Paediatric Injury from Powered Off-Road Vehicles

Background Powered off-road vehicles, such as quad-bikes and two-wheeled motorcycles, are popularly used recreationally by children, and are also used in a variety of farming and agricultural contexts. However, crashes can result in serious injuries and deaths, and as such are an important public health concern for Australian children. Compared to adults, children have different riding patterns, injury causes and risk factors relating to their level of development, as well as different patterns of injury outcomes and severity. Aims This work aims to investigate paediatric quad-bike and motorcycle riding patterns and behaviours, along with risk factors, injury severity, outcomes and potential avenues for injury prevention counter-measures. The work consists of five related studies. Methods and Results The first study was a survey of paediatric off-road vehicle riders, which was undertaken to characterise patterns of use, rider behaviours, experience and attitudes. Recreational motorcycle riding was most common, with children having high rates of previous riding experience and often participating in ‘structured’ riding within organised motorsports competitions and events. There was a small proportion of ‘unstructured’ riding in the context of agriculture or on private properties. Riders generally rode frequently and used helmets and other protective gear. The second study examined a group of children admitted to a paediatric hospital as a result of injury sustained from an off-road vehicle crash. In-depth crash investigation techniques examined injury mechanisms and related them to injury outcomes, along with rider, environmental and vehicular risk factors. A variety of recurring mechanisms emerged, particularly loss-of-control events leading to impacts with the ground or vehicle. A wide range of injuries were also observed, particularly to the extremities. A case-control component of the study identified a lower rider to vehicle weight ratio as a factor associated with higher crash risk. The third and fourth studies used large, linked population-level hospital admission and mortality datasets. The first of these examined injury epidemiology and outcomes for paediatric off-road vehicle crashes across New South Wales over a 17-year time period. The outcomes for different vehicle types were compared. The findings demonstrated the large burden of injury caused by ORV crashes in terms of hospital admissions and operative interventions. Furthermore, although on an individual level, quad-bike injuries were associated with higher injury severity, the far greater number of two-wheeled off-road motorcycle crash admissions suggest that motorcycles should be an injury prevention priority. The second linked data study examined the subset of children who have multiple hospital admissions following off-road vehicle crashes. Children who re-present to hospital repeatedly are a particularly vulnerable group, prone to more serious injury, and higher overall costs to the healthcare system. ‘Recidivist’ riders were compared to non-recidivists across various demographic, vehicle and injury outcome factors, highlighting the areas in which potential recidivists may be identified or targeted for injury prevention interventions. The fifth study was a systematic review of injury prevention countermeasures delivered through clinical environments such as hospitals and Emergency Departments, centred around the concept of the ‘Teachable Moment’: that children may be more receptive or amenable to behaviour change after sustaining an injury. The strengths and weaknesses of interventions that apply this model were identified, which may inform potential interventions pertaining to off-road crashes. The review found that multi-modal approaches combining face-to-face counselling or teaching, supplemented with other forms of written or visual communication, often paired with the provision of safety equipment and accurate monitoring as the most effective means of intervention. However, injury prevention programs are often limited by short-term and largely self-reported outcome measures, so research and programs applying these findings to off-road vehicle riders should be designed with robust design methods and appropriate measures of behaviour change, knowledge gain or injury reduction. Conclusion The results of the project overall demonstrate that off-road vehicle injuries are a large and important cause of injury, disability and death for Australian children. An overarching theme of this project is to demonstrate that children who participate in off-road riding are a unique and vulnerable population. Riding patterns are largely recreational, and the resultant injuries are common, spanning the spectrum of severity. Factors associated with worse injury outcomes and recidivism are explored, which, along with the review of injury prevention countermeasures delivered in clinical settings, may help re-prioritise and target injury prevention resources and research. Ultimately the goal of this project, as with any injury research, is to try to prevent or mitigate the severity off-road crashes. The studies investigate various aspects of paediatric off-road riding and provide important foundational knowledge for researchers and clinicians to work towards real-world applications and interventions

Safety (Basel)

