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Background: Motor vehicle crashes are the second leading cause of injury death among adults aged 65 and older in the U.S., second only to falls. A common state-level approach to mitigating older adult crash risk is the implementation of driver license renewal policies which vary largely between states and data on their effectiveness in preventing crashes and injuries are limited. To fill this gap, the aim of this study is to examine the association between state driver license renewal policies and older driver crash and injury rates., Methods: Historical crash data, license renewal policy data, and other relevant policy and demographic data were gathered from 13 U.S. states (CO, IL, IA, KS, MN, MO, NE, ND, OH, SD, UT, WI, WY) for years 2000 through 2019, inclusive. Main exposures included six license renewal policies: renewal period, in-person renewal frequency, vision testing, knowledge testing, on-road drive testing, and mandatory physician reporting. The primary outcomes were crash and injury rates per 100,000 population., Results: The study population included 19,010,179 crash-involved drivers aged 40 and older. State policies became less restrictive in many states over the study period, even for drivers aged 75 and older, resulting in longer times between renewals and fewer in-person renewal requirements. Loosening of in-person renewal from every time to less than every time was associated with increased crash rates, among drivers aged 65 to 74 (RR crash  = 1.08, 95% CI: 1.01-1.16). A longer duration between in-person renewals was associated with increased injury rates among drivers 75 and older (RR injury  = 1.18, 95% CI: 1.00-1.39)., Conclusions: Generally, state policies became less restrictive and resulted in longer required intervals between license renewal. Loosening of driver license renewal policies was associated with increased crash and injury rates. However, safety benefits of restrictive older driver licensing policies should be carefully weighed against costs to older adult well-being and quality of life following licensure loss. Additional methods to assess fitness to drive are necessary to identify the mechanisms behind the increased rates., Competing Interests: Declarations. Competing interests: The authors declare no competing interests. Ethics approval and consent to participate: Not applicable. Consent for publication: Not applicable., (© 2025. The Author(s).)

4-to-3 lane conversions, often called road diets, have been implemented throughout the U.S. as a means to reduce crashes. However, the reduction in lanes has led to community wide concerns across the country regarding the possible negative effect on emergency responses. This study investigates the impact of 4-to-3-lane roadway conversions on emergency response in Iowa through surveys and a retrospective analysis of EMS data. The 170 survey responses were analyzed descriptively, and a text analysis was done on two open text survey questions. Generalized linear models were constructed to examine the impact of lane conversions on emergency response times. Over half of EMS respondents believed there was no effect or a positive effect on responses, while 40% believed there was a negative effect. The negative effect was often attributed to driver confusion on how to properly yield to EMS vehicles. Despite the differing perceptions, EMS response rates from before to after the implementation of 4-to-3 lane conversions did not meaningfully differ. Overall, there was a lack of evidence of an effect of 4-to-3 lane conversions on EMS response rates in Cedar Rapids, Iowa. However, survey results showed that public guidance on how to properly respond to the presence of EMS vehicles on these roadways may be needed. This study provides evidence for addressing local concerns about road diets and emergency response to add to other known safety benefits. Results of this analysis may be applicable to other lane conversion sites when appropriately combined with local context relevant to the target area., Competing Interests: Declarations of Interest: None

Aim: The aims of this study were to evaluate the demographics and crash profiles of road traffic-related traumatic brain injury (TBI) patients treated at two emergency departments in the Republic of Moldova, and to identify areas for prevention., (This is an open access article distributed under the terms of the Creative Commons Attribution License (CC BY 4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Objectives: Deterrence of risky driving behavior is important for the prevention of crashes and injuries. Traffic law enforcement is a key strategy used to decrease risky driving, but there is little evidence on the deterrent effect of issuing warnings versus citations to drivers regarding the prevention of future crashes. The purpose of this study was to 1) investigate the difference between citations and written warnings in their association with future crash culpability and 2) investigate whether drivers who were issued written warnings or citations have different associations with future crash culpability likelihood than those without prior citations or written warnings., Methods: Data for this study included Iowa Department of Transportation crash data for 2016 to 2019 linked to data from the Iowa Court Case Management System. A quasi-induced exposure method was used based on driver pairs involved in the same collision in which one driver was deemed culpable and one was non-culpable. Conditional logistic regression models were constructed to examine predictors of crash culpability. The main independent variable was traffic citation and warnings history categorized into moving warning, non-moving warning, moving citation, non-moving citation, or no citation or warning in the 30 days prior to the crash., Results: The study sample included a total of 152,986 drivers. Among drivers with moving violations, previously cited drivers were more likely to be crash culpable than previously warned drivers (OR = 1.64, 95% CI = 1.29-2.08). Drivers with prior non-moving citations were less likely to be the culpable party in a crash than a driver who had no recent warnings or citations (OR = 0.72, 95% CI = 0.58-0.89). Drivers with prior warnings (moving or non-moving) did not appreciably differ in crash culpability relative to drivers who had not received any citations or warnings in the previous 30 days., Conclusions: Drivers with prior moving citations were more likely to be culpable in a future crash than drivers with prior moving warnings, which may relate to overall driving riskiness as opposed to effectiveness of citations in deterring risky driving behaviors. Results from this study also suggest that officer discretion was being appropriately applied by citing the riskiest drivers, while giving lower risk drivers warnings. Results from this study may be useful to support strengthening of state driver improvement programming., 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 © 2023 Elsevier Ltd. All rights reserved.)

Background: Motor vehicle crashes among teen drivers often involve passengers in the teen's vehicle and occupants of other vehicles, and the full cost burden for all individuals is largely unknown. This analysis estimated direct hospitalisation and emergency department charges for teen-involved crashes by teen culpability, comparing charges for the teen driver, passengers and occupants of other vehicles., Methods: Probabilistic linkage was performed to link the Iowa police crash reports with Iowa emergency department and Iowa hospital inpatient data. Teen drivers aged 14-17 involved in a crash from 2016 through 2020 were included. Teen culpability was determined through the crash report and examined by teen and crash characteristics. Direct medical charges were estimated from charges through linkage to the Iowa hospital inpatient and the Iowa emergency department databases., Results: Among the 28 062 teen drivers involved in vehicle crashes in Iowa between 2016 and 2020, 62.1% were culpable and 37.9% were not culpable. For all parties involved, the inpatient charges were $20.5 million in culpable crashes and $7.2 million in non-culpable crashes. The emergency department charges were $18.7 million in teen culpable crashes and $6.8 million in teen non-culpable crashes. Of the $20.5 million total inpatient charges in which a teen driver was culpable, charges of $9.5 million (46.3%) were for the injured teen driver and $11.0 million (53.7%) for other involved parties., Conclusions: Culpable teen-involved crashes lead to higher proportions of injury and higher medical charges, with most of these charges covering other individuals in the crash., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2023. No commercial re-use. See rights and permissions. Published by BMJ.)

