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As autonomous driving advances, autonomous vehicles will share the road with human drivers. This requires autonomous vehicles to adhere to human traffic laws under safe conditions. Simultaneously, when confronted with dangerous situations, autonomous driving should also possess the capability to deviate from traffic laws to ensure safety. However, current autonomous vehicles primarily prioritize safety and collision avoidance in their decision-making and planning. This may lead to misunderstandings and distrust from human drivers in mixed traffic flow, and even accidents. To address this, this paper proposes a decoupled hierarchical framework for compliance safety decision-making. The framework primarily consists of two layers: the decision-making layer and the motion planning layer. In the decision-making layer, a candidate behavior set is constructed based on the scenario, and a dual layer admission assessment is utilized to filter out unsafe and non-compliant behaviors from the candidate sets. Subsequently, the optimal behavior is selected as the decision behavior according to the designed evaluation metrics. The decision-making layer ensures that the vehicle can meet lane safety requirements and comply with static traffic laws. In the motion planning layer, the surrounding vehicles and the road are modeled as safety potential fields and traffic laws potential fields. Combining the optimal decision behavior, they are incorporated into the cost function of the model predictive control to achieve compliant and safe trajectory planning. The planning layer ensures that the vehicle meets trajectory safety requirements and complies with dynamic traffic laws under safe conditions. Finally, four typical scenarios are used to evaluate the effectiveness of the proposed method. The results indicate that the proposed method can ensure compliance in safe conditions while also temporarily deviating from traffic laws in emergency situations to ensure safety., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024. Published by Elsevier Ltd.)

German driving licence law takes a reactive approach to dealing with suitability deficiencies of senior citizens. If the driver is no longer fit to drive and nevertheless participates in traffic, an administrative offence has been committed. If this endangers or injures other people or causes significant damage to property, it may even be a criminal offence. In addition to prosecuting these offences, the driving licence authority may restrict or even withdraw the licence issued. In this respect, senior citizens have a high degree of personal responsibility when assessing their fitness to drive. This article presents the current driving license law and discusses the need for changes.Legally, various corrections are required to the current Driving Licence Ordinance and its annexes. At present, there is no clear regulation regarding the general reduction in performance in old age for an event-related assessment of fitness to drive. In addition, in the event of doubts about fitness to drive, the driving licence authority should be expressly granted the power to order standardised driving tests. Furthermore, the legislator must take preventive measures to ensure road safety. He must no longer ignore the current accident situation. In view of the fact that senior citizens aged 75 and over are disproportionately involved in traffic accidents with personal injury in terms of their culpable behaviour, it is important to impose moderate restrictions on the personal responsibility of driving licence holders. This is especially true for sensory abilities, which are particularly important in road traffic. Seniors should therefore be required to undergo eye tests from the age of 75. From this age onwards, it also seems sensible to introduce compulsory advice on fitness to drive, preferably from your family doctor., (© 2024. Springer-Verlag GmbH Deutschland, ein Teil von Springer Nature.)

Background: The recent Lancet Commission on Legal Determinants of Global Health argues that governance can provide the framework for achieving sustainable development goals. Even though over 90% of fatal road traffic injuries occur in low- and middle-income countries (LMICs) primarily affecting motorcyclists, the utility of helmet laws outside of high-income settings has not been well characterized. We sought to evaluate the differences in outcomes of mandatory motorcycle helmet legislation and determine whether these varied across country income levels., Methods and Findings: A systematic review and meta-analysis were completed using the PRISMA checklist. A search for relevant articles was conducted using the PubMed, Embase, and Web of Science databases from January 1, 1990 to August 8, 2021. Studies were included if they evaluated helmet usage, mortality from motorcycle crash, or traumatic brain injury (TBI) incidence, with and without enactment of a mandatory helmet law as the intervention. The Newcastle-Ottawa Scale (NOS) was used to rate study quality and funnel plots, and Begg's and Egger's tests were used to assess for small study bias. Pooled odds ratios (ORs) and their 95% confidence intervals (CIs) were stratified by high-income countries (HICs) versus LMICs using the random-effects model. Twenty-five articles were included in the final analysis encompassing a total study population of 31,949,418 people. There were 17 retrospective cohort studies, 2 prospective cohort studies, 1 case-control study, and 5 pre-post design studies. There were 16 studies from HICs and 9 from LMICs. The median NOS score was 6 with a range of 4 to 9. All studies demonstrated higher odds of helmet usage after implementation of helmet law; however, the results were statistically significantly greater in HICs (OR: 53.5; 95% CI: 28.4; 100.7) than in LMICs (OR: 4.82; 95% CI: 3.58; 6.49), p-value comparing both strata < 0.0001. There were significantly lower odds of motorcycle fatalities after enactment of helmet legislation (OR: 0.71; 95% CI: 0.61; 0.83) with no significant difference by income classification, p-value: 0.27. Odds of TBI were statistically significantly lower in HICs (OR: 0.61, 95% CI 0.54 to 0.69) than in LMICs (0.79, 95% CI 0.72 to 0.86) after enactment of law (p-value: 0.0001). Limitations of this study include variability in the methodologies and data sources in the studies included in the meta-analysis as well as the lack of available literature from the lowest income countries or from the African WHO region, in which helmet laws are least commonly present., Conclusions: In this study, we observed that mandatory helmet laws had substantial public health benefits in all income contexts, but some outcomes were diminished in LMIC settings where additional measures such as public education and law enforcement might play critical roles., Competing Interests: The authors have declared that no competing interests exist.

Purpose: To determine the trends with fatally or otherwise injured pedestrians lying on the road and the relationship to hit-and-run incidents in Japan., Methods: We extracted data for 2012-2016 from the records of the Institute for Traffic Accident Research and Data Analysis, Japan, a nationwide traffic accident database. All the injured and fatally injured pedestrians were selected. We examined the levels of pedestrian injury, vehicle speed immediately before the collision, whether or not the pedestrian was lying on the road, and hit-and-run incidents. Chi-square test was employed to make a statistical comparison between the two groups., Results: The database contained data on 286,383 pedestrian casualties and 7256 fatalities; 8.3% of fatalities (602 persons) and 0.6% of casualties (1827 persons) involved pedestrians lying on the road. The rates of fatalities and severe injuries were significantly higher for pedestrians who were lying on the road than for those who were not. Hit-and-run incidents were evident in 4.0% of casualties and 7.3% of fatalities. The rate of hit-and-run cases was also significantly higher among pedestrians who were lying on the road. Among fatally injured pedestrians not lying on the road, the rates with speeds of ≥30 km/h did not differ significantly between hit-and-run and other cases. However, when the pedestrians were lying on the road, the rate was significantly increased in hit-and-run cases., Conclusion: This is the first report to focus on pedestrians lying on the road and being involved in hit-and-run incidents. In addition to preventing hit-and-run incidents, prevention of pedestrians lying on the road could also decrease fatalities., Competing Interests: Declaration of competing interest The authors declare that they have no conflicts of interest., (Copyright © 2020 Chinese Medical Association. Production and hosting by Elsevier B.V. All rights reserved.)

