Investigating driver injury severity patterns in rollover crashes using support vector machine models

Rollover crash is one of the major types of traffic crashes that induce fatal injuries. It is important to investigate the factors that affect rollover crashes and their influence on driver injury severity outcomes. This study employs support vector machine (SVM) models to investigate driver injury severity patterns in rollover crashes based on two-year crash data gathered in New Mexico. The impacts of various explanatory variables are examined in terms of crash and environmental information, vehicle features, and driver demographics and behavior characteristics. A classification and regression tree (CART) model is utilized to identify significant variables and SVM models with polynomial and Gaussian radius basis function (RBF) kernels are used for model performance evaluation. It is shown that the SVM models produce reasonable prediction performance and the polynomial kernel outperforms the Gaussian RBF kernel. Variable impact analysis reveals that factors including comfortable driving environment conditions, driver alcohol or drug involvement, seatbelt use, number of travel lanes, driver demographic features, maximum vehicle damages in crashes, crash time, and crash location are significantly associated with driver incapacitating injuries and fatalities. These findings provide insights for better understanding rollover crash causes and the impacts of various explanatory factors on driver injury severity patterns.     

Idiosyncratic Drug-Induced Liver Injury: Mechanistic and Clinical Challenges

Idiosyncratic drug-induced liver injury (IDILI) remains a significant problem for patients and drug development. The idiosyncratic nature of IDILI makes mechanistic studies difficult, and little is known of its pathogenesis for certain. Circumstantial evidence suggests that most, but not all, IDILI is caused by reactive metabolites of drugs that are bioactivated by cytochromes P450 and other enzymes in the liver. Additionally, there is overwhelming evidence that most IDILI is mediated by the adaptive immune system; one example being the association of IDILI caused by specific drugs with specific human leukocyte antigen (HLA) haplotypes, and this may in part explain the idiosyncratic nature of these reactions. The T cell receptor repertoire likely also contributes to the idiosyncratic nature. Although most of the liver injury is likely mediated by the adaptive immune system, specifically cytotoxic CD8+ T cells, adaptive immune activation first requires an innate immune response to activate antigen presenting cells and produce cytokines required for T cell proliferation. This innate response is likely caused by either a reactive metabolite or some form of cell stress that is clinically silent but not idiosyncratic. If this is true it would make it possible to study the early steps in the immune response that in some patients can lead to IDILI. Other hypotheses have been proposed, such as mitochondrial injury, inhibition of the bile salt export pump, unfolded protein response, and oxidative stress although, in most cases, it is likely that they are also involved in the initiation of an immune response rather than representing a completely separate mechanism. Using the clinical manifestations of liver injury from a number of examples of IDILI-associated drugs, this review aims to summarize and illustrate these mechanistic hypotheses.     

Fluoro-Photoacoustic Polymeric Renal Reporter for Real-Time Dual Imaging of Acute Kidney Injury

Photoacoustic (PA) imaging agents detect disease tissues and biomarkers with increased penetration depth and enhanced spatial resolution relative to traditional optical imaging, and thus hold great promise for clinical applications. However, existing PA imaging agents often encounter the issues of slow body excretion and low-signal specificity, which compromise their capability for in vivo detection. Herein, a fluoro-photoacoustic polymeric renal reporter (FPRR) is synthesized for real-time imaging of drug-induced acute kidney injury (AKI). FPRR simultaneously turns on both near-infrared fluorescence (NIRF) and PA signals in response to an AKI biomarker (γ-glutamyl transferase) with high sensitivity and specificity. In association with its high renal clearance efficiency (78% at 24 h post-injection), FPRR can detect cisplatin-induced AKI at 24 h post-drug treatment through both real-time imaging and optical urinalysis, which is 48 h earlier than serum biomarker elevation and histological changes. More importantly, the deep-tissue penetration capability of PA imaging results in a signal-to-background ratio that is 2.3-fold higher than NIRF imaging. Thus, the study not only demonstrates the first activatable PA probe for real-time sensitive imaging of kidney function at molecular level, but also highlights the polymeric probe structure with high renal clearance.     

