Under-reporting bicycle accidents to police in the COST TU1101 international survey: Cross-country comparisons and associated factors.

Police crash reports are often the main source for official data in many countries. However, with the exception of fatal crashes, crashes are often underreported in a biased manner. Consequently, the countermeasures adopted according to them may be inefficient. In the case of bicycle crashes, this bias is most acute and it probably varies across countries, with some of them being more prone to reporting accidents to police than others. Assessing if this bias occurs and the size of it can be of great importance for evaluating the risks associated with bicycling. This study utilized data collected in the COST TU1101 action "Towards safer bicycling through optimization of bicycle helmets and usage". The data came from an online survey that included questions related to bicyclists' attitudes, behaviour, cycling habits, accidents, and patterns of use of helmets. The survey was filled by 8655 bicyclists from 30 different countries. After applying various exclusion factors, 7015 questionnaires filled by adult cyclists from 17 countries, each with at least 100 valid responses, remained in our sample. The results showed that across all countries, an average of only 10% of all crashes were reported to the police, with a wide range among countries: from a minimum of 0.0% (Israel) and 2.6% (Croatia) to a maximum of a 35.0% (Germany). Some factors associated with the reporting levels were type of crash, type of vehicle involved, and injury severity. No relation was found between the likelihood of reporting and the cyclist's gender, age, educational level, marital status, being a parent, use of helmet, and type of bicycle. The significant under-reporting - including injury crashes that do not lead to hospitalization - justifies the use of self-report survey data for assessment of bicycling crash patterns as they relate to (1) crash risk issues such as location, infrastructure, cyclists' characteristics, and use of helmet and (2) strategic approaches to bicycle crash prevention and injury reduction.

Causes of near misses in critical care of neonates and children.

AIM: The primary goal of this study was to examine the nature and causes of medical errors known as almost adverse events (AAEs) and potential adverse events (PAEs) in intensive care units. METHODS: Observations were conducted in the Neonatal Intensive Care Unit and in the Pediatric Intensive Care Unit in a large hospital in Israel. The AAEs and PAEs were classified into three main categories: environmental, system and human factors. Data encoding and analysis was based on a Bayesian model previously developed to analyse causes of traffic accidents, and the categories were based on systems and ergonomics approaches. RESULTS: 'Workload' (a system factor) was the main cause of AAEs and 'communication failures' (a human factor) was the second main cause of AAEs. Among the environmental factors, 'failures in medical devices' was the most cited cause of AAEs. Environmental factors accounted for most of PAEs and among them 'form failures' was the most 'AAE'-prone factor. CONCLUSIONS: Environmental factors (mainly 'failures in medical device') and system factors (mainly 'workload') accounted for most of AAEs in the intensive care units studied. The systems and the ergonomics approaches to error analysis can be useful in creating a comprehensive error management programme in order to minimize the gap between work demands and individual capabilities.

A portable bio-impedance system for monitoring lung resistivity.

The principles of a hybrid bio-impedance technique are implemented in a novel, lung resistivity monitoring system ("CardioInspect" Tel-Aviv University, Israel). The system is to be utilized in the clinic or at home, for daily monitoring of patients suffering from pulmonary edema. The developed system consists of an eight-electrode belt worn around the thorax, an electronic unit containing analog and digital boards, and a stand-alone DSP based system with a designated software to analyze the data. A Newton-Raphson algorithm based on the finite-volume method is employed for the optimization of the left and right lung resistivity values, making use of the voltage measurements retrieved from opposite current injections. In this preliminary study, 33 healthy volunteers were measured with the system during tidal respiration, yielding symmetric mean left and right lung resistivity values of (1205+/-163, 1200+/-165) (Omega cm). The system reproducibility was better than 2% for both within and between tests measurements, and no dependency between the reconstructed values and various anthropometric parameters was found.

Minimum and comfortable driving headways: reality versus perception.