Background: Cell phone use while driving (CPWD) increases the risk of crashing and is a major contributor to injuries and deaths. The objective of this study was to describe the evaluation of a multifaceted, evidence-based population health strategy for the reduction of distracted driving., Methods: A multipronged campaign was undertaken from 2014 to 2016 for 16- to 44-year-olds, based on epidemiology, focused on personal stories and consequences, using the "Es" of injury prevention (epidemiology, education, environment, enforcement, and evaluation). Education consisted of distracted driving videos, informational cards, a social media AdTube campaign, and a movie theater trailer, which were evaluated with a questionnaire regarding CPWD attitudes, opinions, and behaviors. Spatial analysis of data within a geographic information system was used to target advertisements. A random sample telephone survey evaluated public awareness of the campaign. Increased CPWD enforcement was undertaken by police services and evaluated by ARIMA time series modeling., Results: The AdTube campaign had a view rate of >10% (41,101 views), slightly higher for females. The top performing age group was 18- to 24-year-olds (49%). Our survey found 61% of respondents used handheld CPWD (14% all of the time) with 80% reporting our movie trailer made them think twice about future CPWD. A stakeholder survey and spatial analysis targeted our advertisements in areas of close proximity to high schools, universities, near intersections with previous motor vehicle collisions, high traffic volumes, and population density. A telephone survey revealed that 41% of the respondents were aware of our campaign, 17% from our print and movie theater ads and 3% from social media. Police enforcement campaign blitzes resulted in 160 tickets for CPWD. Following campaign implementation, there was a statistically significant mean decrease of 462 distracted driving citations annually (p = 0.001)., Conclusion: A multifaceted, evidence-based population health strategy using the Es of injury prevention with interdisciplinary collaboration is a comprehensive method to be used for the reduction of distracted driving., Level of Evidence: Therapeutic, level IV., (Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.)

Purpose: This research examined road traffic injury mortality and morbidity disparities across of country development status, and discussed the possibility of reducing country disparities by various actions to accelerate the pace of achieving Sustainable Development Goals target 3.6 - to halve the number of global deaths and injuries from road traffic accidents by 2020., Methods: Data for road traffic mortality, morbidity, and socio-demographic index (SDI) were extracted by country from the estimates of the Global Burden of Disease study, and the implementation of the three types of national actions (legislation, prioritized vehicle safety standards, and trauma-related post-crash care service) were extracted from the Global Status Report on Road Safety by World Health Organization. We fitted joinpoint regression analysis to identify and quantify the significant rate changes from 2011 to 2017., Results: Age-adjusted road traffic mortality decreased substantially for all the five SDI categories from 2011 to 2017 (by 7.52%-16.08%). Age-adjusted road traffic mortality decreased significantly as SDI increased in the study time period, while age-adjusted morbidity generally increased as SDI increased. Subgroup analysis by road user yielded similar results, but with two major differences during the study period of 2011 to 2017: (1) pedestrians in the high SDI countries experienced the lowest mortality (1.68-1.90 per 100,000 population) and morbidity (110.45-112.72 per 100,000 population for incidence and 487.48-491.24 per 100,000 population for prevalence), and (2) motor vehicle occupants in the high SDI countries had the lowest mortality (4.07-4.50 per 100,000 population) but the highest morbidity (428.74-467.78 per 100,000 population for incidence and 1025.70-1116.60 per 100,000 population for prevalence). Implementation of the three types of national actions remained nearly unchanged in all five SDI categories from 2011 to 2017 and was consistently stronger in the higher SDI countries than in the lower SDI countries. Lower income nations comprise the heaviest burden of global road traffic injuries and deaths., Conclusion: Global road traffic deaths would decrease substantially if the large mortality disparities across country development status were reduced through full implementation of proven national actions including legislation and law enforcement, prioritized vehicle safety standards and trauma-related post-crash care services., Competing Interests: Declaration of competing interest The authors declare that they have no conflicts of interest., (Copyright © 2021. Production and hosting by Elsevier B.V.)

Introduction: International drink-driving policy research generally focuses on aggregate outcomes (e.g., rates of crashes, fatalities) without emphasizing secondhand alcohol-related vehicular harms. In contrast, we investigate associations between drink-driving policies and harms involving another driver's impairment., Methods: Alcohol's harms to others (AHTO) survey data from 12 countries (analytic N = 29,616) were linked to national alcohol policy data from the World Health Organization. We examined separately associations of two 12-month driving-related AHTOs (passenger with an impaired driver; vehicular crash involving someone else's drink driving) with 3 national drinking-driving policies-legal blood alcohol concentration (BAC) limits, use of random breath testing, use of sobriety checkpoints, and comprehensive penalties for drink-driving (community service, detention, fines, ignition interlocks, license suspension/revocation, mandatory alcohol treatment, vehicle impoundment, and penalty point system), plus 2 alcohol tax variables (having excise taxes and value-added tax [VAT] rate). Multilevel logistic regression addressed clustering of individuals within countries and subnational regions, while adjusting for individuals' gender, age, marital status, risky drinking, and regional drinking culture (% male risky drinkers in sub-national region)., Results: Controlling for national-, regional-, and individual-level covariates, comprehensive penalties were significantly and negatively associated with both outcomes; other vehicular policy variables were not significantly associated with either outcome. A society's VAT rate was negatively associated with riding with a drunk driver. Regional male drinking culture was positively associated with riding with an impaired driver, but was not significantly associated with being in a vehicular crash due to someone else's drinking. In both models, being male, being younger, and engaging in risky drinking oneself each were positively associated with vehicular harms due to someone else's drinking., Conclusions: Although results are associational and not causal, comprehensive penalties may be promising policies for mitigating driving-related harms due to another drinker. Higher VAT rate might reduce riding with a drunk driver., (© 2020 by the Research Society on Alcoholism.)

Between March and May 2020, Japan experienced a lockdown due to the COVID-19 crisis. Empty roads possibly triggered speed-related traffic violations that caused fatal motor vehicle collisions (MVCs). Using police data on the monthly number of fatal MVCs between January 2010 and February 2020 in which motor vehicle drivers were at fault, we forecasted the numbers of fatal MVCs due to the speed-related violations during the lockdown and compared these with those observed. We also compared the observed to forecasted using the ratio of the number of speed-related fatal MVCs to that of non-speed related fatal MVCs. The observed numbers of speed-related fatal MVCs were within the 95% CIs of the forecasted numbers. The observed ratio was higher than the forecasted ratio in April (p=0.016). In the second month of the lockdown, drivers were more likely to commit speed-related violations that caused fatal MVCs than before the lockdown., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2021. No commercial re-use. See rights and permissions. Published by BMJ.)

Objective: This study investigated the effect of keg registration laws on alcohol consumption and alcohol-related traffic fatalities in the United States., Method: The 1993-2013 data from Youth Risk Behavior Surveillance System (n = 107,480) and Fatality Analysis Reporting System (n = 12,102) and difference-in-differences type models were used to estimate the effect of keg registration laws on different indicators of alcohol consumption and alcohol-related traffic fatalities among underage youth., Results: Introduction of keg registration laws was associated with a 2.3 percentage point reduction (p < .01) in heavy episodic drinking among minors. The significant effects of these laws were mainly driven by the states with relatively strict keg registration laws. However, these laws did not have a significant impact on alcohol-related traffic fatalities among underage youth. These results were robust under alternative model specifications., Conclusions: We found that keg registration laws are effective in reducing heavy episodic drinking among underage youth. This result is important given that an increasing number of states have adopted keg registration laws in recent years, yet the empirical evidence of the effectiveness of this policy is quite limited.

