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BackgroundDistracted driving is a global epidemic, injuring and killing thousands of people every year. To better understand why people still engage in this dangerous behavior, we need to assess how the public gets informed about this issue. Knowing that many people use the internet as their primary source of initial research on topics of interest, we conducted an assessment of popular distracted driving videos found on YouTube. ObjectiveThis study aimed to gauge the popularity of distracted driving videos and to assess the messages portrayed by classifying the content, context, and quality of the information available on YouTube. MethodsWe conducted a search on YouTube using 5 different phrases related to distracted driving. Videos with more than 3000 views that mentioned or portrayed any aspect of distracted driving were identified, collected, and analyzed. We measured popularity by the number of videos uploaded annually and the number of views and reactions. Two independent researchers reviewed all the videos for categorical variables. Content variables included distractions; consequences; orthopedic injuries; and whether the videos were real accounts, reenactments, fictitious, funny, serious, and graphic. Context variables assessed the setting of the events in the video, and quality of information was measured by the presence of peer-reviewed studies and inclusion and referencing of statistics. Discrepancies in data collection were resolved by consensus via the coding authors. A comparative subanalysis of the 10 most viewed videos and the overall results was also done. ResultsThe study included a total of 788 videos for review, uploaded to YouTube from 2006 to 2018. An average of 61 videos with greater than 3000 views were uploaded each year (SD 34.6, range 3-113). All videos accumulated 223 million views, 104 million (46.50%) of them being among the 10 most viewed videos. The top 3 distractions depicted included texting, talking on the phone, and eating and/or drinking. Motor vehicle crashes (MVCs) and death were depicted in 742 (94.2%) videos, whereas 166 (21.1%) of the videos depicted injuries. Orthopedic injuries were described in 90 (11.4%) videos. Furthermore, 220 (27.9%) of the videos contained statistics, but only 27 (3.7%) videos referenced a peer-reviewed study. ConclusionsThis study demonstrates that there is a high interest in viewing distracted driving videos, and the popularity of these videos appears to be relatively stable over time on a forum that fluxes based on the current opinions of its users. The videos mostly focused on phone-related distractions, overlooking many other equally or more common forms of distracted driving. Death, which in reality is a far less common distracted driving consequence than injuries, was portrayed 1.7 times as much. Surprisingly, orthopedic injuries, which lead to a massive source of long-term disability and often result from MVCs, are vastly underrepresented.

Comment & Response B To the Editor b The recent Review[1] about primary brain malignancies in adults recommended that "patients receiving the equivalent of prednisone 20 mg daily for more than a month...should receive prophylaxis for I Pneumocystis jirovecii i pneumonia." A reference was then provided to an earlier article by the same author that calculated a I P jirovecii i pneumonia incidence rate of 1.3% (8 of 595 patients with brain tumors developed I P jirovecii i pneumonia).[4] Therefore, the recommendation from the Review on glioblastoma and other primary brain malignancies[1] was based on 30- to 60-year-old data from 1 institution. More high-quality evidence is needed before recommending I P jirovecii i pneumonia prophylaxis in all patients with malignant brain tumors who are taking corticosteroids for a prolonged period. [Extracted from the article]

Objective: Multiple strategies exist to facilitate microdissection and obliteration of intracranial aneurysms during microsurgical clipping. Rapid ventricular pacing (RVP) can be used to induce controlled transient hypotension to facilitate aneurysm manipulation. We report the indications and outcomes of intraoperative RVP for clipping of ruptured and unruptured complex aneurysms., Methods: We completed a retrospective review of adult patients who underwent RVP-facilitated elective and emergent microsurgical aneurysm clipping by a single senior neurosurgeon between 2016 and 2023. Intraoperative RVP was performed at a rate of 150 to 200 beats per minute through a transvenous pacing wire and repeated as needed based on surgical requirements. Intraoperative procedural and pacing data and perioperative cardiac and neurosurgical variables were collected., Results: Forty patients were included in this study. The median (interquartile range) number of pacing episodes per patient was 8 (5 to 14), resulting in a median mean arterial pressure of 37 (30 to 40) mm Hg during RVP. One patient developed wide complex tachycardia intraoperatively, which resolved after cardioversion. Fifteen out of 36 (42%) patients who had postoperative troponin measurements had at least one troponin value above the 99th percentile upper reference limit. One patient had markedly elevated troponin with anterolateral ischemia in the context of massive postoperative intracranial hemorrhage. There were no other documented intraoperative or postoperative cardiac events., Conclusions: This retrospective case series suggests that RVP could be an effective adjunct for clipping of complex ruptured and unruptured aneurysms, associated with transient troponin rise but rare postoperative cardiac complications., Competing Interests: D.I.M receives salary support from The Ottawa Hospital Anaesthesia Alternate Funds Association, a Research Chair from the University of Ottawa Faculty of Medicine, and the Physician Services Inc. Mid-Career Knowledge Translation Award. J.S. receives an academic contribution towards the University of Ottawa neurosurgical oncology fellowship program from Integra Lifesciences. He has received teaching honoraria from Medexus. The remaining authors have no conflicts of interest to declare., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)