A field study was conducted to evaluate drivers' actual headways in car-following situations, their relationship to the drivers' brake reaction times, and their relationship to the drivers' ability to estimate those headways using different metrics. Drivers were asked to maintain "minimum safe distance" and "comfortable, normal distance with no intention to pass" behind the car ahead. The lead car speeds varied from 50 to 100 km/hr. The results showed that under both sets of instructions, drivers adjusted their distance headways in relation to speed, maintaining constant time headways. A significant portion of the drivers maintained time headways that are considered unsafe in relation to drivers' reaction times. There was no significant relationship between the minimal headways maintained by the drivers and their brake reaction times under conditions of maximum attention and preparedness to apply brakes. Accuracy of spoken estimates of headways varied widely among the three measures used to report perceived headway; meters and car lengths yielded much lower estimates (and ones closer to the actual headways) than did seconds. The results have implications for headway perception, driving safety, driver education, and smart cruise-control design.

Self-reports of safe driving behaviors in relationship to sex, age, education and income in the US adult driving population.

This study analyzed the data of a health and safety survey conducted on a representative sample of the adult driving population. The analysis focused on the relationships between self-reported safe driving behaviors (including belt use, observing speed limits, and abstaining from drinking and driving), and demographic characteristics (including sex, age, education and income). The results showed that the three behaviors are quite independent of each other, and, contrary to some stereotypes, there is no single high-risk group that is most likely to violate all three safe driving behaviors. The only consistent effect was that of sex: women reported higher observance rates of all three behaviors. Reported use of safety belts increases with age and education for both men and women. However while for women the reported use increases with income, for males the reported use does not change with income. Complete avoidance of drinking and driving was reported by most drivers in all groups, and the high rates hardly varied across the different age, education, and income groups. The number of people who reported that they observe the speed limit all the time increased with age, but decreased with increasing education and income. The results have implications for identifying violation-specific high-risk groups, and stressing different factors for each.

A computational fluid dynamic model of antigen-antibody surface adsorption on a piezoelectric immunosensor.

A novel computational fluid dynamic model describing the antigen-antibody binding on an electrode surface is presented. It was assumed that the adsorption rate of the antibody sample is dependent upon the flow field in the vicinity of the electrode. Numerical solution of the steady flow in a two-dimensional triangular cell using the Navier-Stokes equations was carried out for predicting mass adsorption on the surface of the crystal. The relationships between the mass adsorbed over the area surface of the electrode, the kinetics of the binding process, and the flow field were determined. The effect of the inlet conditions (location, velocity magnitude, and direction) on the time constant of the mass adsorption process was investigated. It was found that the time constant was decreased by moving the inlet near the edge of the crystal or increasing the normal to the boundary component of the velocity. These changes may significantly reduce the time needed to conduct the test.

Fleet study evaluation of an advance brake warning system.

The advance brake warning system (ABWS) is a mechanism that activates the brake lights in response to a rapid disengagement of the gas pedal, before the driver's foot reaches the brake pedal. Two previous studies showed that (a) such rapid releases of the gas pedal are typically followed by brake activation, and (b) the ABWS can prevent a high percentage of rear-end collisions in which an attentive following driver maintains a headway of 1.0 s or less from the vehicle ahead. In the present study the crash involvement of 764 government cars and light trucks was tracked over an average period of 35 months. The vehicles were matched in pairs--one of each pair with the ABWS and one without it. Data analyses focused on collisions in which the government vehicles were rear-ended. Overall, ABWS-equipped vehicles were not significantly less involved in rear-end collisions. However, an examination of the struck vehicles only showed that the ABWS-equipped vehicles were involved in fewer rear-end collisions per kilometer driven than were the vehicles without the ABWS. In conclusion, despite the theoretical appeal and the results of earlier studies, the fleet study failed to demonstrate that such a system is a cost-effective safety device for the prevention of rear-end crashes. Actual or potential applications include the evaluation of new in-vehicle technologies by a hierarchy of multiple validation studies prior to consideration.

Trends in safe driving behaviors and in relation to trends in health maintenance behaviors in the USA: 1985-1995.

