survey. RESULTS: In 2021, construction workers were disproportionately affected by suicide deaths. Almost a fifth (17.9%) of deaths by suicide with a reported industry code were in construction, despite construction workers accounting for only 7.4% of the workforce. Male construction workers accounted for a majority (97.8%) of suicide deaths. The highest percent of deaths by suicide were among individuals who were white, non-Hispanic, completed high school or equivalent, and single, across construction and all industries for males and females. DISCUSSION AND CONCLUSIONS: Male and female construction workers had the highest rates of suicide across all characteristics when compared to all industries. Our findings support the need for ongoing prevention efforts within the industry. Future research is needed to understand suicide risk among certain characteristics and occupations. In addition, the work environment or other work-related factors should be studied to understand how the unique nature of the construction industry may be associated with higher suicide rates.

Headgear use in girls' lacrosse-stakeholders not ready for change.

Purpose: Mandating headgear for field players in girls' lacrosse to reduce head injuries, including concussion, has been heavily debated. However, research regarding the need and effectiveness of mandated headgear use in girls' lacrosse is still developing. Therefore, this qualitative study aimed to identify the need for and barriers to the development of mandated headgear use policies in girls' lacrosse in Ohio. Methods: We conducted six virtual focus groups, three with concussion experts (clinicians and researchers) and three with girls' lacrosse stakeholders (high school players, parents, coaches, and officials). A focus group guide was developed to explore study participants' perceptions and opinions on concussion in girls' lacrosse, headgear use among players, and policies and policy development related to headgear use or a headgear mandate. We developed the codebook using an inductive and iterative approach based on focus group transcripts and used ATLAS.TI to code and analyze the transcript data. Results: Concussion experts and stakeholders understood the potential consequences of concussion but did not perceive concussion as a pervasive problem in girls' lacrosse. The prevention of head and facial injuries was regarded as a potential benefit of headgear use. However, stakeholders expressed that the myriad of arguments discussed opposing mandated headgear use including increased aggressive play and/or targeting, concerns over changes in the game, and cost strongly outweighed the benefits. Finally, both concussion experts and stakeholders identified multiple organizations, including USA Lacrosse, who could act as facilitators and/or barriers to developing, enacting, and implementing headgear policies. Conclusions: Concussion experts and stakeholders identified possible reasons for headgear use related to injury prevention but also identified several important barriers to the development of a headgear mandate for girls' lacrosse in Ohio.

Emergency Department Presentations for Injuries Following Agency-Notified Child Maltreatment: Results From the Childhood Adversity and Lifetime Morbidity (CALM) Study.

Child maltreatment (CM) is associated with negative health outcomes in adulthood, including deliberate self-harm (DSH), suicidal behaviours, and victimisation. It is unknown if associations extend to emergency department (ED) presentations for non-DSH related injuries. Birth cohort study data was linked to administrative health data, including ED presentations for non DSH related injuries and agency-reported and substantiated notifications for CM. Adjusted analyses (n = 6087) showed that any type of agency-reported notification for CM was significantly associated with increased odds of ED presentation for injuries (aOR = 1.57; 95% CI 1.32-1.87). In moderation analyses, women yielded significantly higher odds of notified and substantiated physical abuse, substantiated emotional abuse, and being subject to more than one type of substantiated abuse than males. ED presentations for injuries could be a proxy for risky behaviours, disguised DSH/suicidal behaviours, or physical abuse. The consistent findings in women may point to victimisation via interpersonal violence.

Traffic safety comprehensive evaluation of urban tunnel visual guiding system based on extension matter-element model: a case study in tunnel curves.