Introduction: Motorcycle fatality rates are increasing, and impaired driving is a major contributing factor. Impaired driving laws are a main component of state efforts to reduce drunk driving, but motorcycle crash charge and conviction outcomes have yet to be studied. The purpose of this study was to evaluate driver charge and conviction outcomes following alcohol-related motorcycle crashes., Methods: Data for this study were drawn from Iowa crash, charge, and conviction data from 2011 to 2018. The study sample included 480 alcohol-influenced drivers (428 motorcyclists and 52 other vehicle drivers) involved in motorcycle crashes. Driver crash-related charges were categorized by type: Alcohol, Moving Violations, and Administrative/Miscellaneous. Factors associated with convictions were determined and estimated with multivariable logistic regression models. The main factor of interest was charge combination., Results: Over three-quarters (78.5%) of the 480 alcohol-influenced drivers in crashes received any charge type and 68.1% received an alcohol-related charge. Among drivers with any charge, 88.6% were convicted, and among drivers with alcohol charges, 87.2% were convicted on an alcohol charge. After adjusting for BAC, drivers with a combination of Alcohol, Administrative, and Moving Violation charges had more than three times the odds of conviction of any charge compared to drivers with alcohol only charges (OR = 3.21, 95% CI = 1.00-10.26). However, charge combinations had little impact on alcohol-related convictions., Conclusions: Convictions were more likely when the impaired driver was charged with multiple types of offenses than with a single offense. An increased variety of charges was not associated with greater rates of conviction on alcohol-specific charges, which had high conviction rates overall., Practical Applications: Law enforcement officers should be informed that lesser infractions impact driver conviction outcomes in alcohol-related crashes and procedures for issuing charges should be evaluated to assure equitable enforcement and to hold drivers accountable for unsafe driving behaviors., 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 © 2022 National Safety Council and Elsevier Ltd. All rights reserved.)

Background: Low-middle-income countries experience among the highest rates of traumatic brain injury in the world. Much of this burden may be preventable with faster intervention, including reducing the time to definitive care. This study examines the relationship between traumatic brain injury severity and time to definitive care in major trauma hospitals in three low-middle-income countries., Methods: A prospective traumatic brain injury registry was implemented in six trauma hospitals in Armenia, Georgia and the Republic of Moldova for 6 months in 2019. Brain injury severity was measured using the Glasgow Coma Scale (GCS) at admission. Time to definitive care was the time from injury until arrival at the hospital. Cox proportionate hazards models predicted time to care by severity, controlling for age, sex, mechanism, mode of transportation, location of injury and country., Results: Among 1135 patients, 749 (66.0%) were paediatric and 386 (34.0%) were adults. Falls and road traffic were the most common mechanisms. A higher proportion of adult (23.6%) than paediatric (5.4%) patients had GCS scores indicating moderate (GCS 9-11) or severe injury (GCS 0-8) (p<0.001). Less severe injury was associated with shorter times to care, while more severe injury was associated with longer times to care (HR=1.05, 95% CI 1.01 to 1.09). Age interacted with time to care, with paediatric cases receiving faster care., Conclusions: Implementation of standard triage and transport protocols may reduce mortality and improve outcomes from traumatic brain injury, and trauma systems should focus on the most severe injuries., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2022. No commercial re-use. See rights and permissions. Published by BMJ.)

Objective: Pediatric restraint use has increased over time in the United States, but motor vehicle crashes remain a leading cause of death for children under age 18. Age-appropriate use of safety restraints (safety seats, booster seats, seat belt) and statewide child restraint laws can greatly reduce injury or death in the event of a crash. Surveillance of pediatric restraint use and compliance with policy can inform prevention efforts. This study aims to examine time trends in pediatric restraint use and compliance with pediatric passenger laws in Iowa by rurality and age., Methods: Fourteen years of Iowa observational pediatric restraint use data (2006-2019) are included in this cross-sectional study. Proportions of restrained youth by year, age, and rurality (rural, urban) were calculated. Log-linear models were used to compute the Annual Percent Change (APC) by year to explore trends in restraint use over time by rurality and by age group., Results: A total of 42,007 observed pediatric passengers with complete data from 2006 to 2019 were included in this study. Restraint use increased across all years and all age groups observed, with the largest increases among the older pediatric age groups. However, restraint use was consistently highest among the youngest child passengers. With all study years combined, the odds of being compliantly restrained were 13% lower in rural areas (OR = 0.87, 95% CI = 0.80, 0.95) compared to urban areas., Conclusions: Restraint use was lower in rural areas and among older pediatric passengers, suggesting targeted efforts to increase restraint use among these groups may have the greatest impact on overall occupant protection.

Introduction: Crash data suggest an association between driver seatbelt use and child passenger restraint. However, community-based restraint use is largely unknown. We examined the association between driver seatbelt use and child restraint using data from a state-wide observational study., Methods: Data from Iowa Child Passenger Restraint Survey, a representative state-wide survey of adult seat belt use and child passenger safety, were analyzed. A total of 44,996 child passengers age 0-17 years were observed from 2005 to 2019. Information about driver seatbelt use and child restraint was directly observed by surveyors and driver age was reported. Logistic regression was used to examine the association between driver seatbelt use and child restraint adjusting for vehicle type, community size, child seating position, child passenger age, and year., Results: Over the 15-year study period, 4,114 (9.1%) drivers were unbelted, 3,692 (8.2%) children were completely unrestrained, and another 1,601 (3.6%) children were improperly restrained (analyzed as unrestrained). About half of unbelted drivers had their child passengers unrestrained (51.8%), while nearly all belted drivers had their child passengers properly restrained (92.3%). Compared with belted drivers, unbelted drivers had an 11-fold increased odds of driving an unrestrained child passenger (OR = 11.19, 95%CI = 10.36, 12.09). The association between driver seatbelt use and child restraint was much stronger among teenage drivers. Unbelted teenage drivers were 33-fold more likely (OR = 33.34, 95%CI = 21.11, 52.64) to have an unrestrained child passenger., Conclusion: These data suggest that efforts to increase driver seatbelt use may also have the added benefit of increasing child restraint use. Practical applications: Enforcement of child passenger laws and existing education programs for new drivers could be leveraged to increase awareness of the benefits of seatbelt use for both drivers themselves and their occupants. Interventions aimed at rural parents could emphasize the importance of child safety restraints., (Published by Elsevier Ltd.)