Specific health and safe driving behaviors of the American adult population during the period 1985-1995, were examined for trends and for consistencies in observing them. The data base consisted of the results of annual surveys conducted on representative samples of 1250 people of the US adult population. Two indices were developed: a Health Index (HI) and a Safety Index (SI). The Health Index reflects the level of practice of six health and disease preventing behaviors (in order of decreasing importance: not smoking, frequent exercises, avoiding fat foods, having an annual blood pressure test, avoiding high-cholesterol foods, and having an annual dental exam). The Safety Index reflects the level of practice of three safe driving behaviors (in order of decreasing importance: wearing safety belts, avoiding drinking and driving, and observing the speed limit). Only a weak association was found among the individual safe driving behaviors, among the individual health maintenance behaviors, and between the two sets of behaviors. Over the 11-year study period the change in the Health Index has been practically and statistically insignificant, whereas the change in the Safety Index was both statistically and practically significant. The small improvement in the Safety Index actually masked a complex pattern of changes in safe driving habits. The three component Safety Index behaviors did not change in the same manner over the 11-year period. The greatest and most consistent increase was in the use of safety belts, with the reported percent who use it all the time increasing from 41.5% in 1985 to 74.1% in 1995 (an increase of 80%). There was also a consistent positive trend in refraining from drinking and driving, but the overall improvement was less dramatic than that reported for use of safety belts: from 71.6% reporting they never drink and drive in 1985 to 79.1% in 1995 (an increase of 10%). Still, it is noteworthy that by 1995 nearly 80% of the people reported they never drink and drive. Finally, obeying the speed limit did not improve over the 11-year period.

Eye movements of younger and older drivers.

This 2-part study focuses on eye movements to explain driving-related visual performance in younger and older persons. In the first task, participants' eye movements were monitored as they viewed a traffic scene image with a numeric overlay and visually located the numbers in their sequential order. The results showed that older participants had significantly longer search episodes than younger participants, and that the visual search of older adults was characterized by more fixations and shorter saccades, although the average fixation durations remained the same. In the second task, participants viewed pictures of traffic scenes photographed from the driver's perspective. Their task was to assume the role of the driver and regard the image accordingly. Results in the second task showed that older participants allocated a larger percentage of their visual scan time to a small subset of areas in the image, whereas younger participants scanned the images more evenly. Also, older participants revisited the same areas and younger participants did not. The results suggest how aging might affect the efficacy of visual information processing. Potential applications of this research include training older drivers for a more effective visual search, and providing older drivers with redundant information in case some information is missed.

How automatic is manual gear shifting?

Manual gear shifting is often used as an example of an automated (vs. controlled) process in driving. The present study provided an empirical evaluation of this assumption by evaluating sign detection and recall performance of novice and experienced drivers driving manual shift and automatic transmission cars in a downtown area requiring frequent gear shifting. The results showed that manual gear shifting significantly impaired sign detection performance of novice drivers using manual gears compared with novice drivers using an automatic transmission, whereas no such differences existed between the two transmission types for experienced drivers. The results clearly demonstrate that manual gear shifting is a complex psychomotor skill that is not easily (or quickly) automated and that until it becomes automated, it is an attention-demanding task that may impair other monitoring aspects of driving performance. Actual or potential applications of this research include a reevaluation of the learning process in driving and the need for phased instruction in driving from automatic gears to manual gears.

Older people's driving habits, visual abilities, and subjective assessment of daily visual functioning.

OBJECTIVES: To explore the relationship between the status of daily visual functions, as measured by Mangione et al.'s (1992) ADVS, and: (a) visual functions that are related to driving; (b) the tendency of elderly people to drive in different visual conditions; and (c) the reasons older people give for limiting their driving under different conditions. STUDY DESIGN: The subjects were 80 elderly people, ages 64-85. Seventy three of these people still drove and seven had quit driving. Each participant was individually administered (a) a subjective questionnaire containing the ADVS and questions from the Established Populations for the Epidemiological Studies of the Elderly (EPESE); (b) objective measures of visual performance including visual acuity, contrast sensitivity, and visual search speed. RESULTS: Strong correlations were obtained between the responses to the subjective questionnaire and the objective measures of visual skills. Most subjects were cognizant of the changes in their quality of vision and changed their driving habits accordingly by avoiding driving at dark, on unfamiliar roads, and on long trips. There were also significant associations between the changes in driving behavior and performance on the vision tests. CONCLUSION: The ADVS can be used as a self-administered test of driving-related visual functioning, and is most relevant to self-restrictions in night driving.

Duration estimates and users' preferences in human-computer interaction.