Background: Traumatic brain injury (TBI) constitutes a major health and socioeconomic problem worldwide. It represents the greatest contribution to death and disability among all trauma-related injuries globally. TBIs are a leading cause of death and disability in Nepal, despite improvements in safety regulations and implementation of strict drunk driving laws. We describe the epidemiology of patients with TBI following admission to our hospital. We discuss the implementation of specific strategies to reduce its incidence., Methods: We conducted a retrospective cross-sectional study of patients presenting to Annapurna Neurological Institute & Allied Sciences (ANIAS), Kathmandu, with a TBI between September 2018 to September 2019., Results: One-hundred and sixty-seven patients presented with a TBI. The most common age groups were younger than 15 years old and 15-25 years old, and the majority were male (73%). The commonest cause of TBI was road traffic accidents (RTA) (59%). Drivers riding motorcycles were the predominant mechanism of RTA (38%). Helmet use was seen in 57% of patients riding 2-wheelers. Alcohol consumption was reported in 22% of all patients. Skull fractures were the most common diagnosis. Most patients were managed conservatively (84%)., Conclusions: TBI should be recognized as an important public health problem in Nepal. TBI is responsible for a considerable number of neurosurgical admissions to ANIAS. Our study showed patients most vulnerable to TBI are males younger than 25 years old. The implementation of stricter traffic rules and regulations, helmet law enforcement, and public education programs may be helpful in decreasing the number of TBI., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Fatalities and injuries resulting from road traffic crashes is always a serious problem. The overall economic losses caused by road traffic crashes are beyond imagination. Including the economic cost of property damage, productivity loss, medical cost, travel delay time cost, legal cost and insurance cost, the total economic cost of traffic crashes in China in 2017 is calculated as 490.1 billion yuan (72.6 billion USD 2017), which is equivalent to 0.60% of the GDP. The cost of productivity loss accounts for the highest proportion of total economic cost, which is 72%. The second is the travel delay cost, accounting for 12% insurance cost, property damage cost and medical cost are followed. The more serious the injury, the higher the unit economic cost. The unit cost of a crash that caused only property damage is 11,274 yuan. The unit cost of a minor injured crash is 20,223 yuan. The highest unit economic cost is the unit cost of a fatal crash, which is 3,181,394 yuan. This study provides important insights into the cost-benefit analysis of China's road safety policies.

Background: It is estimated that more than 270 000 people die yearly in alcohol-related crashes globally. To tackle this burden, government interventions, such as laws which restrict blood alcohol concentration (BAC) levels and increase penalties for drunk drivers, have been implemented. The introduction of private-sector measures, such as ridesharing, is regarded as alternatives to reduce drunk driving and related sequelae. However, it is unclear whether state and private efforts complement each other to reduce this public health challenge., Methods: We conducted interrupted time-series analyses using weekly alcohol-related traffic fatalities and injuries per 1 000 000 population in three urban conglomerates (Santiago, Valparaíso and Concepción) in Chile for the period 2010-2017. We selected cities in which two state interventions-the 'zero tolerance law' (ZTL), which decreased BAC, and the 'Emilia law' (EL), which increased penalties for drunk drivers-were implemented to decrease alcohol-related crashes, and where Uber ridesharing was launched., Results: In Santiago, the ZTL was associated with a 29.1% decrease (95% CI 1.2 to 70.2), the EL with a 41.0% decrease (95% CI 5.5 to 93.2) and Uber with a non-significant 28.0% decrease (95% CI -6.4 to 78.5) in the level of weekly alcohol-related traffic fatalities and injuries per 1 000 000 population series. In Concepción, the EL was associated with a 28.9% reduction (95% CI 4.3 to 62.7) in the level of the same outcome. In Valparaíso, the ZTL had a -0.01 decrease (95% CI -0.02 to -0.00) in the trend of weekly alcohol-related crashes per 1 000 000 population series., Conclusion: In Chile, concomitant decreases of alcohol-related crashes were observed after two state interventions were implemented but not with the introduction of Uber. Relationships between public policy interventions, ridesharing and motor vehicle alcohol-related crashes differ between cities and over time, which might reflect differences in specific local characteristics., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: Motor vehicle crashes (MVCs) continue to be the leading cause of death in youth 16 to 24 years old in the United States. Distracted driving has been shown to increase the risk of MVCs in all drivers, particularly teenagers. We aimed to determine the association between fatal MVC rates involving 16- to 19-year-old drivers and state distracted driving laws., Methods: We conducted a retrospective time series analysis of fatal MVCs in the United States involving drivers and passengers 16 to 19 years old from 2007 to 2017 using the Fatality Analysis Reporting System. Multivariable negative binomial regression analysis was performed to compare MVC rates across states on the basis of different types and strengths of distracted driving laws., Results: There were 38 215 drivers 16 to 19 years old involved in fatal MVCs from 2007 to 2017. Incidence of fatal MVCs was highest for 19-year-old drivers (27.2 out of 100 000 19-year-old persons) and lowest for 16-year-olds (10.7 out of 100 000). States with primarily enforced texting bans had lower MVC fatality rates overall involving 16- to 19-year-old drivers (adjusted incidence rate ratio: 0.71; 95% confidence interval: 0.67-0.76). Texting bans and handheld bans for all drivers were associated with decreased MVC fatalities in all age groups., Conclusions: In the United States, primarily enforced distracted driving laws are associated with a lower incidence of fatal MVCs involving 16- to 19-year-old drivers. Bans on all handheld device use and texting bans for all drivers are associated with the greatest decrease in fatal MVCs. Adoption of universal handheld cellphone bans in all states may reduce the incidence of distracted driving and decrease MVC fatalities., Competing Interests: POTENTIAL CONFLICT OF INTEREST: The authors have indicated they have no potential conflicts of interest to disclose., (Copyright © 2020 by the American Academy of Pediatrics.)

Objective: Identifiable individual-level driver licensing and motor vehicle crash data are essential to advancing transportation safety research. However, epidemiologic studies using such data are rare, which may reflect their inaccessibility. We conducted a legal mapping study to evaluate US state laws regulating access to driver licensing and motor vehicle crash data for use in scientific research., Methods: Legal statutes regulating the release of driver licensing and motor vehicle crash data for all 50 US states and the District of Columbia (D.C.) were retrieved. Legal text was evaluated to determine whether these jurisdictions authorize release of identifiable individual-level licensing and crash data for use in non-governmental research., Results: Thirty-six states and D.C. explicitly authorize release of identifiable individual-level licensing data to researchers. Only five states and D.C. authorize release of identifiable individual-level crash records. No states explicitly prohibit the release of individual-level data about licensing records and only three states prohibit release of individual-level crash record data, meaning that in many states it is ambiguous whether and when releasing such data to researchers is permitted., Conclusions: It is important to understand why licensing data are not used more frequently in transportation safety research given that many state laws permit access for non-governmental researchers. Reforming state laws to clarify and increase access to identifiable individual-level crash report data is an important priority for transportation safety advocates and researchers., Competing Interests: Declaration of Competing Interest None., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

Injury compensation claimants use legal services to help them navigate compensation schemes, including accessing benefits and resolving disputes. Little is known, however, about the extent of lawyer use by compensation claimants, including changes over time. This paper presents findings from one of the largest empirical investigations of lawyer use in an injury compensation setting to date. Using evidence from more than 275,000 claims in the road traffic injury scheme in the state of Victoria, Australia, this study examines the prevalence of, and changes in, lawyer use between 2000 and 2015. The analysis identifies a significant increase in the use of lawyers in the scheme, and explores possible explanations. This study provides critical insights into lawyer use in compensation settings: the steep increase in lawyer involvement has both access to justice and financial implications for compensation schemes, given the associations between lawyer use, claimant outcomes, and long-term scheme viability., Competing Interests: The authors have declared that no competing interests exist.