Side-by-side (SxS) vehicles have become increasingly popular, but there are few reports on injury epidemiology. Newspaper reports of SxS and all-terrain vehicle (ATV) crashes were analyzed for nine U.S. states from 2009 to 2011, including comparisons between the two vehicle types. Seventy-nine SxS crashes involving 104 injured victims were identified; three-fourths were males. There was a relatively high percentage of injured passengers (37%), and a higher proportion of female victims were passengers as compared to males (p = 0.015). Children <16 years of age were 44% of those injured and had the highest proportion of both passenger and operator victims as compared to other age groups. Over half of the crashes occurred on roadways; nearly two-fifths occurred at night. As compared to adults, a lower percentage of crashes involving youth were at night (p = 0.0037) but the percentages on roadways were similar. Only one in five roadway SxS crashes involved a collision with a motorized vehicle. Rollovers were the most common mechanism (50%). Two-thirds of victims were ejected, and one-half were struck or pinned by the vehicle. Twenty-eight deaths (27%) were reported. Although most current SxSs have roll bars, lack of safety belt use has likely reduced their benefit. Children should be prohibited from operating SxSs.20162022-08-16T00:00:00ZU54 OH007548/OH/NIOSH CDC HHSUnited States/35979514PMC93804331183

ATV Safety Training: It\u27s a Valuable Tool for Everyone!

All-Terrain Vehicles (ATVs) are fun to ride but they are only a machine. As much as everyone would like to blame the ATV when things go wrong, the end result ultimately stems from the operator’s actions. It doesn’t have a brain, it does what you tell it to do, and it cannot tell the operator that this is a bad idea or what the consequences might be. These thoughts are ultimately the operator’s responsibility to assess and acknowledge what risks exist. Driving is a skill and education is a key portion of ATV safety training. Our current requirements are not regulated to be the same across the nation, creating complicated and miss-matched rules that vary from one state to the next. If knowledge is power and experience takes practice than ATV safety training could be the difference between life and death. In this study, there were 447 fatalities reported in Minnesota and Wisconsin during 2007-2020 that were attributed to ATVs but only 6% of these individuals had ATV safety training. Adults in the sample represented a whopping 82.7% of the population and our current system is providing a perpetually failing protective system that continuously provides our citizens with an educational injustice that is on the border of being negligent. It is time that we work together to fix this by requiring all ATV operators to take an ATV safety training class that teaches the same fundamental material, regardless of their age or experience level. This training is a valuable tool in reducing and preventing injuries or deaths and age should never be used as the defining characteristic that decides if safety education is necessary because age will never be a reliable indicator of experience on these machines, contrary to popular belief

Hard hitting facts on childhood head trauma: an epidemiological analysis

Background: According to the World Health Organization (WHO), Traumatic Brain Injury (TBI) will become the third largest cause of global disease by the year 2020. Despite its astonishing numbers, TBI remains a silent or even forgotten epidemic with significant paucity in epidemiological data. TBI in developing countries represents a disproportionate burden of disease and data are lacking regarding the unique demographics in South Africa to design and implement focused prevention programmes. A valuable tool to assess the severity of TBI is the use of Computer tomography (CT). CT also is the main imaging modality to provide rapid identification and information for the management of children with TBI. CT scanning utilises ionising radiation and as an imaging modality poses risk to the patient. In order to guide decision protocol/algorithm, various Clinical Decision Rules (CDRs) have been established in High Income Countries. These protocols, including the need for CT scan might differ in a Medium/Low Income setting. Methodology: This is a prospective, single centre cohort study. Data were collected over an 18-month period (1 August 2015 - 31 January 2017). Children under the age of 13 years (n=3007) presenting to RCWCH after sustaining a head injury were included. Various epidemiological data were collected. A Road Safety Questionnaire was also used to evaluate safety knowledge of health care workers. Three different CDRs were compared to the standard of practice in RCWCH. A final analysis of demographics, mechanism of injury, radiology outcome, safety analysis and evaluation of a comparison of local protocol compared to the other CDRs was performed using descriptive statistics. Results: The mean age of paediatric patients presenting after a head injury was 4.6 years. There was a significant male predominance (66%) and almost two thirds of all children were of pre-school age. Falls (53%; n=1601) represented the most common mechanism of injury across all age groups, followed by road traffic related injuries (RTI) (29%; n=864), struck by or against an object (9%; n=279) and injuries as a result of interpersonal violence (8%; n=230). Within the subset of RTI (n=864) only 6 passengers were appropriately restrained, with 142 unrestrained and 56 passengers transported on the back of a goods vehicle. In the under 3-yearold age group, only 1 patient was appropriately transported in a car seat, with 51 unrestrained and 6 transported on the back of a goods vehicle. Pedestrian related injuries were by far the largest group of RTI (70%) with 50% of these under the age of 5 years. Intentional injuries inflicted by an adult were most common (34%) in the pre-verbal (under 2 years old) group. Interpersonal violence among minors (assault with a brick or stone) constituted 52% of intentional injuries. Eight firearm related injuries were recorded. Appliances and iron gates that were not correctly installed were additional causes of injury. CT scans were obtained according to the RCWCH protocol in 59% of cases and 34% showed an abnormal result. The sensitivity (98%) and specificity (93%) while using the standard of practice protocol was better than the 3 CDRs developed in High Income Countries. Analysing our Road Safety Questionnaire there appears great room for improvement regarding awareness of road safety guidelines and legislation. Conclusion: The performance of the current RCWCH CT scan protocol appears appropriate in our setting although there is some room for improvement using the strengths of the other CDRs. Valuable insight regarding the epidemiology of TBI in our setting has been highlighted. Of specific importance is the large proportion of very young children at risk of injury by all mechanisms of injury, particularly pedestrian-related injuries, unrestrained passengers and interpersonal violence among minors. Important gaps in knowledge about current recommendations for road safety were identified by the questionnaire. As long as these issues are not appropriately addressed through enhanced injury prevention programmes, children will continue to carry the heavy burden of TBI morbidity and mortality