Two experiments assessed the effect of various static and dynamic computer 'wait' message displays on (1) subjective estimates of the duration of intervals during which a subject had to wait for the computer's response, and (2) subjective preferences among the different displays. All the static displays led to identical duration estimates. For dynamic displays a direct relation between the rate of changes and the estimate was found. Faster rates led in most cases to increased estimates of duration, and slow-changing graphic displays appeared to have the shortest duration. Subjects preferred epigrams to all other displays, and cumulative graphic displays to a blinking or static WAIT. The rate of change did not affect preference ratings for the graphic displays, whereas slower blink rates were preferred for the WAIT. The results demonstrate that the findings and models from earlier basic research on time estimation are relevant for predicting the subjective assessment of wait-periods. However, users' satisfaction with the displays depends not only on the apparent duration of the wait period, but also on other variables. These should be considered when choosing the display that is shown while users wait for the system to complete a task.

Thoracoscopic upper thoracic sympathectomy for primary palmar hyperhidrosis in children and adolescents.

After 20 years of experience with the "open" transaxillary approach, the authors are presently performing the thoracoscopic technique for upper thoracic sympathectomy in severe primary hyperhidrosis. During a period of 14 months, 23 operations were performed and 22 patients had immediate and permanent relief of palmar sweating. The immediate postoperative course was uneventful in all cases. Hospitalization was short, and all patients returned to school and full activity 3 to 5 days after operation. These initial results compare favorably to the "open" method and, pending further experience, are actually better in terms of less pain, early discharge, quicker return to normal activity, and a smaller, less conspicuous scar.

Drinking and driving of pub patrons in Israel.

A chance sample of people exiting pubs in Israel were interviewed and their blood alcohol concentration (BAC) was measured with a portable breathalizer. Approximately 50% of the people intended to drive away themselves, while 50% were driven by others. People's decision whether or not to drive was unrelated to their BAC and to the number of drinks they reportedly had, and only marginally related to whether or not they felt drunk. Thirty percent of those who felt drunk still intended to drive. Although three-quarters of the respondents felt there is a driving and drinking problem in Israel, their knowledge about the effects of alcohol and the number of drinks they need to consume in order to get drunk reflected an alarming ignorance. The results demonstrate a dangerous trend in alcohol consumption that is not coupled with adequate specific knowledge about alcohol's effects.

NER, a new member of the gene family encoding the human steroid hormone nuclear receptor.

NER, a new member of the steroid hormone nuclear receptor (NR)-encoding gene family, was isolated from a human osteosarcoma SAOS/B10 cell line cDNA library. NER codes for a polypeptide of 461 amino acids which contains the conserved sequences of the DNA-binding and ligand-binding domains of typical steroid hormone NR. It has highest homology with the retinoic acid receptors: 55% at the DNA-binding domain and 38-40% at the ligand-binding domain. A single transcript of 2.3 kb was detected in all cells and tissues tested. Although no ligand was identified for NER-I, its wide distribution may indicate that this novel steroid hormone NR may play a basic role in cell function.

Demographic and socioeconomic correlates of safety belt use.

This study analyzed the relationship between safety belt use rates--as measured by observational surveys at preselected sites--and demographic and socioeconomic characteristics--as reflected by the U.S. Census Bureau data for the sites. The results showed consistent and moderately high associations between observed safety belt use rates and socioeconomic status indicators, primarily home value. Once redundancies among variables were removed, other variables that contributed significantly to explaining differences between high- and low-belt use sites were the percentage of elderly people (55+ years old) and the mix of blue and white collar workers. Sites having high safety belt use rates had higher average home values, a higher percentage of elderly people, and a lower percentage of blue collar workers than sites having low use rates. Simple correlations with belt use rates were also obtained for race, marital status, presence of children in household, education, and income.

Expression of alpha v and beta 3 integrin subunits in rat osteoclasts in situ.