Introduction: This study aimed to evaluate the impact of the helmet law on the changes in potential years of life lost (PYLL) due to traffic mortality and to examine modification effects of socioeconomic factors on the impacts in Vietnam., Methods: We applied an interrupted time series design using the Bayesian framework to estimate the impact of the law at the provincial level. Then, we used random effects meta-analysis to estimate the impact of the law at the country level and to examine the modification effects of socioeconomic factors., Results: The results indicate that the impacts varied among the provinces. These impacts could be classified by four main groups comprising positive impact, and positive impact without sustainability, possible positive impact, negative or inconsistent impact. For the country-level impact, the results reveal a significantly consistent change in monthly PYLLs at the level of 18 per 100 000 persons, and the post-trend was stable without significant change. The results of meta-regression show that 1 unit increase in the population density (persons/km 2 ), migration rate (%) and income (×1000 dong) are non-significantly associated with increases of PYLLs at 1.3, 27 and 27 per 100 000 person-months, respectively, whereas 1% increase in literacy associated with a decrease of PYLL at 44 per 100 000 person-months., Discussion: Further studies should be warranted to provide a comprehensive evaluation of the law implementation, including its acceptability, adoption, appropriateness, feasibility, cost-effectiveness and sustainability., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2020. No commercial re-use. See rights and permissions. Published by BMJ.)

Introduction: The majority of Thailand's road traffic deaths occur on motorised two-wheeled or three-wheeled vehicles. Accurately measuring helmet use is important for the evaluation of new legislation and enforcement. Current methods for estimating helmet use involve roadside observation or surveillance of police and hospital records, both of which are time-consuming and costly. Our objective was to develop a novel method of estimating motorcycle helmet use., Methods: Using Google Maps, 3000 intersections in Bangkok were selected at random. At each intersection, hyperlinks of four images 90° apart were extracted. These 12 000 images were processed in Amazon Mechanical Turk using crowdsourcing to identify images containing motorcycles. The remaining images were sorted manually to determine helmet use., Results: After processing, 462 unique motorcycle drivers were analysed. The overall helmet wearing rate was 66.7 % (95% CI 62.6 % to 71.0 %). Taxi drivers had higher helmet use, 88.4% (95% CI 78.4% to 94.9%), compared with non-taxi drivers, 62.8% (95% CI 57.9% to 67.6%). Helmet use on non-residential roads, 85.2% (95% CI 78.1 % to 90.7%), was higher compared with residential roads, 58.5% (95% CI 52.8% to 64.1%). Using logistic regression, the odds of a taxi driver wearing a helmet compared with a non-taxi driver was significantly increased 1.490 (p<0.01). The odds of helmet use on non-residential roads as compared with residential roads was also increased at 1.389 (p<0.01)., Conclusion: This novel method of estimating helmet use has produced results similar to traditional methods. Applying this technology can reduce time and monetary costs and could be used anywhere street imagery is used. Future directions include automating this process through machine learning., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2020. No commercial re-use. See rights and permissions. Published by BMJ.)

Purpose: Excessive daytime sleepiness (EDS) while driving is a major international public health issue resulting in a more than doubled risk of motor vehicle accidents (MVAs). Obstructive sleep apnea (OSA) is the most frequent medical cause of EDS. Therefore, the European Union Directive 2014/85/EU determined that "untreated moderate to severe OSA coincident with EDS constitutes a medical disorder leading to unfitness to drive." The paper aims are to provide a brief review of sleepiness and its implications for driving safety, as well as to describe the subjective and objective methods to accurately evaluate EDS in order to assess fitness to drive in patients with OSA., Methods: We examined databases including PubMed, Medline, and EMBASE using the search terms "sleepiness at the wheel, excessive daytime sleepiness, sleepiness measure, sleep-wake cycle, obstructive sleep apnea, driving license, fitness to drive.", Results: Significant interindividual variability in EDS exists in patients with comparable severity of OSA. Objective methods of measuring EDS are too expensive and time consuming to be suitable for the certification of driving licenses. The reliability of subjective methods depends upon the clinical setting and subjective tools assess only limited aspects of EDS. Objective measures, such as biochemical biomarkers, must, therefore, support subjective methods., Conclusions: Extensive data have supported different subjective and objective methods for the appraisal of EDS in patients with OSA depending upon the clinical and experimental setting. Challenges remain to determine an appropriate tool for the evaluation of fitness to drive.

When an automated car harms someone, who is blamed by those who hear about it? Here we asked human participants to consider hypothetical cases in which a pedestrian was killed by a car operated under shared control of a primary and a secondary driver and to indicate how blame should be allocated. We find that when only one driver makes an error, that driver is blamed more regardless of whether that driver is a machine or a human. However, when both drivers make errors in cases of human-machine shared-control vehicles, the blame attributed to the machine is reduced. This finding portends a public under-reaction to the malfunctioning artificial intelligence components of automated cars and therefore has a direct policy implication: allowing the de facto standards for shared-control vehicles to be established in courts by the jury system could fail to properly regulate the safety of those vehicles; instead, a top-down scheme (through federal laws) may be called for.

Attributions of fault are often associated with worse injury outcomes; however, the consistency and magnitude of these impacts is not known. This review examined the prognostic role of fault on health, mental health, pain and work outcomes after transport injury. A systematic search of five electronic databases (Medline, Embase, CINAHL, PsycINFO, Cochrane Library) yielded 16,324 records published between 2000 and January 2018. Eligibility criteria were: adult transport injury survivors; prospective design; multivariable analysis; fault-related factor analysed; pain, mental health, general health or work-related outcome. Citations (n = 10,558, excluding duplicates) and full text articles (n = 555) were screened manually (Reviewer 1), and using concurrent machine learning and text mining (Reviewer 2; using Abstrackr, WordStat and QDA miner). Data from 55 papers that met all inclusion criteria were extracted, papers were evaluated for risk of bias using the QUIPS tool, and overall level of evidence was assessed using the GRADE tool. There were six main fault-related factors classified as: fault or responsibility, fault-based compensation, lawyer involvement or litigation, blame or guilt, road user or position in vehicle, and impact direction. Overall there were inconsistent associations between fault and transport injury outcomes, and 60% of papers had high risk of bias. There was moderate evidence that fault-based compensation claims were associated with poorer health-related outcomes, and that lawyer involvement was associated with poorer work outcomes beyond 12 months post-injury. However, the evidence of negative associations between fault-based compensation claims and work-related outcomes was limited. Lawyer involvement and fault-based compensation claims were associated with adverse mental health outcomes six months post-injury, but not beyond 12 months. The most consistent associations between fault and negative outcomes were not for fault attributions, per se, but were related to fault-related procedures (e.g., lawyer engagement, fault-based compensation claims)., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

Background: Road traffic accidents is a leading cause of injury and death globally. The consequences of road traffic accidents are prominent in developing countries that can least afford to meet the health services, economic and societal challenges. Nepal and Bangladesh are two developing country of South Asia who bear a large share of burden due to road traffic injuries., Methods: A non-systematic review of relevant documents using Google scholar and PubMed as well as review of relevant legal documents was done., Results: Nepal and Bangladesh have traffic laws including all the key risk factors as recommended by the World Health Organization except the child restraint systems laws. The existing laws for both countries include speed, drunk driving, use of seatbelts and motorcycle helmet, driver license, vehicle condition, overloading and accident related compensations.In both the countries for post-crash response, national emergency care access number has partial coverage and in Nepal there are some provisions related to trauma registry.Vulnerable groups are pedestrians with majority of male and higher mortality found in rural areas than urban areas for both the countries., Conclusions: Both the countries have traffic laws that focus on the prevention of road traffic accidents and protection of victims. However, amendments in the existing laws are required for confronting immediate challenges of increasing accidents and injuries that both the countries face every year.