OBJECTIVE: The visual guiding system, as a tunnel traffic safety improvement method by using visual guiding facilities to actively guide driving safely, has been widely used in countries with many tunnels, in recent years. This paper aims to quantitatively study the comprehensive evaluation of traffic safety of the visual guiding system in tunnels, which has certain engineering application value and can provide support for the quantitative evaluation and optimal design of tunnel traffic safety. METHODS: Based on the analysis of the relevant factors of urban tunnel traffic safety, a multi-factor comprehensive evaluation system with 5 upper-level indicators and 12 basic-level indicators was proposed. Considering the independent and incompatible indicators, a comprehensive evaluation method of traffic safety of the visual guiding system in urban tunnels was constructed by using the extension matter-element model. Taking the scene of 4 types of tunnel curves, such as no facilities, horizontal stripe, chevron alignment sign, and LED arch, as examples, the comprehensive evaluation of various schemes were carried out by using simulation tests. RESULTS: The traffic safety comprehensive evaluation system of visual guiding system in urban tunnels can be analyzed from five aspects: perception reaction, guidance ability, driver factor, driving task, and facility appearance. The results demonstrated significant the comprehensive evaluation result of the target level of scene 1 was L4, scene 2 was L3, scene 3 was L2, and scene 4 was L1. That is, the final results of the comprehensive evaluation of the four scenes were poor, medium, good, and very good, respectively. CONCLUSIONS: In the scheme of visual guiding system for urban tunnel curves, the effectiveness of the three types of designs, from high to low, was the LED arch, chevron alignment sign, and horizontal stripe, and the safety of the scene without facilities was the lowest. Hence, setting the LED arch in the urban tunnel curve has a good effect in the aspects of guidance ability, sight distance, and sight zone, and is conducive to the driver's perception reaction and driving task.

Acute effects of Nordic hamstring exercise on hip and knee joints proprioception.

BACKGROUND AND OBJECTIVES: Nordic Hamstring Exercise (NHE) is one of the best exercises proposed for injury prevention of hamstring muscles. However, its effects on lower extremity proprioception are unclear. The aim of this study was to investigate the immediate effects of a single bout of NHE on hip and knee joints' proprioception. METHODS: Forty collegiate male soccer players participated in this study with a mean age of 22.85 ± 1.82 years and were randomized into either control (n = 20) or experimental (n = 20) groups. Each subject participated in pre-test measurements in which hip and knee active joints position sense (JPS) were assessed in standing and lying tasks using the image-capturing method. The experimental group then performed three sets of NHE with 10 repetitions in each set, while the control group rested for 10 min. Paired and independent t-tests were used for calculating the differences within and between groups on SPSS software, respectively. The level of significance was P ≤ 0.05. RESULTS: Hip JPS in the lying task and knee JPS in both of the standing and lying tasks were impaired significantly after performing a single bout of NHE (P ≤ 0.05). However, the effects of this exercise on hip JPS in the standing task were not significant (P ≥ 0.05). CONCLUSIONS: NHE performing with three sets of 10 repetitions can significantly impair hip and knee JPS immediately after exercise and reduce the proprioception acuity of the lower limbs. It is recommended to perform this exercise at a time rather than before training or match sessions.

Single-legged landing behavior of high school basketball players with chronic ankle instability.

OBJECTIVES: Anterior cruciate ligament injury is one of the most serious ligamentous injuries. The purpose is to compare the impact of the ankle joint on the knee during landing between athletes with chronic instability and a control group (coper group) and to verify the effects of the kinetic chain from other joints. DESIGN: Prospective study. SETTING: High school basketball. PARTICIPANTS: Participants were 62 female high school basketball players who had participated in team sports for >6 months. MAIN OUTCOME MEASURES: Player joint angles, movements, and moments. RESULTS: The knee valgus moment was significantly higher in the chronic ankle instability group than in the coper group (20%-60% [p < 0.01]; 80%-100% [p < 0.05]) during landing motion. The knee valgus moment was also significantly higher during the change from the maximum knee joint flexion position to the maximum extension (p < 0.05). In addition, the landing motions of the chronic instability group may have utilized suboptimal compensatory motor strategy on the sagittal plane, depending heavily on the knee joint's abduction moment. CONCLUSIONS: Our findings indicate that the chronic ankle instability group uses a different landing strategy pattern than the coper group by changing the joint moment and joint angle during landing, which may increase the risk of anterior cruciate ligament injury.

Anterior Cruciate Ligament Injury Prevention Programs in Welsh Netball: A Survey of Knowledge, Implementation and Barriers Amongst Players and Coaches.

