Search

Magnetoencephalography (MEG) is particularly well-suited to the study of human motor cortex oscillatory rhythms and motor control. However, the motor tasks studied to date are largely overly simplistic. This study describes a new approach: a novel event-based simulated drive made operational via MEG compatible driving simulator hardware, paired with differential beamformer methods to characterize the neural correlates of realistic, complex motor activity. We scanned 23 healthy individuals aged 16-23 years (mean age = 19.5, SD = 2.5; 18 males and 5 females, all right-handed) who completed a custom-built repeated trials driving scenario. MEG data were recorded with a 275-channel CTF, and a volumetric magnetic resonance imaging scan was used for MEG source localization. To validate this paradigm, we hypothesized that pedal-use would elicit expected modulation of primary motor responses beta-event-related desynchronization (B-ERD) and movement-related gamma synchrony (MRGS). To confirm the added utility of this paradigm, we hypothesized that the driving task could also probe frontal cognitive control responses (specifically, frontal midline theta [FMT]). Three of 23 participants were removed due to excess head motion (1.5 cm/trial), confirming feasibility. Nonparametric group analysis revealed significant regions of pedal-use related B-ERD activity (at left precentral foot area, as well as bilateral superior parietal lobe: p .01 corrected), MRGS (at medial precentral gyrus: p .01 corrected), and FMT band activity sustained around planned braking (at bilateral superior frontal gyrus: p .01 corrected). This paradigm overcomes the limits of previous efforts by allowing for characterization of the neural correlates of realistic, complex motor activity in terms of brain regions, frequency bands and their dynamic temporal interplay.

Motor vehicle crash rates are highest immediately after licensure, and driver error is one of the leading causes. Yet, few studies have quantified driving skills at the time of licensure, making it difficult to identify at-risk drivers before independent driving. Using data from a virtual driving assessment implemented into the licensing workflow in Ohio, this study presents the first population-level study classifying degree of skill at the time of licensure and validating these against a measure of on-road performance: license exam outcomes. Principal component and cluster analysis of 33,249 virtual driving assessments identified 20 Skill Clusters that were then grouped into 4 major summary “Driving Classes”; i) No Issues (i.e. careful and skilled drivers); ii) Minor Issues (i.e. an average new driver with minor vehicle control skill deficits); iii) Major Issues (i.e. drivers with more control issues and who take more risks); and iv) Major Issues with Aggression (i.e. drivers with even more control issues and more reckless and risk-taking behavior). Category labels were determined based on patterns of VDA skill deficits alone (i.e. agnostic of the license examination outcome). These Skill Clusters and Driving Classes had different distributions by sex and age, reflecting age-related licensing policies (i.e. those under 18 and subject to GDL and driver education and training), and were differentially associated with subsequent performance on the on-road licensing examination (showing criterion validity). The No Issues and Minor Issues classes had lower than average odds of failing, and the other two more problematic Driving Classes had higher odds of failing. Thus, this study showed that license applicants can be classified based on their driving skills at the time of licensure. Future studies will validate these Skill Cluster classes in relation to their prediction of post-licensure crash outcomes.