Objective: Auto-Brewery Syndrome is defined as the production of ethanol by microorganisms becoming dominant when inhabiting the gastrointestinal system or through the impairment of flora because of carbohydrate-rich nutrition, and the elevation of levels of measured ethanol. This study aimed to consider medicolegal approaches to individuals with Auto-Brewery Syndrome. Methods: A 38-year-old male patient who was involved in a traffic accident about two months ago and whose driving license was taken away due to his blood alcohol level measuring above the legal limits was referred to our department for the detection of any condition which might cause the elevation of blood alcohol levels without alcohol intake, in consequence of his objection submitted to the judicial authorities claiming that he had not drunk alcohol on the day of the event. Results: After the informed consent of the individual was obtained, he was admitted under supervision to an inpatient unit with a visitor ban in a manner which inhibited his intake of alcohol, and during admission his blood alcohol levels were measured at intervals. His blood alcohol level was measured as 160 mg/dl at the time of admission for monitoring and as 141 mg/dl, 322 mg/dl, 208 mg/dl and 279 mg/dl after two hours, six hours, 12 hours and 20 hours, respectively. His liver function test results were high and neurological examination was normal. The individual was diagnosed with Auto-Brewery Syndrome. Conclusion: Various gastrointestinal system abnormalities such as through laparotomy, gastrectomy are reported in most of Auto-Brewery syndrome cases. There are cases, although rare, where gastrointestinal disorders are not detected and secondary disorders of normal intestinal flora due to frequent antibiotic use seem to be a factor. Such a condition is present in the current case. Those who are aware of this condition may falsely rely on it as a method to avoid penalties. On the other hand, genuine patients suffering from this condition may be caught by traffic control and become victims of the condition. For that reason, a meticulous and planned approach should be taken to verify the condition and to ensure that it is not overlooked.

Background: Cell phone use while driving laws do not appear to be heavily enforced in the USA. This study seeks to gain law enforcements' perspective and learn potential barriers to cell phone law enforcement., Methods: Qualitative interviews (ie, focus groups) were conducted with officers (N=19) from five West Virginia law enforcement agencies. The officers who participated were >18 years of age, sworn into their departments and employed in law enforcement for >1 year. Focus group sessions lasted 45-60 min and followed a standardised, pilot-tested script. These sessions were audio recorded and transcribed. Qualitative content analysis was employed among three researchers to determine themes surrounding enforcement., Results: Four themes emerged including current culture, the legal system, the nature of police work and issues with prevention. Specific barriers to enforcement included cultural norms, lack of perceived support from courts/judges, different laws between states, the need for a general distracted driving law, unclear legislation, officers' habits and perceived risk, wanting to maintain a positive relationship with the public, not being able to see the driver (impediments of vehicle design, time of day), phones having multiple functions and not knowing what drivers are actually doing, risk of crashing during traffic stops and lack of resources. Prevention activities were debated, and most felt that technological advancements implemented by cell phone manufacturers may deter use., Conclusions: Numerous barriers to cell phone law enforcement exist. Legislation could be amended to facilitate enforcement. Prevention opportunities exist to deter cell phone use while driving., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2018. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: We examined marijuana and alcohol use trends among drivers aged ≥16 years evaluated at Level I trauma centers before and after Arizona legalized medical marijuana in April 2011., Methods: We conducted interrupted time series (ITS) analysis of urine drug screens for marijuana metabolites and blood alcohol concentration (BAC) data from the 2008-2014 Arizona State Trauma Registry., Results: Among 30,083 injured drivers, 14,710 had marijuana test results, and 2590 were positive for marijuana; of these, 1087 (42%) also tested positive for alcohol. Among 23,186 drivers with BAC results, 5266 exceeded the legal limit for their age. Compared with prelaw trends (models if law had not been enacted), postlaw models showed small but significant annual increases in the proportions of drivers testing positive for either substance. By the end of 2014, the proportion of drivers testing positive for marijuana was 9.6% versus a projected 5.6% if the law had not been enacted, and the proportion of drivers with illegal BACs was 15.7% versus a projected 8.2%. When ITS was restricted to only substance-tested drivers, no significant differences were detected., Conclusions: Despite the small annual postlaw increases in the proportion of marijuana-positive drivers compared with the prelaw trend, alcohol-impaired driving remains a more prevalent threat to road safety in Arizona., (Published by Elsevier B.V.)

This study aimed to analyze the trend in the number of fatalities, severe injuries, and minor injuries from traffic accidents on Brazil's federal highways according to the country's major geographic regions before and after the start of the Decade of Action for Road Safety (DARS). This was an interrupted time series study of data on accidents with fatal or injured victims provided by the Brazilian Federal Highway Police from 2007 to 2017. The Prais-Winsten method was used to calculate the monthly percentage change (MPC) in the number of fatalities, severe injuries, and minor injuries. Before the DARS, there was an upward monthly trend in the number of fatalities in these accidents in the country as a whole (MPC 0.71%) and in all five regions, especially in the South (MPC 1.01%) and Central-West (MPC 0.84%). There was an inverse trend after the start of the DARS, with a significant decrease in Brazil as a whole (MPC -1.24%) and in the major geographic regions. For each person that dies in an accident on a federal highway, at least 12 others suffer non-fatal injuries. There was an upward trend in the number of victims with severe injuries (MPC 0.53%) and minor injuries (MPC 0.8%) in Brazil and in the major geographic regions in the period prior to the DARS. After the start of the DARS, there was a significant downward trend in the absolute frequencies of these outcomes at the national and regional levels. In conclusion, before the DARS, there was an upward monthly trend in the number of fatal and injured victims of traffic accidents on Brazil's federal highways. After the start of the DARS, in 2011, there was an inverse trend, namely a decline in these outcomes in the country.