Introduction: Rural crashes result in fatality rates twice as high as urban, after accounting for vehicle miles traveled, and those involving farm vehicles tend to be the most severe. Farm vehicle crash interventions have focused on the farm equipment (e.g., lighting and marking) or the farm vehicle operator (e.g., training), despite crashes being most frequently caused by other vehicle driver actions. Community-based campaigns focused on rural drivers have potential to influence driver behavior. The objective of this study was to describe the role, formation, and lessons learned from a community advisory board (CAB) in the development and dissemination of a community-based rural roadway safety campaign., Methods: The CAB provided campaign input through quarterly meetings and email. The campaign had three main CAB and crash data-informed messages: 1) Slow Down, 2) Leave More Space, and 3) Avoid Passing. The CAB led campaign activities to publicize the message, distribute swag, and organize event logistics. To evaluate CAB effectiveness and inform future community engagement efforts, we conducted in-depth, semi-structured telephone interviews with CAB members in July 2020. Interviews were transcribed, coded, and codes were categorized into five main themes., Results: Overall, CAB membership was described as an overwhelmingly positive experience in terms of the CAB structure, culture fostered among the group, responsibilities, and time commitment. Board members reported successful campaign implementation, gave positive feedback regarding the research team's engagement efforts, and provided valuable recommendations for future campaigns (e.g., adding social media components, expansion of CAB age and industry diversity, and increasing group bonding activities)., Conclusions: Results from this study demonstrate the instrumental role and logistics involved in engagement of community advisors for the development and implementation of a rural roadway safety campaign. Steps and lessons from this study can be applied to other community-level injury and violence prevention topics, with a particular focus on rural communities., Competing Interests: Declaration of competing interest The authors do not have any competing interests to declare.

Introduction: The aging population has been rapidly growing in the United States (U.S.). In line with this trend, older adults' mobility and transportation safety are an increasing priority. Many states have implemented driver licensure laws specific to older adults to limit driving among the elderly with driving skill decline. Evaluations of these laws have primarily focused on their safety benefits related to older drivers' fatal crash rate or injury rate. However, very few studies investigated licensure law effects on older adults' mobility., Objective: The objective of our study is to evaluate the association between older driver licensure laws and older adult daily traveling and passenger exposure., Methods: The 2003-2017 American Time Use Survey (ATUS) data were linked with statewide driver licensure law provisions. Adults aged 55-64 years were used as the reference group to control for the effects of non-licensure-law factors (e.g., economic trend). We used modified Poisson regressions with robust variance to estimate the relationships between licensure law provisions and the likelihoods of older men and women's daily traveling and passenger behaviors., Results: Laws requiring a vision test at in-person renewal were associated with increased daily traveling likelihood for women aged 75 years or older, primarily as a passenger. Laws requiring a knowledge test were related to a reduced daily overall traveling likelihood for women aged 75 years or older., Conclusions: In general, licensure law provisions are not strongly related to older adults' mobility, in particular for older male adults. Older female adults' daily mobility may be more likely to be influenced by the change of licensure laws than older male adults. The existence of gender-based disparities in responding to licensure laws requires future studies to account for the gender difference in estimating the effects of those traffic policies on older adults' mobility and traffic safety.

This randomized controlled trial evaluated the impact of integrating Steering Teens Safe, a parent communication intervention, with feedback from an in-vehicle video recording system. In-vehicle video systems that trigger a recording when the vehicle exceeds a g-force threshold have been used to provide feedback to young drivers. Few of these programs have involved parental engagement. Parent-teen dyads were randomized to three groups and 150 dyads completed the study. All groups received an in-vehicle video system that recorded driving events. The control group received no feedback or intervention. In the first intervention group, teens received real-time feedback, and parent-teen dyads received summary feedback, based on information recorded by the in-vehicle system. The second intervention group received the same feedback, plus parents were taught strategies to improve communication with their teen about safe driving. The primary outcome variable was unsafe driving event rates per 1000 miles driven and the primary independent variable was group assignment. Generalized linear models were used to calculate effect estimates. Compared with the control group, the Event Recorder Feedback group had a rate ratio of 0.35 (95% CI = 0.24 - 0.50) and the combined intervention group (Event Recorder Feedback and parent communication) had a rate ratio of 0.21 (95% CI = 0.15 - 0.30). Furthermore, the combined intervention group had a significantly lower event rate than the Event Recorder Feedback only group (rate ratio = 0.60, 95% CI = 0.41 - 0.87). While in-vehicle feedback systems can help reduce unsafe driving events in early independent driving, teaching parents strategies for effective communication with their young driver may further improve impact., (Copyright © 2019. Published by Elsevier Ltd.)

Introduction: Efforts to encourage bicycling to school have increased in the United States. However, little is known about how parent-child communication affects bicycle safety. The purpose of this study was to examine parent-child agreement on biking instructions and their correlation with the early adolescents' real-world riding behavior., Methods: Parent-child dyads were asked open-ended questions about instructions they had given/received about bicycling. Answers were then coded into nine categories (e.g., crossing the road, bicycle control/handling). Distributions of parent-child agreement on parent-given bicycle safety instructions were examined in relation to the adolescent's real-world riding behaviors., Results: 36 parent-child dyads were included. Average age was 11.9 (Range: 10-15) for adolescents and 43.3 (Range: 30-59) for parents. Common parental instructions included: wear helmet, ride on sidewalk, and trip routing specifications. High 'ride on sidewalk' instruction (38.9% both parent and adolescent, 22.2% parent only, 16.7% adolescent only) was concerning due to potential driveway conflicts. Agreement between parents and adolescents on reported instructions was low, overall. Mean safety-relevant event rates in real-world cycling did not differ significantly between bicycle safety instruction agreement groups (both parent & adolescent reported, parent only, adolescent only, neither). The proportion of time an adolescent rode on different infrastructure types (sidewalk, street, etc.) did not vary between dyads reporting parents had given instructions to ride on the sidewalk and those who had not., Conclusions: Results highlight lack of agreement between parents and adolescents on cycling instructions the adolescent receives from the parent. Parent instructions to adolescents regarding bicycling safety were not associated with actual riding behaviors. Results suggest parent messaging to adolescents may be ineffective. Given parents are in a position of influence, results indicate a need for parental training on effective safety-related communication strategies to assist them in capitalizing on their parental role to increase their child's safety., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

Objective: There are a plethora of child bicycle safety education programs worldwide. However, the content and durations vary widely from program to program and no gold standard has been established. The main objective of this project was to create an inventory of youth bicycle safety education programs and their content, approaches, and age and developmental considerations. Methods: Methods used to gather program information included web and online database searches, extraction from personal lists, and a widely distributed online survey. A total of 89 programs met inclusion criteria and were reviewed (78 from the United States and 11 from other countries). Results: Over half (56.2%) of the included programs were not explicitly age specific, meaning that the content was not appropriately designated by age and developmental cut points. Many programs had target age groups, but these were often very wide age ranges (e.g., all elementary school-age children) resulting in content too advanced for the youngest children. Only 12.4% of included programs had published program evaluations and their scientific rigor varied widely. Main results from this inventory revealed a weak evidence base for program effectiveness due to lack of program evaluations. Results also highlighted a need for age, development, and skill-level considerations in youth bicycle education programs. Conclusions: This study provides a comprehensive list of program components and approaches that can be used as a foundation upon which child bicycle education standards can be evaluated and built, with the long-term goal of increased childhood safety.