Despite US graduated driver licensing laws, young novice driver crash rates remain high. Study findings suggest comprehensive license policy that mandates driver education including behind-the-wheel (BTW) training may reduce crashes postlicensure. However, only 15 states mandate BTW training.To identify differences in licensing and crash outcomes for drivers younger than 18 years who are subject to comprehensive licensing requirements (graduated driver licensing, driver education, and BTW training) vs those aged 18 to 24 years who are exempt from these requirements.This prospective, population-based cohort study used Ohio licensing data to define a cohort of 2018 license applicants (age 16-24 years, n = 136 643) and tracked licensed driver (n = 129 897) crash outcomes up to 12 months postlicensure. The study was conducted from January 1, 2018, to December 31, 2019, and data analysis was performed from October 7, 2019, to February 11, 2022.Licensing examination performance and population-based, police-reported crash rates in the first 2 months and 12 months postlicensure across age groups, sex, and census tract-level sociodemographic variables were measured. Poisson regression models compared newly licensed driver crash rates, with reference to individuals licensed at 18 years, while controlling for census tract-level sociodemographic factors, time spent in the learner permit period, and licensing examination performance measures.Of 136 643 novice drivers, 69 488 (50.9%) were male and 67 152 (49.1%) were female. Mean (SD) age at enrollment (age at first on-road examination) was 17.7 (2.1) years. License applicants aged 16 and 17 years performed best on license examinations (15 466 [21.6%] and 5112 [30.9%] failing vs 7981 [37.5%] of applicants aged 18 years). Drivers licensed at 18 years had the highest crash rates of all those younger than 25 years. Compared with drivers licensed at 18 years, crash rates were 27% lower in individuals aged 16 years and 14% lower in those aged 17 years during the first 2 months postlicensure when controlling for socioeconomic status, time spent in learner permit status, and license examination performance measures (adjusted relative risk [aRR] at age 16 years: 0.73; 95% CI, 0.67-0.80; age 17 years: aRR, 0.86; 95% CI, 0.77-0.96). At 12 months postlicensure, crash rates were 19% lower for individuals licensed at age 16 years (aRR, 0.81; 95%, CI, 0.77-0.85) and 6% lower at age 17 years (aRR, 0.94; 95% CI, 0.89-0.99) compared with individuals aged 18 years.In Ohio, drivers younger than 18 years who are subject to graduated driver licensing and driver education, including BTW training requirements, had lower crash rates in the first year postlicensure compared with those aged 18 years, with controls applied. These findings suggest that it may be fruitful for future work to reconsider the value of mandated driver license policies, including BTW training, and to examine reasons for delayed licensure and barriers to accessing training.

Motor vehicle crashes remain the leading cause of adolescent mortality and injury in the United States. For young drivers, crash risk peaks immediately after licensure and declines during the next two years, making the point of licensure an important safety intervention opportunity. Legislation in Ohio established a unique health-transportation partnership among the State of Ohio, Children’s Hospital of Philadelphia, and Diagnostic Driving, Inc., to identify underprepared driver license applicants through a virtual driving assessment system. The system, a computer-based virtual driving test, exposes drivers to common serious crash scenarios to identify critical skill deficits and is delivered in testing centers immediately before the on-road examination. A pilot study of license applicants who completed it showed that the virtual driving assessment system accurately predicted which drivers would fail the on-road examination and provided automated feedback that informed drivers on their skill deficits. At this time, the partnership’s work is informing policy changes around integrating the virtual driving assessment system into licensing and driver training with the aim of reducing crashes in the first months of independent driving. The system can be developed to identify deficits in safety-critical skills that lead to crashes in new drivers and to address challenges that the coronavirus disease 2019 pandemic has introduced to driver testing and training.

The popularity of mobile wearable health devices has skyrocketed. Some of these devices are worn on the wrist and have been associated with the development of allergic contact dermatitis. Although nickel has been the suspected culprit in cases reported by the media for consumers, we present a rare report of a patient who developed a localized contact dermatitis that was linked to acrylate allergy on epicutaneous patch testing. We surmise that the source of this acrylate might derive from leaching of this compound from the rechargeable battery housing given its correspondence to where the rash arose.

Since nearly half of children fatally injured in automobile crashes were restrained, optimizing occupant protection systems for children is essential to reducing morbidity and mortality. Data from the Partners for Child Passenger Safety study were used to compare the differential injury risk between drivers and their child passengers in the same crash, with a focus on vehicle model year. A matched cohort design and conditional logistic regression model were used in the analyses. Overall, injury risk for drivers was higher than for children, but the risk difference was largest for the oldest model year vehicles, particularly for children aged 4–8 in seat belts. While drivers experienced significant benefits in safety with increasing model years, children restrained by safety belts alone derived less safety benefit from newer vehicles.

In the United States, the sport utility vehicle (SUV) is the fastest growing segment of the passenger vehicle fleet, yet SUVs vary widely in size and crashworthiness. Using data collected from a population-based sample of crashes in insured vehicles, we quantified the risk of injury to child occupants in SUVs by vehicle weight. There is an increased risk in both Small and Midsize SUVs when compared to Large SUVs. Parents who are purchasing a SUV should strongly consider the size of the vehicle and its crashworthiness.