Tort law currently debates the value of facilitating apology to enhance the restoration of victims' nonmaterial needs, and to promote dispute resolution. However, the extent to which apology can augment these outcomes beyond conventional, monetary reparations is not yet clear. The present research aimed to provide some first insights into this question, by means of 2 experimental studies conducted among community members recruited through Amazon Mechanical Turk (MTurk; Study 1) and Prolific (Study 2). Participants imagined a scenario in which they became victims of a traffic accident. Study 1 (N = 81, 42 men, 39 women, M age = 35.90) manipulated the resulting harm (personal injury or property loss) to examine which needs participants experienced, and what remedies (apology, compensation) they desired. Factor analysis revealed (nonmaterial) needs for interpersonal treatment, responsibility taking, closure, and punishment, and (material) needs for compensation; these needs were as prominent after property loss as after personal injury. Nonmaterial needs predicted greater desire for apology (and not compensation). Study 2 (N = 485, 286 men, 199 women, M age = 31.03) examined how these remedies impacted the satisfaction of these needs and dispute resolution by manipulating apology (no apology, apology), compensation level (partial, approximate, or exact), and harm within the same scenario. Apologies enhanced the restoration of participants' nonmaterial needs. However, settlement remained mostly contingent on compensation: (modest) effects of apology were restricted to partial compensation. These findings, therefore, imply that apologies could augment victims' restoration after torts, but may be limited as a catalyst for settlement. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

The present study aims to determine the association between bus drivers' socio-demographic characteristics, personality traits, mental health and traffic violations. This case-control study included 596 bus drivers who were recruited during October 2014 to May 2016, including 295 drivers with traffic violations and 301 drivers without traffic violations. The bus drivers' personality traits and mental health were assessed by the Eysenck Personality Questionnaire (EPQ) and the Symptom Checklist (SCL-90-R). Drivers aged 26-35 years were 72% less likely to be involved in traffic violations compared to drivers aged ≤25 years (OR:0.284,95%CI:0.137-0.586). Drivers with ≤2 years driving experience were associated with almost a three-fold increased risk of traffic violations compared to ≥21 years driving experience (OR:3.174,95%CI:1.097-9.187). The OR value decreased with the increase of annual income (OR:4.631,95%CI:2.667-8.042;OR:3.569,95%CI:2.038-6.251;OR:3.781,95%CI:1.999-7.151). Occasionally drinking drivers and regularly drinking drivers, compared to nondrinking drivers, exhibited a higher risk of traffic violations (OR:2.487,95%CI:1.521-4.065;OR:3.271,95%CI:1.387-7.716).Extroversion and neuroticism were identified as significant factors associated with traffic violations (OR:1.262,95%CI:1.145-1.393;OR:1.159,95%CI:1.060-1.267).Somatization increased eleven-fold risk of bus drivers' traffic violations (OR:11.185,95%CI:4.563-27.419). The results revealed that bus drivers' traffic violations were mainly affected by specific socio-demographic characteristics, personality traits and mental health, which increase the risk of traffic violations.

Self-inflicted fractures simulating traffic accident represent a new social fraud opportunity for criminality. Recognising scams through an increase of awareness of existence of self-inflicted arm fractures for insurance fraud could help community health workers to report these injuries to the competent authorities. In this article, authors have recognised an unusual but consistent pattern of upper and lower limb fractures whose incidence does not coincide in numerical terms with what is reported in literature. The aim of the present study is to describe fracture patterns observed over the past 2 years. Further, authors describe clinical presentations of these fractures and attempt to define a possible mechanism of these types of injuries.

There are two parts to the aim of this study. The first part comprised reviewing how men and women are represented in regulatory tests conducted to assess adult occupant safety in vehicles in Europe. This part also contains an overview of some differences between females and males that may influence dynamic responses in a crash. Based on the results of the review an outline for how to better represent the adult population in regulatory tests has been suggested. The second part was to reflect on these issues from a specific critical legal perspective, that is from a Gender Legal Studies point of view, focusing on the European legal framework that governs the tests of adult occupant safety in vehicles in Europe. Since the beginning of the 1970s legal scholars have shown in several areas of law that there is a gap between superior legislation and practice, but also between gender equality as a superior legal principle and subordinate legal rules that govern safety requirements. The same pattern can be discerned in the area of Transportation Law. The results of the review of the ECE regulations shows that the average sized male represents the adult population and that the average sized female has been excluded from regulations assessing the protection of adult vehicle occupants. The fundamental values, on which the Union is founded, including the overarching goals of the Union, seem to be rendered invisible in the laws and critically impact the safety of women in everyday life. According to the gender system theory, the interests and priorities of men are continuing to shape the law. Consequently, the law neglecting the safety of women on roads has implications on the development of society. The lack of legal provisions that demand female crash test dummies representing the female part of the population, means that there is no incentive for car manufacturers, authorities or other stakeholders to develop test methods and female crash test dummies in ways that promote political objectives expressed in legal form, i.e., the legal values expressed in general provisions and principles stated in the Treaty on European Union and the Treaty on the Functioning of the European Union, such as gender equality between women and men as well as non-discrimination This study highlights the undeniable gap between the legal framework and legal requirements with regard to occupant safety for the whole adult population. It would be attainable to bridge this particular gender gap by providing equal representation for the female part of the population with regard to vehicle safety, as that males benefit from., (Copyright © 2019 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Objectives: To compare monthly rates of specific types of crashes, violations, and license suspensions over the first years of licensure for drivers with and without attention-deficit/hyperactivity disorder (ADHD)., Methods: We identified patients of New Jersey primary care locations of the Children's Hospital of Philadelphia who were born in 1987-1997, were New Jersey residents, had their last primary care visit at age ≥12 years, and acquired a driver's license ( N = 14 936). Electronic health records were linked to New Jersey's licensing, crash, and violation databases. ADHD diagnosis was based on International Classification of Diseases, Ninth Revision, Clinical Modification diagnostic codes. We calculated monthly per-driver rates of crashes (at fault, alcohol related, nighttime, and with peers), violations, and suspensions. Adjusted rate ratios were estimated by using repeated-measures Poisson regression., Results: Crash rates were higher for drivers with ADHD regardless of licensing age and, in particular, during the first month of licensure (adjusted rate ratio: 1.62 [95% confidence interval: 1.18-2.23]). They also experienced higher rates of specific crash types: their 4-year rate of alcohol-related crashes was 2.1 times that of drivers without ADHD. Finally, drivers with ADHD had higher rates of moving violations (for speeding, seat belt nonuse, and electronic equipment use) and suspensions. In the first year of driving, the rate of alcohol and/or drug violations was 3.6 times higher for adolescents with ADHD., Conclusions: Adolescents with ADHD are at particularly high crash risk in their initial months of licensure, and engagement in preventable risky driving behaviors may contribute to this elevated risk. Comprehensive preventive approaches that extend beyond current recommendations are critically needed., Competing Interests: POTENTIAL CONFLICT OF INTEREST: Dr Yerys was part of a single consultation meeting with Aevi Genomic Medicine about development of a novel treatment of attention-deficit/hyperactivity disorder; the other authors have indicated they have no potential conflicts of interest to disclose., (Copyright © 2019 by the American Academy of Pediatrics.)