Among roadway users, bicyclists are considered vulnerable due to their high risk for injury when involved in a crash. Little is known about the circumstances leading to near crashes, crashes, and related injuries or how these vary by age and gender. The purpose of this study was to examine the rates and characteristics of safety-relevant events (crashes, near crashes, errors, and traffic violations) among adult and child bicyclists. Bicyclist trips were captured using Pedal Portal, a data acquisition and coding system which includes a GPS-enabled video camera and graphical user interface. A total of 179 safety-relevant events were manually coded from trip videos. Overall, child errors and traffic violations occurred at a rate of 1.9 per 100min of riding, compared to 6.3 for adults. However, children rode on the sidewalk 56.4% of the time, compared with 12.7% for adults. For both adults and children, the highest safety-relevant event rates occurred on paved roadways with no bicycle facilities present (Adults=8.6 and Children=7.2, per 100min of riding). Our study, the first naturalistic study to compare safety-relevant events among adults and children, indicates large variation in riding behavior and exposure between child and adult bicyclists. The majority of identified events were traffic violations and we were not able to code all risk-relevant data (e.g., subtle avoidance behaviors, failure to check for traffic, probability of collision). Future naturalistic cycling studies would benefit from enhanced instrumentation (e.g., additional camera views) and coding protocols able to fill these gaps., (Copyright © 2017 Elsevier Ltd. All rights reserved.)

Bicycling has become increasingly popular in the United States in recent years for both recreation and utilitarian purposes. Yet, attributes of the bicycle riding experience and riding differences between adults and children and males and females are not well documented. Most existing data on bicycling trip characteristics are based on self-reported interviews or surveys, which are prone to recall bias. The purpose of this exploratory study was to capture naturalistic bicycling data to examine trip characteristics and compare exposure classification accuracy between GPS and video data. We enrolled 10 children and 10 adults and captured their bicycling trips for one week each using PedalPortal, a GPS-enabled helmet camera data capture and coding system developed by the authors and a team of engineering students. Overall, 261 trips, 57 hours, and 670 miles of bicycling were captured. The video data allowed for correct classification of riding location (sidewalk, bicycle lane, street, etc.), an advantage over GPS data alone. Child trips were significantly shorter in both time and distance than adult trips (p<0.01). The majority of male trips were commutes (69.8% child, 60.5% adult), while female trips were more evenly distributed among commute, non-commute utilitarian, and recreation. Adults primarily chose paved streets with no bicycle facilities, but also sought out on-road bicycle facilities (bike lanes and shared lane markings). Children rode most frequently on sidewalks. Results from this study demonstrate that the addition of video data can improve classification of bicycling exposure and differences by age and gender that can help planners and engineers better understand bicyclist behavior variations and increase safety by selecting appropriate and targeted countermeasures.

Objective: The purpose of this study was to describe disaster preparedness strategies and behaviors among rural families who have children with special health care needs and to examine the effect of self-efficacy and response-efficacy on disaster preparedness., Methods: Data for this study were drawn from the baseline surveys of 287 rural families with children with special health care needs who were part of a randomized controlled trial examining the impact of an intervention on disaster preparedness. Distributions of child, parent, and family characteristics were examined by preparedness. Linear regression models were built to examine the impact of self-efficacy and response-efficacy on level of disaster preparedness., Results: Disaster preparedness (overall, emergency plan, discussion/practice, and supplies) was low (40.9-69.7%) among study families. Disaster preparedness was found to increase with each unit increase in the level of self-efficacy and family resilience sources across all 4 categories of preparedness., Conclusions: Disaster preparedness among rural families with children with special health care needs is low, which is concerning because these children may have increased vulnerability to adverse outcomes compared to the general population. Results suggest that increasing the levels of self-efficacy and family resilience sources may increase disaster preparedness.

Purpose: We critically reviewed recent parent-directed teen driving interventions to summarize their success in meeting stated goals; identify promising intervention components and knowledge gaps; aid in the selection, adaptation, and dissemination of effective interventions; and guide future research efforts., Methods: We focused on interventions that included a direct parent component, explicitly stated outcomes related to the teen and/or their parents, were evaluated for parent or teen outcomes, targeted drivers younger than the age of 21 years, and had at least one evaluation study published since 1990 and in English. We conducted a comprehensive systematic search of 26 online databases between November 2013 and January 2014 and identified 34 articles representing 18 interventions., Results: Several interventions-in particular, those that had an active engagement component, incorporated an in-vehicle data recorder system, and had a strong conceptual approach-show promise in improving parental supervisory behaviors during the learner and early independent phases, increasing teen driver skill acquisition, and reducing teens' risky driving behaviors., Conclusions: We identify essential characteristics of effective parent-involved teen driving interventions and their evaluation studies, propose a comprehensive and multitiered approach to intervention, and discuss several research areas and overarching issues for consideration., (Copyright © 2015 Society for Adolescent Health and Medicine. All rights reserved.)

Objectives: To examine pre-licensure agreement on driving expectations and predictors of teen driving expectations among parent-teen dyads., Methods: Cross-sectional survey of 163 parent-teen dyads. Descriptive statistics, weighted Kappa coefficients, and linear regression were used to examine expectations about post-licensure teen driving., Results: Teens reported high pre-licensure unsupervised driving (N = 79, 48.5%) and regular access to a car (N = 130, 81.8%). Parents and teens had low agreement on teen driving expectations (eg, after dark, κw = 0.23). Each time teens currently drove to/from school, their expectation of driving in risky conditions post-licensure increased (β = 0.21, p = .02)., Conclusions: Pre-licensure improvement of parent-teen agreement on driving expectations are needed to have the greatest impact on preventing teens from driving in high risk conditions.

Purpose: To determine whether simulation training of ultrasound (US)-guided central venous catheter (CVC) insertion skills on a partial task trainer improves cannulation and insertion success rates in clinical practice., Method: This prospective, randomized, controlled, single-blind study of first- and second-year residents occurred at a tertiary care teaching hospital from January 2007 to September 2008. The intervention group (n = 90) received a didactic and hands-on, competency-based simulation training course in US-guided CVC insertion, whereas the control group (n = 95) received training through a traditional, bedside apprenticeship model. Success at first cannulation and successful CVC insertion served as the primary outcomes. Secondary outcomes included reduction in technical errors and decreased mechanical complications., Results: Blinded independent raters observed 495 CVC insertions by 115 residents over a 21-month period. Successful first cannulation occurred in 51% of the intervention group versus 37% of the control group (P = .03). CVC insertion success occurred for 78% of the intervention group versus 67% of the control group (P = .02). Simulation training was independently and significantly associated with success at first cannulation (odds ratio: 1.7; 95% confidence interval: 1.1-2.8) and with successful CVC insertion (odds ratio: 1.7; 95% confidence interval: 1.1-2.8)--both independent of US use, patient comorbidities, or resident specialty. No significant differences related to technical errors or mechanical complications existed between the two groups., Conclusions: Simulation training was associated with improved in-hospital performance of CVC insertion. Procedural simulation was associated with improved residents' skills and was more effective than traditional training.