Passenger air bags experienced considerable design modification in the late 1990s, principally to mitigate risks to child passengers. This study utilized Data from the Partners for Child Passenger Safety study, a large-scale child-focused crash surveillance system, to examine the effect of vehicle type on the differential performance of first and second generation air bags on injuries to restrained children in frontal impact crashes. Our results show that the benefit of second-generation air bags was seen in passenger cars – those children exposed to second-generation air bags were half as likely to sustain a serious injury – and minivans. However, in SUVs the data suggest no reduction in injury risk with the new designs. This field data provides crucial real-world experience to the automotive industry as they work towards the next generation of air bag designs.

In the United States, passenger cars are the most common passenger vehicle, yet they vary widely in size and crashworthiness. Using data collected from a population-based sample of crashes in State Farm-insured vehicles, we quantified the risk of injury to child occupants by passenger car size and classification. Injury risk is predicted by vehicle weight; however, there is an increased risk in both Large vs. Luxury and Sports vs. Small cars, despite similar average vehicle weights in both comparisons. Parents who are purchasing passenger cars should strongly consider the size of the vehicle and its crashworthiness.

From 1999 to 2002, 32% fewer US children between 9 and 36.4 kg (20–80 lb) were restrained inappropriately in seat belts and the most prevalent form of restraint shifted from seat belts to child restraints with harnesses. There was a significant increase in the use of combination child restraint/booster seats with harnesses by children 9.1–18.1 kg (20–40 lb). Among children weighing 14.1–18.1 kg (31–40 lb), the inappropriate use of seat belts and shield boosters decreased. Among children weighing 18.6–27.2 kg (41–60 lb), the use of belt-positioning booster seats increased while the inappropriate use of seat belts decreased. Of note, by the end of 2002, 27% of children weighing between 18.6 and 22.7 kg (41–50 lb) were restrained in child restraints with harnesses. These children were of weights typically above the manufacturer’s recommended limit. Despite progress, substantial inappropriate restraint still remains and continued investment in outreach efforts is necessary. The risk of injury for heavier children in child restraints with harnesses should be monitored.

The number of children killed by passenger airbags (PAB) has declined dramatically in recent years. However, little is known about how commonly children are exposed to PAB, and their risk of nonfatal injuries. Data between 12/1/98 and 11/30/01 from the Partners for Child Passenger Safety study, a unique child-focused crash surveillance system, were used to determine the risk of nonfatal injuries to restrained children in frontal impact crashes. Nearly 1% of all children in crashes were exposed to a deploying PAB. A specific pattern of facial, chest, and upper extremity injuries were found to be significantly more likely in airbag -exposed children. These real-world data may be of use to vehicle manufacturers and restraint suppliers as they face design decisions with regard to child passengers.

The applicability of the federal safety standard that governs child restraints (FMVSS 213) has recently been called into question. Population- based estimates of the risk of injury to children in child restraints and a description of the patterns and mechanisms of injury are necessary to evaluate this standard and identify areas of needed improvement. A probability sample of children 12 to 47 months in crashes was identified in an on-going crash surveillance system (1998-2002) which links insurance claims data to telephone survey and crash investigation data. The risk of injury in forward facing child restraints (FFCRS) was estimated and a series of cases was examined using in-depth crash investigation to identify the mechanisms of these injuries. Although children in FFCRS are well protected in crashes, further reductions in serious injuries might be achieved by reducing head, neck, and extremity injury risks. These results have implications for the current efforts to upgrade the current FMVSS 213 and better protect child passengers.

The objective of this study was to quantify the relationship between harness type and the prevalence of child restraint system (CRS) misuse. Data were collected at 21 child safety seat clinics between August, 1997 and November, 1998 in southeastern Pennsylvania and southern New Jersey. The main outcome measured was the prevalence of CRS misuse for each of the three most common harness types. Of the 438 convertible CRS evaluated, 89% demonstrated at least one form of misuse. This rate of misuse did not vary by harness type: 5-points (89%), T-shields (87%), and tray-shields (93%). However specific misuses were more common for specific harness types. Having marked/ twisted harness straps was more common among five-point harnesses. T-shields were more commonly recalled, due mainly to the high market share of a particular T-shield CRS recalled for defects with the shield buckle and harness retractor mechanism. Although not statistically significant, there was a trend towards not using a chest clip when necessary in both tray-shields and T-shields when compared to five-point harnesses. This study confirmed a high prevalence of CRS misuse and extended previous results by demonstrating that this misuse is consistent across CRS harness designs. The data further suggest specific design improvements for each harness design based on the particular pattern of misuse.