Background: In 2010, Brazil introduced child restraint legislation (CRL). We assessed the effectiveness of CRL in reducing child (aged 0-8 years) injuries and fatalities by race. We performed an evaluation study with an interrupted time-series design., Methods: We measured the effect of CRL on two outcomes-number of child deaths and number of child injured in traffic collisions per child population, stratified by race, from 2008 to 2014. We controlled for time, unemployment rate and oil consumption (barrels/day in thousands)., Results: The CRL was associated with a 3% reduction in the rate of child injuries among whites (incidence rate ratio (IRR): 0.97; 95% CI: 0.96-0.99), but no reduction in child injuries among non-whites (IRR: 0.99; 95% CI: 0.99-1.00). In the first month after the implementation of Brazil's CRL we observed a 39% reduction in all child fatalities (IRR: 0.61; 95% CI: 0.44-0.84), including a 52% reduction among whites (IRR: 0.48; 95% CI: 0.33-0.68), but no reduction in non-white fatalities (IRR: 0.87; 95% CI: 0.55-1.37)., Conclusions: Our results support the hypothesis that socially advantaged populations were more likely to consistently adopt and employ restraint devices following the reform. Countries should also consider complementary policies that facilitate an equitable distribution of safety devices that reach vulnerable populations., (© The Author(s) 2018. Published by Oxford University Press on behalf of Faculty of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Background: Traumatic brain injury (TBI) is major contributor to the global burden of disease, especially in low- and middle- income countries, where most TBIs are traffic-related. Evidence shows that helmets protect against severe TBI. Cambodia continues to have the greatest motorcycle fatality rate in Southeast Asia. We investigated whether the National Motorcycle Helmet Law introduced in January 2016 had an impact on the epidemiology of motorcycle-related TBI in a neurosurgical referral center in Phnom Penh., Methods: This is a cross-sectional study of all patients admitted to the Department of Neurosurgery at Preah Kossamak Hospital with TBI following motorcycle accidents between January 2014 and December 2017., Results: TBI admissions increased (from 234 in 2014 to 768 in 2017). The median age was 26 years, and most patients were male. The percentage of helmeted patients was 9% in 2014 and 13% in 2015; this increased to 18% in 2016, but dropped to 9% in 2017. Most TBIs occurred during the evening rush hour. Since 2016, more patients wore helmets in the daytime (up to 23%) than at night (5% between 1:00 and 5:00 am). Skull fracture, the most common pathology pre-law, decreased by 25% post-law (P < 0.001)., Conclusions: With growing urbanization and motorization, TBI is a significant cause of morbidity and mortality in Cambodia. Two years after helmets became compulsory, most patients with TBI are still unhelmeted. Likely contributing factors are low penalty for noncompliance and inconsistent law enforcement. TBI is a major public health problem warranting further efforts to understand how to improve prevention strategies and advocate for change., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Objectives: To examine the impact of state texting bans on motor vehicle crash (MVC)-related emergency department (ED) visits., Methods: We used ED data from 16 US states between 2007 and 2014. We employed a difference-in-difference approach and conditional Poisson regressions to estimate changes in counts of MVC-related ED visits in states with and without texting bans. We also constructed age cohorts to explore whether texting bans have differential impacts by age group., Results: On average, states with a texting ban saw a 4% reduction in MVC-related ED visits (incidence rate ratio = 0.96; 95% confidence interval = 0.96, 0.97). This equates to an average of 1632 traffic-related ED visits prevented per year in states with a ban. Both primary and secondary bans were associated with significant reductions in MVC-related visits to the ED regardless of whether they were on all drivers or young drivers only. Individuals aged 64 years and younger in states with a texting ban saw significantly fewer MVC-related ED visits following its implementation., Conclusions: Our findings suggest that states' efforts to curb distracted driving through texting bans and decrease its negative consequences are associated with significant decreases in the incidence of ED visits that follow an MVC.

Direct road mortality and the barrier effect of roads are typically identified as one of the greatest threats to wildlife. In addition, collisions with large mammals are also a threat to human safety and represent an economic cost to society. We documented and explored the effects of animal-vehicle crashes on human safety in São Paulo State, Brazil. We estimated the costs of these crashes to society, and we summarized the legal perspectives. On average, the Military Highway Police of São Paulo reported 2,611 animal-vehicle crashes per year (3.3% of total crashes), and 18.5% of these resulted in human injuries or fatalities. The total annual cost to society was estimated at R$ 56,550,642 (US $ 25,144,794). The average cost for an animal-vehicle crash, regardless of whether human injuries and fatalities occurred, was R$ 21,656 (US $ 9,629). The Brazilian legal system overwhelmingly (91.7% of the cases) holds the road administrator liable for animal-vehicle collisions, both with wild and domestic species. On average, road administrators spent R$ 2,463,380 (US $ 1,005,051) per year compensating victims. The logical conclusion is that the Brazilian legal system expects road administrators to keep animals, both wild and domestic species, off the road. We suggest an improved coordination between the laws that relate to animal-vehicle collisions and human safety, and the process for environmental licenses that focusses on reducing collisions with wildlife and providing habitat connectivity. In addition, we suggest better management practices, raising awareness and social change with regard to abandoned domesticated animals including horses, cattle, and dogs. This should ultimately result in a road system with improved human safety, reduced unnatural mortality for both domestic and wild animal species, safe crossing opportunities for wildlife, and reduced monetary costs to society., Competing Interests: CMH was employed at the law firm Lazzarini Moretti Advogado during the time of study and did not receive any salary support. This does not alter the authors' adherence to PLOS ONE policies on sharing data and materials.

In 2017/2018 the Australian Capital Territory held its first citizens' jury to deliberate changes to the Territory's Compulsory Third Party (CTP) insurance scheme, for injury compensation after motor vehicle accidents. Such citizens' juries were designed to aid the transition to next-generation parliamentary processes (such as liquid democracy - citizen direct electronic voting on laws or individual transfer of their vote to respected politicians) by enabling a variety of key stakeholders and interests to be actively represented in the process of statutory development. In effect such a process is a democratic alternative to the current model of corporate lobbyists covertly influencing the legislative process. This column investigates how the citizens' jury chose one from four proposed CTP models. It then critiques how, following the jury's recommendation, the Australian Capital Territory Government introduced the Motor Accidents Injuries Bill 2018 (ACT). Once enacted, this is designed to create a "no-fault" expedited scheme, but on our analysis, at the cost of certain adverse outcomes. These include greatly reducing an injured person's entitlements to fair compensation, a "whole person impairment threshold" that limits entitlements to treatment and care, wage loss and compensation for pain and suffering, removing the right to compensation for gratuitous care, and giving the insurance companies unfettered power over the provision of entitlements.

Purpose: To investigate the changes and underlying mechanisms in parents' safety awareness and the use of child safety seats after the mandatory legislation in Shanghai city, China., Methods: This study was carried out by Shanghai Key Laboratory of Environment and Children's Health using a multi-stage, simple random sampling method. Volunteers with children aged 0-12 months were recruited. Child safety seats were sent to each volunteer's family. Telephone encounters and/or on-site visits were used to collect data from parents using a phased survey on children's safety during car use., Results: Among all respondents, 91.2% had heard of motor vehicle accidents involving children, and 97.2% could describe the appropriate use of a safety seat to minimize the risk of child injury in a collision. Among 1078 families with newborns, awareness of child safety seats was 91.9%. There were 86% patients aware that new laws and regulations have been released regarding the use of child safety seats, and 98.5% of them plan to comply with the new laws. Moreover, 61% patients think that taxis should be routinely equipped with child safety seats., Conclusion: The parents in Shanghai obtained a high level of awareness of children's traffic safety after the introduction of child safety seats legislation, and had a positive experience related to the use of child safety seats. Taxi may be an important area of focus for implementation of child traffic safety. Traffic safety laws and regulations with further impact should be continuously studied., (Copyright © 2019. Production and hosting by Elsevier B.V.)