Purpose: To design an independent rater (IR) direct observation system to monitor invasive procedures performed by residents in the hospital setting., Method: The authors recruited, trained, and tested nonphysicians to become IRs for an Agency for Healthcare Research and Quality-funded study evaluating the impact of partial task simulation training of ultrasound-guided central venous catheter (CVC) insertion on skills transfer at a major academic medical center. IR applicants completed four hours of training: a two-hour didactic session and a two-hour testing session, including observation of 5 of 10 choreographed CVC insertion videotapes and completion of a 50-data-point procedural checklist. Eligibility to be hired as an IR included timing the procedure accurately, detecting technical errors and complications, and completing the procedural checklist accurately., Results: Thirty-eight IR trainees completed the training module and videotape examinations. Twenty-seven (71%) trainees met criteria to be hired IRs by accurately assessing the duration of the procedure to within one minute, validating the checklist to within 95% accuracy, and detecting technical errors/complications to within a 3% margin of error. The authors found no association between educational level and hired status, and all 13 IRs assessed after the study had maintained their skills., Conclusions: Recent innovations in procedural training with partial task simulation trainers necessitate developing methods to measure skills transfer from the simulator to the clinical setting. This description of a nonphysician IR direct observation system for CVC insertion offers a feasible tool that may be generalized to monitoring other invasive procedures.

Simulation allows educators to develop learner-focused training and outcomes-based assessments. However, the effectiveness and validity of simulation-based training in emergency medicine (EM) requires further investigation. Teaching and testing technical skills require methods and assessment instruments that are somewhat different than those used for cognitive or team skills. Drawing from work published by other medical disciplines as well as educational, behavioral, and human factors research, the authors developed six research themes: measurement of procedural skills; development of performance standards; assessment and validation of training methods, simulator models, and assessment tools; optimization of training methods; transfer of skills learned on simulator models to patients; and prevention of skill decay over time. The article reviews relevant and established educational research methodologies and identifies gaps in our knowledge of how physicians learn procedures. The authors present questions requiring further research that, once answered, will advance understanding of simulation-based procedural training and assessment in EM.

Introduction: Traumatic brain injuries are a major public health concern that contributes to youth morbidity and mortality in developing nations, including Ethiopia. Despite of this, little is known about head injury in the study area. The goal of the study was to identify the incidence, risk factors and outcomes for traumatic head injury among trauma patients who visited at the Yanet Trauma and Surgery Specialized Centre. Methods: This was a 5 year an institutional-based retrospective cohort study conducted among 1,029 patients who experienced trauma and admitted at the Yanet Trauma and Surgical Specialized Centre. The research was carried out between September 01/2023 to October 15/2023. The study units were selected by using simple random sampling techniques through computer-generated random numbers. The data were collected via a checklist designed on the Kobo toolbox with a smart smartphone. The collected data were exported to a statistical package for Social Science version 27. Then, descriptive statistical analysis was conducted to determine the mean, standard deviation, and median. Bivariate and multivariate logistic regression was subsequently conducted to determine the associations between head injury and the independent variables. Result: A total of 1,029 injured patients were followed for 2,302 person-days. Over all, incidence density rate of 14.03/100 person-days (323, 31.4%) [95% CI: 29.5–34%]. The third year of follow-up showed the greatest incidence compared to other years. The most common type of head injury observed during following up were brain contusion (38.1%), followed by epidural hematoma (33.1%), skull fracture (15.8%), and intracerebral hematoma (13.0%). In multivariate logistic model, rural residence [AOR = 1.6; 95% CI: 1.18–2.16], mechanism of injury namely road traffic accident [AOR = 5.5; 95% CI: 2.27–13.34], assault [AOR = 3.4; 95% CI: 1.35–8.37] and comorbidity of chronic disease [AOR = 2.2; 95% CI: 1.13–4.18] were the risk factors significantly associated with head injury. Discussions: The incidence density rate of 14.03/100 person-days. As the result, more has to be done by health professionals, traffic police officers and local government raise awareness and enforce the implementation of driving rules and regulations. [ABSTRACT FROM AUTHOR]

People with disabilities, especially children and youth, are often not considered in emergency and disaster preparedness planning, which leaves them vulnerable and at a higher risk of the negative effects of natural and human caused disasters. The purpose of this study was to understand the extent of emergency and disaster preparedness and factors influencing preparedness among children and youth with disabilities and chronic conditions, their caregivers and service providers. Our scoping review involved searching six international databases that identified 1146 studies of which 27 met our inclusion criteria. The studies in this review involved 2613 participants (i.e., children, parents, educators and clinicians) across nine countries over a 20-year period. Our results highlighted the following trends: (1) the extent of emergency preparedness; (2) factors affecting emergency preparedness; and (3) interventions to enhance preparedness. Our findings underscore the critical need for more attention to emergency preparedness for children and youth with disabilities, their families and service providers and their inclusion in planning. Support is needed for emergency preparedness for children with disabilities at an individual, family and community level. Clinicians should assist children with disabilities and their families to develop a disaster and emergency preparedness plan that includes their medical needs, basic supplies and connections to relevant resources and supports. Clinicians and educators should advocate for the inclusion of children and youth with disabilities in emergency and disaster preparedness. [ABSTRACT FROM AUTHOR]