Recent findings suggest that the vitronectin receptor, a member of the integrin family, plays an important role in the attachment of osteoclasts to bone matrix. We report here the localization by in situ hybridization of the mRNA for the alpha and beta subunits of the vitronectin receptor in rat bone sections. To generate the rat-specific RNA probes used in this study, we cloned cDNA fragments of integrin chains alpha v, beta 3, and beta 5 by the polymerase chain reaction from rat cDNA. These fragments share 86-91% homology with the respective human sequences. In situ hybridization localized the alpha v and beta 3 mRNAs to regions undergoing extensive bone resorption. The histologic appearance and prestaining of bone sections for tartrate-resistant acid phosphatase (TRAP) indicated the presence of these mRNAs in osteoclasts. These observations support immunohistochemical findings that osteoclasts express high levels of the vitronectin receptor, confirm the identity of this receptor as integrin alpha v/beta 3, and suggest that osteoclasts may actively synthesize these molecules.

Differential expression of insulin-like growth factor-I (IGF-I) and IGF-II messenger ribonucleic acid in growing rat bone.

Insulin-like growth factors (IGF-I and IGF-II) are among the most abundant growth factors found in bone. Although their local production has been implicated in growth and development, localization of the cells that express these proteins is not well documented. We have studied, by in situ hybridization, the temporal and spatial expression of IGF-I and IGF-II mRNA in rat long bones at different stages of postnatal bone development. In 2-day-old rats, IGF-II was highly expressed in cartilage and in the mesodermal structures that surround the bone. At later stages of bone development, the IGF-II signal decreased in intensity, but could still be detected in the growth plate of tibial bones at 3 and 5 weeks. At this stage, the IGF-II signal in the epiphyseal growth plate was unevenly distributed and was stronger in the periphery than in the center, where it was mainly concentrated in the germinal layer and in some, but not all, cartilage columns. IGF-I, on the other hand, was only faintly detected in the periosteum at the early cartilaginous stage of bone development. At later stages, IGF-I was strongly associated with regions of ossification in the trabecular bone of the metaphysis and epiphysis and along the endosteal and periosteal surfaces. Surprisingly, we did not detect at any time IGF-I mRNA in chondrocytes of the epiphyseal growth plate. These results suggest that in the rat, IGF-II plays a role in early development of bone and in the longitudinal growth of the epiphyseal plate. IGF-I is more closely associated with the osteogenic regions and does not replace the declining levels of IGF-II in the growth plate.

Identification of a new member of the steroid hormone receptor superfamily that is activated by a peroxisome proliferator and fatty acids.

We have identified a novel member of the steroid hormone receptor superfamily by cDNA cloning from a human osteosarcoma SAOS-2/B10 cell library. Sequence analysis predicts a protein of 441 amino acids, which includes the conserved amino acid residues characteristic of the DNA- and ligand-binding domains of nuclear receptors. Amino acid sequence alignment and transcriptional activation experiments revealed that the new protein is closely related to the mouse peroxisome proliferator activated receptor. The overall homology is 62%, and the highest similarity is seen in the DNA- and ligand-binding domains, 86% and 71%, respectively. Northern blot analysis showed that in mature rats, the receptor is highly expressed in heart, kidney, and lung as a transcript of approximately 3500 nucleotides. In human cells, the size of the mRNA is approximately 4000 nucleotides. Transcription assays using hybrid receptors consisting of the ligand-binding domain of the new protein and the DNA-binding domain of the glucocorticoid receptor showed weak stimulation by the peroxisome proliferator activator WY14643, suggesting a relationship to that receptor. Similar stimulation was observed with arachidonic and oleic acid (100-250 microM).

Impact of court monitoring on the adjudication of driving while intoxicated (DWI).

Court monitoring of driving while intoxicated (DWI) cases is a labor-intensive effort conducted by over 300 concerned citizen groups across the United States. The present study assessed the impact of court monitoring by analyzing the difference in court dispositions (guilty, not guilty, and dismissed) and case outcomes (jail, fine, and license suspension) between monitored cases and non-monitored cases. The data base for this study consisted of all 9,137 DWI arrests made in the state of Maine in one calendar year. The results demonstrated that court monitoring is an effective tool in affecting the adjudication process. In the presence of court monitors the conviction rates of DWI offenders were higher and their case dismissal rates were lower than those of drivers not court-monitored. Furthermore, once convicted, the likelihood of a jail sentence was higher and the length of the jail sentence was longer for court-monitored DWI drivers than for non-monitored drivers. Monitoring impact was most pronounced for first-time offenders with BAC levels of .10-.11, and those refusing the BAC test.