Methodische Ansätze zur Analyse biomechanischer Zeitreihendaten

Die vorliegende Dissertation beschäftigt sich mit der Frage inwiefern der Einsatz von Zeitreihenmethoden - also Methoden, die den kontinuierlichen Charakter biomechanischer Zeitreihendaten berücksichtigen - einen aus methodischer Sicht günstigeren Auswertungsansatz darstellt als herkömmliche, diskrete Methoden. Damit liefert die Arbeit einen wichtigen Beitrag zur Überwindung der postulierten Konfidenzkrise biomechanisch-bewegungswissenschaftlicher Forschung, nach der sich die Ergebnisse vieler Studien aufgrund u. a. methodischer Defizite nicht oder nur eingeschränkt reproduzieren lassen. Dabei konnte in drei Teilstudien für verschiedene methodische Bereiche (Inferenzstatistik, Klassifikation, Trenderkennung) gezeigt werden, dass der Einsatz von Zeitreihenmethoden bekannte Probleme diskreter Methoden erfolgreich addressieren kann. Die vorgestellte Arbeit regt über das spezifische Thema hinaus zu einem kritischeren Umgang mit methodischen Aspekten an und zeigt mögliche Lösungsansätze auf

April 15, 2010

The Breeze is the student newspaper of James Madison University in Harrisonburg, Virginia

A Case Study on Examining Systemic African American Poverty in Caddo Parish and Bossier Parish, Louisiana