Background: Teen drivers with a traffic violation are at increased risk for crashes and crash-related injuries; however, most parent-focused interventions target teen drivers with supervised learner's permits. Very few interventions are implemented at the probationary driver's license stage or target high-risk teen drivers, such as those with traffic violations. This paper describes the protocol of ProjectDRIVE, A Randomized Controlled Trial to Improve Driving Practices of High-Risk Teen Drivers with a Traffic Violation, which targets improving parent-teen communication about safe driving practices to reduce unsafe driving behaviors and traffic violation recidivism of teen drivers cited for traffic violation. Methods: Teen drivers (ages 16 or 17) cited for a moving violation and the parent/legal guardian most involved with the teen's driving are recruited from juvenile traffic courts following their required court hearing. After completing informed consent/assent, enrolled dyads are randomized into one of three groups using stratified block randomization: control, device feedback only, or device feedback plus parent communication training. Participating dyads are followed for 6 months with 3 months of active intervention. Using in-vehicle device and smartphone application technology, the study provides real-time and cumulative driving feedback to intervention teens and collects continually recorded, objectively measured driving outcome data throughout the teen's study participation. Primary outcomes include rates of risky driving events and unsafe driving behaviors per 1000 miles driven. Secondary outcomes include traffic violation recidivism up to 12 months following study completion and frequency and quality of parent-teen communication about safe driving practices. Discussion: Through partnership with the local juvenile traffic courts, this study integrates recruitment and randomization into existing court practices. Successfully completing this study will significantly impact juvenile traffic court's practices and policies by informing judges' decisions regarding the driving safety programs they refer to teens to prevent motor vehicle crashes and crash-related injuries and deaths. Trial registration The study was registered on ClinicalTrials.gov Registry (NCT04317664) on March 19, 2020, https://clinicaltrials.gov/study/NCT04317664 and updated on April 27, 2021. This protocol was developed per the SPIRIT (Standard Protocol Items: Recommendations for Interventional Trials) Checklist. [ABSTRACT FROM AUTHOR]

Background: The impact of young drivers' motor vehicle crashes (MVC) is substantial, with young drivers constituting only 14% of the US population, but contributing to 30% of all fatal and nonfatal injuries due to MVCs and 35% ($25 billion) of the all medical and lost productivity costs. The current best-practice policy approach, Graduated Driver Licensing (GDL) programs, are effective primarily by delaying licensure and restricting crash opportunity. There is a critical need for interventions that target families to complement GDL. Consequently, we will determine if a comprehensive parent-teen intervention, the Drivingly Program, reduces teens' risk for a police-reported MVC in the first 12 months of licensure. Drivingly is based on strong preliminary data and targets multiple risk and protective factors by delivering intervention content to teens, and their parents, at the learner and early independent licensing phases. Methods: Eligible participants are aged 16-17.33 years of age, have a learner's permit in Pennsylvania, have practiced no more than 10 h, and have at least one parent/caregiver supervising. Participants are recruited from the general community and through the Children's Hospital of Philadelphia's Recruitment Enhancement Core. Teen-parent dyads are randomized 1:1 to Drivingly or usual practice control group. Drivingly participants receive access to an online curriculum which has 16 lessons for parents and 13 for teens and an online logbook; website usage is tracked. Parents receive two, brief, psychoeducational sessions with a trained health coach and teens receive an on-road driving intervention and feedback session after 4.5 months in the study and access to DriverZed, the AAA Foundation's online hazard training program. Teens complete surveys at baseline, 3 months post-baseline, at licensure, 3months post-licensure, 6 months post-licensure, and 12 months post-licensure. Parents complete surveys at baseline, 3 months post-baseline, and at teen licensure. The primary end-point is police-reported MVCs within the first 12 months of licensure; crash data are provided by the Pennsylvania Department of Transportation. Discussion: Most evaluations of teen driver safety programs have significant methodological limitations including lack of random assignment, insufficient statistical power, and reliance on self-reported MVCs instead of police reports. Results will identify pragmatic and sustainable solutions for MVC prevention in adolescence. Trial Registration: ClinicalTrials.gov # NCT03639753. [ABSTRACT FROM AUTHOR]

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Background: Concerns regarding health equity (HE) and the built environment (BE) are well established in the Canadian urban context. Transport and injury prevention professionals across sectors, such as transportation and public health, are involved in designing and implementing BE interventions that enhance the safety of vulnerable road users (VRUs). Results from a larger study examining barriers and facilitators to BE change are used to illustrate how transport and injury prevention professionals perceive HE concerns in their work in five Canadian municipalities. Broadening our understanding of how HE influences the professional BE change context is crucial when advocating for modifications that enhance the safety of equity-deserving VRUs and groups who experience marginalization. Methods: Interview and focus group data were gathered from transport and injury prevention professionals working in policy/decision-making, transport, police services, public health, non-profit organizations, schools/school boards, community associations, and private sectors across five Canadian urban municipalities: Vancouver, Calgary, Peel Region, Toronto, and Montréal. Data were analyzed using thematic analysis (TA) to illustrate how equity considerations were perceived and applied in participants' BE change work. Results: The results of this study illustrate transport and injury prevention professionals' awareness of the varying needs of VRUs, as well as the inadequacies of current BEs in the Canadian urban context and consultation processes utilized to guide change. Participants emphasized the importance of equitable community consultation strategies, as well as specific BE changes that would support the health and safety of VRUs. Overall, the results highlight how HE concerns inform transport and injury prevention professionals' BE change work in the Canadian urban context. Conclusion: For professionals working in urban Canadian transport and injury prevention sectors HE concerns influenced their perspectives of the BE and BE change. These results illustrate a growing need for HE to guide BE change work and consultation processes. Further, these results contribute to ongoing efforts in the Canadian urban context to ensure that HE is at the forefront of BE policy change and decision-making, while promoting existing strategies to ensure that the BE, and related decision-making processes, are accessible and informed by a HE lens. [ABSTRACT FROM AUTHOR]

Children and youth with special healthcare needs (CYSHCN) are at disproportionate risk of harm from widespread disasters and from life-safety emergencies. These risks may be mitigated by providing preparedness training and support to family caregivers. We conducted a scoping review to identify and map the scholarly literature on home-focused preparedness of families with CYSHCN. Our search strategy yielded 22 relevant articles; 13 pertained to life-safety emergencies, 5 centered on widespread disasters, and 4 addressed preparedness on multiple scales. Approaches to measure or attempt to improve emergency preparedness levels in CYSHCN and their families were diverse and included interviews and focus groups; didactic, video-based, or side-by-side instruction; simulated medical crises; and provisioning of emergency kits. For the studies that involved an intervention (n=15, 68%), several proxy indicators of preparedness were used, including caregiver knowledge, skill, or comfort level with managing emergencies that could affect their CYSHCN; completion of preparedness tasks; and reduction in adverse clinical outcomes. Despite the varied methodologies, prevailing themes in the studies were that family caregivers of CYSHCN felt underprepared for emergencies and disasters, desired training to improve their preparedness at home, and benefited from such trainings, at least in the short term, across domains of self-efficacy, skill, and health outcomes of their CYSHCN. Although more research is needed to compare preparedness interventions and evaluate the durability of these interventions in larger, more diverse samples of CYSHCN and their families, our findings support incorporating preparedness training into preventive care encounters and the hospital-to-home transition. [ABSTRACT FROM AUTHOR]

Climate-driven disasters have disproportionate and often devastating consequences on individuals with disabilities. Warming ocean and air temperatures are fueling more extreme tropical cyclones, further endangering those living in at-risk regions. Although hurricane preparedness is particularly critical for those with functional impairments and/or special medical needs, studies show such persons are less ready for disasters than the general population. This review calls attention to the time-urgent need to improve hurricane readiness among persons with disabilities. It summarizes evidence that climate change is resulting in cyclonic storms that are increasingly jeopardizing the health and safety of affected persons and reflects on how this trend may compound the particular hardships those with disabilities experience during times of disaster. It identifies unique storm-related challenges faced by patient populations commonly cared for by physiatrists, including those with stroke, traumatic brain injury, multiple sclerosis, spinal cord injury, and limb loss. Available research pertaining to the gaps in emergency preparedness practices among persons with disabilities is reviewed as are potential strategies to mitigate barriers to achieving disaster readiness and resilience. Lastly, the review provides physiatrists with a comprehensive guide for optimally safeguarding their patients before, during, and after catastrophic hurricanes., (© 2024 The Authors. PM&R published by Wiley Periodicals LLC on behalf of American Academy of Physical Medicine and Rehabilitation.)