Background Anterior cruciate ligament (ACL) injury prevention programs can reduce injury risk in various sports. The perception of ACL injury prevention programs amongst professional netball players and coaches has not been studied. Purpose The aim of this study was to determine (1) the level of awareness and experience of ACL injury prevention programs, (2) the use of ACL injury prevention programs, and (3) barriers and potential facilitators to implementing a sustainable ACL injury prevention program in netball. Materials and methods Female netball players representing Welsh senior and under-21 teams and elite and amateur coaches were invited electronically to participate in this web-based cross-sectional observational study between 1st May and 31st July 2021. Information on ACL injury susceptibility and seriousness, knowledge, experience, and implementation of ACL injury prevention programs were ascertained. Results Twenty-eight players (78%) and 29 coaches (13%) completed the questionnaire. Seventeen (61%) players and 15 (52%) coaches reported that female athletes were at greater risk of sustaining ACL injuries. Over 90% of respondents identified netball as high-risk, whilst 89% (n=25) of players and 76% (n=22) of coaches reported these injuries to be preventable. Only two (7%) players and six (21%) coaches utilised an ACL injury prevention program with a lack of time and engagement from coaches and players identified. The majority of respondents indicated that their club has neither promoted, advocated the use nor demonstrated exercises for ACL injury prevention. Over 90% of respondents would utilise an ACL injury prevention program if it minimised players' risk with appropriate information and demonstration of exercises. Conclusion This study highlights limited knowledge of female athletes' increased susceptibility to ACL injuries amongst players and coaches with a lack of communication and education on ACL injury prevention programs between sporting associations, coaches, and players. However, the results demonstrate willingness amongst both players and coaches to implement an ACL injury prevention program in netball.

Application of Machine Learning Methods to Investigate Joint Load in Agility on the Football Field: Creating the Model, Part I.

Laboratory studies have limitations in screening for anterior cruciate ligament (ACL) injury risk due to their lack of ecological validity. Machine learning (ML) methods coupled with wearable sensors are state-of-art approaches for joint load estimation outside the laboratory in athletic tasks. The aim of this study was to investigate ML approaches in predicting knee joint loading during sport-specific agility tasks. We explored the possibility of predicting high and low knee abduction moments (KAMs) from kinematic data collected in a laboratory setting through wearable sensors and of predicting the actual KAM from kinematics. Xsens MVN Analyze and Vicon motion analysis, together with Bertec force plates, were used. Talented female football (soccer) players (n = 32, age 14.8 ± 1.0 y, height 167.9 ± 5.1 cm, mass 57.5 ± 8.0 kg) performed unanticipated sidestep cutting movements (number of trials analyzed = 1105). According to the findings of this technical note, classification models that aim to identify the players exhibiting high or low KAM are preferable to the ones that aim to predict the actual peak KAM magnitude. The possibility of classifying high versus low KAMs during agility with good approximation (AUC 0.81-0.85) represents a step towards testing in an ecologically valid environment.

Wrestling injuries during the 2016 Rio and 2020 Tokyo Olympic Games.

OBJECTIVES: To evaluate and compare the injuries of Olympic wrestlers during the 2016 Rio and 2020 Tokyo Olympic Games held in August 2021 due to the COVID-19 pandemic. METHODS: In this descriptive epidemiological study, injury report forms were used to collect and analyse injury data during the competitions. RESULTS: During 410 matches in the Rio Olympic Games, 21 injuries were recorded among 346 wrestlers (112=women), a rate of 5.1 injuries/100 bouts and 6.1 injuries/100 athletes. During 322 matches in the Tokyo Olympic Games, 28 injuries were recorded among 287 wrestlers (96=women), with 8.7 injuries/100 bouts and 9.8 injuries/100 athletes. However, these apparent differences in injury rates between Tokyo and Rio were not statistically significant (injuries/bout: p=0.057, 95% CI: 0.31 to 1.02; injuries/athlete: p=0.087, 95% CI: 0.33 to 1.08). Mild injuries comprised the greatest proportion of injuries in both Olympic Games. Severe injuries accounted for 0%, 16.7% and 36.4% of injuries in Greco-Roman, Freestyle and Women's wrestling, respectively. CONCLUSION: Most wrestling injuries in the 2016 Rio and 2020 Tokyo Olympic Games were mild skin injuries in the head and face regions due to direct body contact during standing positions in the 1/8-final round of wrestling competitions. No critical injury was observed during the recent Olympic Games. Attention should be drawn to preventing upper limb joint dislocations as common severe injuries in both Olympic Games. While not statistically significant, the Tokyo Games, after the COVID-19 pandemic, witnessed a higher injury occurrence than the Rio Games.