There are many states, counties, and cities in the United States of America where people do not have access to basic necessities such as food, housing, proper medical facilities, access to schools, and ready or no transportation, etc. The reason for this situation is due to the issue of poverty. Poverty is an unacceptably low-standard way of life that is a complex human phenomenon. It has multiple causes, manifestations, and dimensions. (Odhiambo, Omiti, Muthaka, 2005) Caddo Parish, Louisiana, is such a place that has high poverty among Black people. The population of African American people in Caddo Parish is larger than the Whites who live there, and African American poverty has more than doubled the White residents. African American poverty in Caddo Parish is higher than the poverty average in the State of Louisiana and is higher than the United States average. The neighboring parish of Bossier is experiencing the same issue as the African Americans in Caddo Parish. Caddo and Bossier Parishes connect by their two largest cities in the parishes, which is named the Shreveport-Bossier City Metropolitan area. Both cities’ poverty level amongst Black people is higher than the United States National Average. This case study explores and argues how systemic racism has blended into urbanization, sprawl, and politics. The research explores how these factors cause poverty in the Black community and has plagued their progress from the colonization of Louisiana through the American Civil War to the present time in Caddo Parish, Louisiana. Dr. Robert Bullard mentions that “racism is and continues to be a conspicuous part of the American sociopolitical system. As a result, Black people in particular, and ethnic and racial minority groups of color, find themselves at a disadvantage in contemporary society. (Bullard, 1994, p. 445) The factor of poverty has caused population change in Shreveport and Bossier City. Shreveport has seen a population decline, whereas Bossier has seen an increase in population. However, Caddo Parish still has a larger population. (Bayliss, 2019) African American homeownership is low considering the heavy populations of these people in the Shreveport-Bossier City area and is disproportionate to the White residents. This study will examine housing discrimination in these areas because housing discrimination denies a substantial segment of the African American community a basic form of wealth accumulation and investment through homeownership. (Bullard, Johnson, Torres, 2000) There are development plans to make the area a more attractive and dynamic location for corporate investments, expansions, and expansion for the future Shreveport-Bossier area. This development attempts to modernize the metropolitan areas’ environmental sustainability, neighborhoods, housing stock, infrastructure, and transportation. Further considerations include aiding with workforce training and business attraction through local organizations and the city’s programs. Eliminating cost-burdened, extremely cost-burdened residences and improving housing conditions for residents with housing maintenance issues are major concerns. The purpose of this case study is to shed light on the history of racism, bad politics, sprawl, spatial mismatch, lack of homeownership, population trends, transportation issues, lack of employment opportunities, high crime, bank deserts, health care, present Jim Crow Laws, and the miseducation of African Americans in Louisiana as these factors play on their social and economic place in Northwest Louisiana. The researcher will use qualitative research to answer questions with spatial and statistical analysis to provide visuals of the data collected on the census tracts. There will be some quantitative information within the qualitative findings. There will be some quantitative information within the qualitative findings. Researchers use qualitative research with some quantitative results because they consider both methods extremely effective for poverty analysis and give a more holistic view to a given study. (Odhiambo, Omiti, Muthaka, 2005) The purpose of this dissertation is to research and understand African American poverty in Caddo Parish, how they ended up in this predicament, and present solutions to rectify the situation. The adverse effects of Urbanization and Sprawl result in poverty. These harmful effects, including the study area, are frequently seen in the African American/Black community. Negative effects of urbanization can be a lack of resources, poverty, unemployment, and overcrowding. Furthermore, the migration from rural areas to metropolitan areas causes congestion that impedes growth and bolsters the negative issues from geographically concentrated poverty, such as crime and violence in Shreveport, LA. This study highlights Poverty, Education, Unemployment, Homeownership, and Renters and contrasts and compares variables in Caddo Parish to Bossier Parish with Black versus White residents with GIS Mapping. The GIS Mapping shows the disproportionate percentages in each factor for the Black population versus the White Population for both Caddo Parish and Bossier Parish, Louisiana. The project distinctively shows (1) inequity and inequality in homeownership, (2) The poor education and miseducation in the Louisiana school system, (3) How incarceration ratios are disproportionate, (4) The lack of employment opportunities in the area, (5) Inequity in public and personal transportation. Furthermore, the results show the negative effects of Black versus White birth rates, IRS inequalities, health care inequalities, and how the factors mentioned in this study are blended in racism, which have kept Blacks in poverty in Caddo Parish and Bossier Parish from the colonization of Louisiana to the last 30 years. Lastly, this study presents mapping, snapshots, and negative effects of food deserts, banking deserts, pay-day loan companies, eye-soar neighborhoods, non-walkable and non-bikeable communities, and lack of enough medical facilities in predominately Black neighborhoods in the study area. Despite the Civil Rights Movement and other Justice Movements, there are still disparities in wealth, employment, health care, education, laws, housing, transportation, poverty, and other factors. To bring change, urban planners and/or environmental justice activists must work diligently to overcome and subdue obstacles to create Smart Growth, Cleaner, Greener Communities, and Sustainable Communities while simultaneously promoting equality and eliminating inequities

Small Electric Vehicles

This edited open access book gives a comprehensive overview of small and lightweight electric three- and four-wheel vehicles with an international scope. The present status of small electric vehicle (SEV) technologies, the market situation and main hindering factors for market success as well as options to attain a higher market share including new mobility concepts are highlighted. An increased usage of SEVs can have different impacts which are highlighted in the book in regard to sustainable transport, congestion, electric grid and transport-related potentials. To underline the effects these vehicles can have in urban areas or rural areas, several case studies are presented covering outcomes of pilot projects and studies in Europe. A study of the operation and usage in the Global South extends the scope to a global scale. Furthermore, several concept studies and vehicle concepts on the market give a more detailed overview and show the deployment in different applications

Small Electric Vehicles

This edited open access book gives a comprehensive overview of small and lightweight electric three- and four-wheel vehicles with an international scope. The present status of small electric vehicle (SEV) technologies, the market situation and main hindering factors for market success as well as options to attain a higher market share including new mobility concepts are highlighted. An increased usage of SEVs can have different impacts which are highlighted in the book in regard to sustainable transport, congestion, electric grid and transport-related potentials. To underline the effects these vehicles can have in urban areas or rural areas, several case studies are presented covering outcomes of pilot projects and studies in Europe. A study of the operation and usage in the Global South extends the scope to a global scale. Furthermore, several concept studies and vehicle concepts on the market give a more detailed overview and show the deployment in different applications