Background: Road traffic crashes (RTCs) are among the eight-leading causes of death globally. Strategies and policies have been put in place by many countries to reduce RTCs and to prevent RTCs and related injuries/deaths. Methods: In this review, we searched the following databases Ovid Medline, Embase, Cochrane Database of Systematic Reviews, Epistemonikos, Web of Science, and LILACS for reviews matching our inclusion criteria between periods January 1950 and March 2020. We did not apply language or publication restrictions in the searches. We, however, excluded reviews that focused primarily on injury prevention and reviews that looked at crashes not involving a motor vehicle. Results: We identified 35 systematic reviews matching our inclusion criteria and most of the reviews (33/35) included studies strictly from high-income countries. Most reviews were published before 2015, with only 5 published between 2015 and 2020. Methodological quality varied between reviews. Most reviews focused on enforcement intervention. There was strong evidence that random breath testing, selective breath testing, and sobriety checkpoints were effective in reducing alcohol-related crashes and associated fatal and nonfatal injuries. Other reviews found that sobriety checkpoints reduced the number of crashes by 17% [CI: (− 20, − 14)]. Road safety campaigns were found to reduce the numbers of RTCs by 9% [CI: (− 11, − 8%)]. Mass media campaigns indicated some median decrease in crashes across all studies and all levels of crash severity was 10% (IQR: 6 to 14%). Converting intersections to roundabouts was associated with a reduction of 30 to 50% in the number of RTCs resulting in injury and property damage. Electronic stability control measure was found to reduce single-vehicle crashes by − 49% [95% CI: (− 55, − 42%)]. No evidence was found to indicate that post-license driver education is effective in preventing road traffic injuries or crashes. Conclusion: There were many systematic reviews of varying quality available which included studies that were conducted in high-income settings. The overview has found that behavioural based interventions are very effective in reducing RTCs. [ABSTRACT FROM AUTHOR]

This study focused on Asian-Americans who have rarely been studied in previous disaster research and examined their disaster preparedness when they provided caregiving. Using a sample of 4316 individuals from the 2017 Federal Emergency Management Agency National Household Survey, linear regressions were performed to investigate racial differences in disaster preparedness of individuals with two types of caregiving responsibilities (i.e., 1) caring for children, and (2) caring for older adults or those with disabilities), as well as how access to preparedness-related information moderated such differences. The results showed that on average individuals who had children in their households reported better disaster preparedness, so did those who provided care for older or disabled family members or friends. But further examination with two-way interaction showed that this finding did not apply to Asians, among whom the caregivers of children were particularly disadvantaged with lower levels of preparedness relative to non-caregivers. Actually, Asian caregivers of children were the most disadvantaged group when compared to either caregivers or and non-caregivers of other races, namely White, African-American, and Native American. In addition, the vulnerability of Asian caregivers of children was magnified when there is a lack of information about how to get better prepared for disasters. The findings highlighted the uniqueness of the Asian population in disaster preparedness, their vulnerability to caregiving responsibilities, and the importance of information access. The findings could guide interventions and programs to serve and engage Asian communities in disaster planning and promote their disaster preparedness and resilience. [ABSTRACT FROM AUTHOR]

Introduction: Young driver behavior and safety are key concerns in Qatar, where they are disproportionately represented amongst road victims and fatalities. This paper summarizes the proceedings of a workshop, entitled 'Enhancing the Safety of Young and Novice Drivers in Qatar', held as a pre-conference workshop of the 24th World Congress of the International Traffic Medicine Association (ITMA) in Doha, Qatar. Methods: A guided discussion was conducted amongst a selected multi-sectoral group of 50 stakeholders, representing Law Enforcement, Health, Society and Education, Transport, and Road Safety. Each group discussed the best evidence and local realities of young driver safety in the State of Qatar. Using a modified Delphi approach, key areas were identified and prioritized; consensus recommendations were obtained and summarized. Results: Based on the stakeholders' discussions a list of twelve key recommendations has been developed and its elements have been classified in order of priority. These recommendations are supported by relevant published evidence as well as expert opinion and have been shared with the relevant authorities to inform future policies. Conclusions: This article summarizes the workshop presentations and the twelve key recommendations that arose from the discussions and put them forward to the concerned authorities. It should be emphasized that the concerned authorities concerned need to take action on at least the top three recommendations (GDL, improved police enforcement, and improved licensing and training), but also to prioritize all other recommendations that can be easily addressed such as improved roads and auditing and risk-based insurance. [ABSTRACT FROM AUTHOR]

Background: The systematic use of child restraint system (CRS) while driving has been promoted by the WHO to improve road safety.Objectives: To assess the levels of practice in CRS use for children aged ≤5 years among mothers attending the Well-baby clinics and to explore the associated factors and attitudes. Methods and Material: A cross-sectional study was conducted among mothers visiting the Well-baby clinics at five primary health care centers in Jeddah, Saudi Arabia, using a multistage stratified-cluster sampling. Practice in CRS was assessed by interviewing the participants regarding the availability of a CRS in their car, usage frequency for a child <5 years, and alternative child-sitting methods. Sociodemographic data, further road safety parameters, and attitudes were analyzed as independent factors of adequate practice using multivariate logistic regression. Results: Of the 192 included mothers, eight (4.2%) had a history of accident while driving with a child. Majority of the participants (62.5%) declared not having their cars equipped with a CRS and used inappropriate car-sitting methods. Of the 37.5% who had CRS in their cars, 27.1% declared using it always or frequently. Adequate practice in CRS was independently associated with mother's age (OR = 0.91, P = 0.09), low (OR = 0.10, P = 0.001) and moderate family income (OR = 0.23, P = 0.012), and the belief that CRS is not essential while driving with children (0.32, P = 0.023). Conclusions: There is inadequate practice in child road safety among families attending the Well-baby clinics in Western Saudi Arabia, which is associated with several misconceptions and negative attitudes towards the utility of CRS. [ABSTRACT FROM AUTHOR]