Identifying emerging hot spots of road traffic injury severity using spatiotemporal methods: longitudinal analyses on major roads in Ghana from 2005 to 2020.

BACKGROUND: Although road traffic injuries and deaths have decreased globally, there is substantial national and sub-national heterogeneity, particularly in low- and middle-income countries (LMICs). Ghana is one of few countries in Africa collecting comprehensive, spatially detailed data on motor vehicle collisions (MVCs). This data is a critical step towards improving roadway safety, as accurate and reliable information is essential for devising targeted countermeasures. METHODS: Here, we analyze 16 years of police-report data using emerging hot spot analysis in ArcGIS to identify hot spots with trends of increasing injury severity (a weighted composite measure of MVCs, minor injuries, severe injuries, and deaths), and counts of injuries, severe injuries, and deaths along major roads in urban and rural areas of Ghana. RESULTS: We find injury severity index sums and minor injury counts are significantly decreasing over time in Ghana while severe injury and death counts are not, indicating the latter should be the focus for road safety efforts. We identify new, consecutive, intensifying, and persistent hot spots on 2.65% of urban roads and 4.37% of rural roads. Hot spots are intensifying in terms of severity and frequency on major roads in rural areas. CONCLUSIONS: A few key road sections, particularly in rural areas, show elevated levels of road traffic injury severity, warranting targeted interventions. Our method for evaluating spatiotemporal trends in MVC, road traffic injuries, and deaths in a LMIC includes sufficient detail for replication and adaptation in other countries, which is useful for targeting countermeasures and tracking progress.

High school rugby coaches' knowledge and opinions of concussion in Kwa-Zulu Natal province in South Africa: an ecological cross-sectional study.

BACKGROUND: Concussions in Rugby Union are common with an increased risk to adolescent players. Coaches are key to injury prevention and a greater understanding of their knowledge and sentiments may guide future initiatives. There is a lack of data on rugby coaches, especially in South Africa. This study aimed to investigate the knowledge and opinions of high school rugby coaches regarding concussion management. METHODS: This cross-sectional study of 37 high school rugby coaches in South Africa, was conducted via a self-reported questionnaire. Concussion knowledge was scored for correct answers only with closed-question scaling methods to measure the importance of items of concussion management using a graphical rating scale. An attitude scale (Likert) was used to assess self-reported opinions and behaviours. Associations were calculated for participant characteristics and overall concussion injury knowledge. RESULTS: More participants showed good overall knowledge of ≥ 75% (n = 22, 59% vs. n = 15, 40%), especially those with greater coaching experience (p = 0.021). Player welfare was perceived more important than player performance (185 vs. 164), with concussion prevention most important (184 of 185). Appealing characteristics of an injury prevention programme were the improvement of player skill (173, SD ± 0.75, mean 4.68), being adaptable (171, ± 0.86, 4.62), and being completed in the warm-up (167, ± 0.93, 4.51). The biggest perceived barriers were duration (138, ± 1.59, mean 3.73), effort (130, ± 1.56, 3.51), compliance and lack of knowledge (both 127, ± 1.68, 3.43). CONCLUSION: These results support the implementation of ongoing concussion education for rugby coaches and identify areas for promoting awareness and knowledge of concussion injury prevention, identification, and specific management of younger athletes. Appealing characteristics and barriers are highlighted and may allow for improved implementation and adherence to concussion prevention programmes.

Comparing the Drop Vertical Jump Tracking Performance of the Azure Kinect to the Kinect V2.