According to Florida law, an individual is not guilty of driving under the influence of drugs unless impairment is observed and is due to one or more controlled drugs listed in the Florida Statutes. Many prescription drugs, over-the-counter drugs and novel psychoactive compounds that can cause significant impairment are not included in this list. Five other states within the USA including Alaska, Hawaii, Massachusetts, New York and Oregon have similar or other restrictive language in their impaired driving statutes. From January of 2007 to February of 2018, 1,344 blood specimens and 1,796 urine specimens were analyzed for drugs in impaired driving cases in Palm Beach County, Florida. Over the past 11 years, 21% (212 out of 1,028) of all drug-positive blood specimens and 47% (711 out of 1,527) of all drug-positive urine specimens contained at least one non-controlled drug, often mixed with controlled drugs. Despite documentation of observed impairment with the concurrent identification of impairing drugs, an impaired driving charge could not be supported due to the phrasing of the law in Florida. If the intent of drug-impaired driving laws is to improve safety by removing impaired drivers from the road, a more all-encompassing "any impairing drug" law would be more appropriate. Linking the charge to a drug possession law framework or using other restrictive language is not the most effective means to improve road safety., (© The Author(s) 2018. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.)

Before 2030, deaths from road traffic accidents (RTAs) will surpass cerebrovascular disease, tuberculosis, and HIV/AIDS. Yet, there is little knowledge on the geographic distribution of RTA severity in Nigeria. Accident Severity Index is the proportion of deaths that result from a road accident. This study analysed the geographic pattern of RTA severity based on the data retrieved from Federal Road Safety Corps (FRSC). The study predicted a two-year data from a historic road accident data using exponential smoothing technique. To determine spatial autocorrelation, global and local indicators of spatial association were implemented in a geographic information system. Results show significant clusters of high RTA severity among states in the northeast and the northwest of Nigeria. Hence, the findings are discussed from two perspectives: Road traffic law compliance and poor emergency response. Conclusion, the severity of RTA is high in the northern states of Nigeria, hence, RTA remains a public health concern.

Objective: Motor vehicle overloading is correlated with the possibility of road crash occurrence and severity. Although overloading of motor vehicles is pervasive in developing nations, few empirical analyses have been performed on factors that might influence the occurrence of overloading. This study aims to address this shortcoming by seeking evidence from several years of crash data from Guangdong province, China., Methods: Data on overloading and other factors are extracted for crash-involved vehicles from traffic crash records for 2006-2010 provided by the Traffic Management Bureau in Guangdong province. Logistic regression is applied to identify risk factors for overloading in crash-involved vehicles and within these crashes to identify factors contributing to greater crash severity. Driver, vehicle, road and environmental characteristics and violation types are considered in the regression models. In addition to the basic logistic models, association analysis is employed to identify the potential interactions among different risk factors during fitting the logistic models of overloading and severity., Results: Crash-involved vehicles driven by males from rural households and in an unsafe condition are more likely to be overloaded and to be involved in higher severity overloaded vehicle crashes. If overloaded vehicles speed, the risk of severe traffic crash casualties increases. Young drivers (aged under 25 years) in mountainous areas are more likely to be involved in higher severity overloaded vehicle crashes., Conclusions: This study identifies several factors associated with overloading in crash-involved vehicles and with higher severity overloading crashes and provides an important reference for future research on those specific risk factors., Competing Interests: Competing interests: None declared., (© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2019. All rights reserved. No commercial use is permitted unless otherwise expressly granted.)

Objective: The objective of this study was to adapt a previously validated Canadian Culpability Scoring Tool (CCST) to Alberta police report data. Methods: Police traffic collision reports from motor vehicle (MV) collisions in Calgary and Edmonton (Alberta, Canada) from 2010 to 2014 were used. Adaptation of the CCST was completed with input from personnel within Alberta Transportation, contributing to face and content validity. Two research assistants, given only the information necessary for scoring, evaluated 175 randomly selected MV-MV collisions. Interrater agreement was estimated using kappa (k) and reported with 95% confidence intervals (CIs). Discussion of disagreements between the research assistants and consultation from Alberta Transportation informed the algorithm used in the Alberta Motor Vehicle Collision Culpability Tool (AMVCCT). The AMVCCT was automated and applied to all motorists involved in collisions. Binary logistic regression was used to examine characteristics of the culpable and nonculpable drivers and their effects were reported using odds ratios (ORs) with 95% CIs. Results: Interrater agreement for the random sample was excellent (k = 0.95; 95% CI, 0.92-0.99). Of those drivers hospitalized, 1,130 (37.54%) were rated not culpable and 1,880 (62.46%) were rated culpable. The odds of being culpable were higher for males than for females (OR = 1.43; 95% CI, 1.23-1.66). The odds of being culpable were higher in those impaired by alcohol than those considered "apparently normal" (OR = 61.10; 95% CI, 22.66-164.75). The odds of being deemed culpable, when compared with drivers >54 years old, were higher for those <25 years old (OR = 1.72; 95% CI, 1.35-2.20) and lower for those in the 40- to 54-year-old age group (OR = 0.78; 95% CI, 0.63-0.96). Driving between 12 a.m. and 6 a.m. resulted in higher odds of being culpable compare with all other 6-h time blocks. Direction and statistical significance remained consistent when applying the tool to all MV collisions. Sensitivity analysis including the removal of single vehicle collisions did not affect the direction or statistical significance of the main results. Conclusions: The AMVCCT identified a culpable group that exhibited characteristics expected in drivers who are at fault in collisions. The age groups 25-39 and 40-54 demonstrated different results than the CCST. However, this is the only difference that exists in the findings of the AMVCCT compared to the CCST and could exist due to differences between the driving populations in Alberta and British Columbia. It is possible to adapt the CCST to provinces outside British Columbia and, in doing so, we can identify risk factors for collision contribution and not-at-fault drivers who represent the driving population.

Objectives: To determine (1) whether the implementation of vehicle impoundment as part of provincial short-term administrative driver licensing suspension (ADLS) programs significantly reduced total and alcohol-related collision fatalities, and (2) if provinces with vehicle impoundment as part of their short-term ADLS programs see greater reductions in total and alcohol-related fatal collisions when compared to provinces without a vehicle impoundment law. Methods: Data on monthly total and alcohol-related fatal collisions from January 2005 to December 2016 are drawn from British Columbia (BC), Alberta (AB), Saskatchewan (SK), Manitoba (MB) and Ontario (ON). Changepoint time series analysis of fatal crashes is employed to detect within-province differences after implementing short-term impoundment programs, and between province differences comparing provinces with short-term impoundment programs (BC, introduced October 2010; AB, introduced July 2012; and SK, introduced July 2014) and those without (ON and MB). Outcome measures are the monthly per capita total and alcohol-related fatal collisions. Results: A significant reduction in per-capita alcohol-related fatal crashes was observed in British Columbia (-47.4%) in the period following the adoption of vehicle impoundment in their short-term ADLS. A significant decrease was also observed in Alberta (-37.5%), though this trend began prior to policy change; no significant effect was observed in per capita alcohol-related fatal crashes rates in Saskatchewan (-6.1%) in the two years following the introduction of vehicle impoundment. Ontario and Manitoba, two provinces without mandatory vehicle impoundment laws, also experienced significant reductions in per-capita alcohol-related fatal crashes between 2005 and 2016 (-36.4% and -35%, respectively). Conclusions: While mandatory vehicle impoundment programs for driving in the "warn" range (0.05%-0.08% BAC) have shown success in reducing fatal crashes in British Columbia, similar reductions in two other provinces with short-term vehicle impoundment were not observed. Moreover, large reductions in fatal crashes were observed in two provinces without vehicle impoundment as part of their short-term ADLS programs. Collectively, these findings suggest that vehicle impoundment, alone, has limited impact on fatal crash rates and that other factors help to explain the observed trends. Further analysis of new vehicle impoundment programs is warranted.