Mixed-criticality systems often need to fulfill safety standards that dictate different requirements for each criticality level, for example given in the 'probability of failure per hour' format. A recent trend suggests designing this kind of systems by jointly scheduling tasks of different criticality levels on a shared platform. When this is done, the usual assumption is that tasks of lower criticality are degraded when a higher criticality task needs more resources, for example when it overruns a bound on its execution time. However, a way to quantify the impact this degradation has on the overall system is not well understood. Meanwhile, to improve schedulability and to avoid over-provisioning of resources due to overly pessimistic worst-case execution time estimates of higher criticality tasks, a new paradigm emerged where task's execution times are modeled with random variables. In this paper, we analyze a system with probabilistic execution times, and propose metrics that are inspired by safety standards. Among these metrics are the probability of deadline miss per hour, the expected time before degradation happens, and the duration of the degradation. We argue that these quantities provide a holistic view of the system's operation and schedulability. [ABSTRACT FROM AUTHOR]

A large body of research has established that cellphone use while driving (CUWD) is common and dangerous. However, little research has been conducted about how people react psychologically to various distraction-reduction strategies and, ultimately, support or do not support them. Understanding support for reduction is important for predicting use of technological solutions and compliance with laws and for improving communication and education about the risks of CUWD. We measured support for a variety of legislative, technological, and organizational strategies to reduce CUWD in an online sample of American drivers (N = 648). We also developed evidence-based communication techniques, describing strategies in terms of benefits vs. costs or using freedom-invoking vs. freedom-reducing language to assess what would influence support. Support for CUWD reduction was generally high. It was predicted by driver characteristics and beliefs. For example, drivers who supported reducing CUWD more also had lower CUWD reactance, greater anti-CUWD beliefs, higher personal risk perceptions of CUWD, and greater self-reported distracted driving. Age and perceived ability to drive distracted did not predict overall support. However, two strategies that allow for handsfree phone use were supported more by people who engaged in more CUWD, perceived they had greater ability to CUWD, perceived more benefits to CUWD, had more positive affect to cellphones, and were younger. Communication techniques also influenced support. Specifically, the same strategy was supported more when described using benefits and permissive language instead of costs and restrictive language. Most respondents supported strategies to reduce CUWD, and beliefs about risks and benefits predicted this snupport. Reactance to CUWD messaging emerged as a key predictor of lower support (and of greater self-reported distracted driving), indicating that it could be an important variable to consider when designing strategies to reduce CUWD. When targeting people resistant to quitting CUWD entirely, communicators could recommend a switch to handsfree use. Communicators who emphasize benefits and use permissive language also may increase support for CUWD reduction. [ABSTRACT FROM AUTHOR]

Background: Placing a peripheral vein catheter can be challenging due to several factors, but using ultrasound as guidance increases the success rate. The purpose of this review is to investigate the knowledge already existing within the field of education in ultrasound-guided peripheral vein catheter placement and explore the efficacy and clinical impact of different types of education. Methods: In accordance with PRISMA-guidelines, a systematic search was performed using three databases (PubMed, EMBASE, CINAHL). Two reviewers screened titles and abstracts, subsequently full-text of the relevant articles. The risk of bias was assessed using the Cochrane Collaboration risk of bias assessment tool and the New Ottawa scale. Results: Of 3409 identified publications, 64 were included. The studies were different in target learners, study design, assessment tools, and outcome measures, which made direct comparison difficult. The studies addressed a possible effect of mastery learning and found e-learning and didactic classroom teaching to be equally effective. Conclusion: Current studies suggest a potential benefit of ultrasound guided USG-PVC training on success rate, procedure time, cannulation attempts, and reducing the need for subsequent CVC or PICC in adult patients. An assessment tool with proven validity of evidence to ensure competence exists and education strategies like mastery learning, e-learning, and the usage of color Doppler show promising results, but an evidence-based USG-PVC-placement training program using these strategies combined is still warranted. [ABSTRACT FROM AUTHOR]

Objectives. To quantify the impact of a citywide bicycle share program on rates of motor vehicle collisions involving a bicycle. Methods. We conducted an interrupted time series analysis, using crash records from the Pennsylvania Department of Transportation for Philadelphia County from 2010 through 2018. We also calculated summary statistics to illustrate annual and monthly trends in rates of motor vehicle crashes involving a bicycle. Results. The baseline rate of bike events was 106% greater (95% confidence interval [CI] = 1.25, 3.38) at the time bicycle share was implemented compared with January 2010. Before bicycle share implementation, the rate of bicycle events decreased 1% (95% CI = 0.95, 1.03) annually. After the bicycle share program started, the rate of bicycle events decreased 13% (95% CI = 0.82, 0.94) annually. Conclusions. In the long term, programs that increase the number of bicycles on the road, such as bike share, may reduce rates of motor vehicle crashes involving a bicycle. [ABSTRACT FROM AUTHOR]

National data suggest drivers who are younger, older, and have lower socioeconomic status (SES) have heightened crash-related injury rates. Ensuring vulnerable drivers are in the safest vehicles they can afford is a promising approach to reducing crash injuries in these groups. However, we do not know the extent to which these drivers are disproportionately driving less safe vehicles. Our objective was to obtain population-based estimates of the prevalence of important vehicle safety criteria among a statewide population of drivers. We analyzed data from the NJ Safety and Health Outcomes warehouse, which includes all licensing and crash data from 2010–2017. We borrowed the quasi-induced exposure method's fundamental assumption—that non-responsible drivers in clean (i.e., only one responsible driver) multi-vehicle crashes are reasonably representative of drivers on the road—to estimate statewide prevalence of drivers' vehicle characteristics across four driver age groups (17–20; 21–24; 25–64, and ≥65) and quintiles of census tract median household income (n = 983,372). We used NHTSA's Product Information Catalog and Vehicle Listing platform (vPIC) to decode the VIN of each crash-involved vehicle to obtain model year, presence of electronic stability control (ESC), vehicle type, engine horsepower, and presence of front, side, and curtain air bags. The youngest and oldest drivers were more likely than middle-aged drivers to drive vehicles that were older, did not have ESC, and were not equipped with side airbags. Additionally, across all age groups drivers of higher SES were in newer and safer vehicles compared with those of lower SES. For example, young drivers living in lowest-income census tracts drove vehicles that were on average almost twice as old as young drivers living in highest-income tracts (median [IQR]: 11 years [6–14] vs. 6 years [3–11]). Vehicle safety is an important component of seminal road safety philosophies that aim to reduce crash fatalities. However, driver groups that are overrepresented in fatal crashes—young drivers, older drivers, and those of lower SES—are also driving the less safe vehicles. Ensuring drivers are in the safest car they can afford should be further explored as an approach to reduce crash-related injuries among vulnerable populations. [ABSTRACT FROM AUTHOR]