Traditional motion analysis systems are impractical for widespread screening of non-contact anterior cruciate ligament (ACL) injury risk. The Kinect V2 has been identified as a portable and reliable alternative but was replaced by the Azure Kinect. We hypothesize that the Azure Kinect will assess drop vertical jump (DVJ) parameters associated with ACL injury risk with similar accuracy to its predecessor, the Kinect V2. Sixty-nine participants performed DVJs while being recorded by both the Azure Kinect and the Kinect V2 simultaneously. Our software analyzed the data to identify initial coronal, peak coronal, and peak sagittal knee angles. Agreement between the two systems was evaluated using the intraclass correlation coefficient (ICC). There was poor agreement between the Azure Kinect and the Kinect V2 for initial and peak coronal angles (ICC values ranging from 0.135 to 0.446), and moderate agreement for peak sagittal angles (ICC = 0.608, 0.655 for left and right knees, respectively). At this point in time, the Azure Kinect system is not a reliable successor to the Kinect V2 system for assessment of initial coronal, peak coronal, and peak sagittal angles during a DVJ, despite demonstrating superior tracking of continuous knee angles. Alternative motion analysis systems should be explored.

Child pedestrian safety training in virtual reality: How quickly do children achieve adult functioning and what individual differences impact learning efficiency?

INTRODUCTION: Pedestrian injuries represent a leading cause of child death globally. One prevention strategy is teaching children street-crossing skills. Virtual reality (VR) has emerged as a strategy to offer repeated street-crossing practice and overcome ethical barriers of training children in live traffic. This study addressed two questions pertinent to implementation of child pedestrian safety training within VR: (a) how much training do children require to achieve adult street-crossing competency, and (b) what individual differences might facilitate children to acquire that competency more efficiently? METHODS: Five hundred 7- and 8-year-olds were recruited. Children completed pedestrian safety training within VR for up to 25 thirty-minute training sessions until they achieved adult levels of mastery. At baseline, four cognitive-perceptual skills (visual memory, visual perception, processing speed, working memory) and parent-reported externalizing symptomatology were assessed. RESULTS: On average, children achieved adult pedestrian safety competency after 10.0 training sessions (SD = 4.8). Just one child (<1%) failed to achieve adult pedestrian functioning after 25 training sessions. In univariate analyses, boys took slightly longer than girls to achieve adult functioning, and visual memory, visual perception, processing speed, working memory, and fewer externalizing symptoms were all positively associated with shorter time to mastery. In a multivariable model, only child age was a statistically significant predictor. CONCLUSION: Almost all participants achieved adult street-crossing skills competency through VR training, although they required about 10 sessions on average. Analysis of predictor variables confirmed that nearly all 7- and 8-year-olds are trainable. PRACTICAL APPLICATION: Implementation of VR pedestrian safety training is recommended, but must be conducted cautiously to ensure children are not permitted to engage independently in traffic until they are assessed and demonstrate sufficient skills.

Racial and Ethnic Differences in Time to Completion of Academic Enrichment Program Applications.

INTRODUCTION: Diversity in healthcare and research is integral to serving our increasingly diverse population. Access to academic enrichment programs, an important pathway to science, technology, engineering, and mathematics (STEM) careers promotes educational attainment through academic preparation and increased interest, useful strategies for improving diverse representation in higher learning. Given this important pathway to STEM fields, attention to equity in enrichment programs admissions is as important as the increasing focus on mitigating racial/ethnic disparities in undergraduate and graduate admissions.  Methods: In a retrospective cohort study at the University of Washington, we used descriptive and Chi-Square statistics to compare a hybrid competitive summer application program with stipend with an asynchronous first-come, first-served enrollment program in injury and violence prevention research. The three main outcomes were: 1) time to application, measured by number of days to apply/enroll after application or enrollment period start date, 2) percentage of application/enrollment period, measured by when application or enrollment occurred in relation to the total application or enrollment period, and 3) differences in Black, Hispanic, and Native American applicants and enrollees.  Results: In a study examining two injury and violence prevention programs, which reached educational institutions including Historically Black Colleges and Universities (HBCU) and Tribal Colleges: 1) Applicants were 9.6% and 6.4% Black (application vs enrollment programs; p<0.0001), 0.4% and 0% Native American to the application and enrollment programs, and 9.1% and 10.3% Hispanic (application vs enrollment programs; p=0.6), 2) Across all racial and ethnic groups, students applied later (last 15% percent of application period) in the competitive application program than to the first-come first-served enrollment program in which students enrolled throughout the enrollment period, and 3) Across both program types, there were racial and ethnic differences in time to application and enrollment start and completion. CONCLUSION: Findings show that free enrollment programs alone do not incentivize educational attainment for all groups and that application rolling admissions processes may not equally promote racial and ethnic diversity for all groups.