Assessment of the static fit of automobile lap-belt systems on front-seat passengers

While automobile seat belts are recognized as reducing injury in frontal collisions, the lap belt can cause injury to the abdominal contents during impact. A lap belt which is malpositioned, i.e., above the anterior superior iliac spines (ASIS) of the pelvis before impact, is suggested as a causative factor in many of these injuries. A questionnaire was completed by 198 adult passengers on lap-belt fit as well as vehicle, anthropometric and behavioural factors. All measures were self-reported. The fit of automobile seat belts was also investigated in the laboratory to determine some of the factors thought important in the pre-impact position of the lap belt. Seven factors, subject size, subject sitting posture, clothing thickness, vehicle configuration, vehicle seat position, seat back angle and the handling of the belt by the occupant, were assessed on 51 subjects sitting in six simulated vehicles. The sample purposely included a disproportionate number of tall, short, heavy and thin subjects.

The questionnaire responses indicated that a high proportion (49%) of lap belts were found to be malpositioned in a normal sitting posture. Moving around in the seat, especially slouching, greatly increased the proportion of malpositions. It was noteworthy that wearing a heavy winter coat did not cause belt malposition. A high incidence of malpositioned lap belts was also found in the laboratory study with 42% of the belts having their centre-lines above the ASIS and 89% having part of the belt overlying the ASIS in a normal upright seated position with the seat in the middle of its fore/aft movement. Slouching in the seat significantly increased this proportion. The malposition rate was adversely affected by a forward seat position in a significant manner. There was a large increase in the malposition rate when the occupant attached the belt compared to when the experimenter attached it, with malposition rates of 43% and 19% respectively in the rearmost seat position. There was no statistically significant effect of clothing thickness on belt fit. Although statistically significant correlations between belt inclination and malposition were found, no clear-cut belt-angle existed above which satisfactory fit existed.     

Transfer of the horizontal patient: The effect of a friction reducing assistive device on low back mechanics

Recognizing that the transfer of bedridden patients is associated with a high rate of low back injuries, various devices have been developed to assist with sparing the patient handlers. The purpose of this study was to quantify the friction-reducing ability of three different ‘sliding’ patient transfer devices together with the subsequent consequences on the low back loads of people performing the transfers. Coefficients of friction of the devices were determined by ‘transferring’ a standard object and a ‘patient’ over several surfaces common to a hospital setting. Then three participants performed controlled transfers with the various devices. Electromyography to measure muscle activation levels together with external forces and kinematic positional data were collected during push, pull and twist transfers. Spine loads were estimated with a three-dimensional biomechanical static link-segment model of the human body. Simply sliding a patient on a cotton sheet (control condition) produced a coefficient of friction of 0.45. The assistive devices substantially reduced friction by well over one-half (coefficients of 0.18?–?0.21). However, when using the devices the subjects adopted a variety of postures and techniques, such that there were no consistent influences on trunk inclination, low back compression or muscle activation profiles. Direct measurement of reduced friction between the bed and the patient with a friction-reducing device together with measurement of the back loads when actually transferring a patient formed a proof of principle. Specifically, while the device lowers friction, the transfer technique adopted by the lifter must be proper to reduce low back loading and any subsequent risks of back troubles associated with patient transfers. The direction of hand forces and torso position remains important.     

The determinants of fishing vessel accident severity

The study examines the determinants of fishing vessel accident severity in the Northeastern United States using vessel accident data from the U.S. Coast Guard for 2001–2008. Vessel damage and crew injury severity equations were estimated separately utilizing the ordered probit model. The results suggest that fishing vessel accident severity is significantly affected by several types of accidents. Vessel damage severity is positively associated with loss of stability, sinking, daytime wind speed, vessel age, and distance to shore. Vessel damage severity is negatively associated with vessel size and daytime sea level pressure. Crew injury severity is also positively related to the loss of vessel stability and sinking.     

The response of the adult and ATD heads to impacts onto a rigid surface

Given the high incidence of TBI, head injury has been studied extensively using both cadavers and anthropomorphic test devices (ATDs). However, few studies have benchmarked the response of ATD heads against human data. Hence, the objective of this study is to investigate the response of adult and ATD heads in impact, and to compare adult Hybrid III head responses to the adult head responses.     

防止乘员受挥鞭伤害的汽车座椅设计及试验

针对挥鞭伤害对某车型座椅开发了主动式座椅靠背控制系统(ABCS),同时对座椅骨架和泡沫等结构进行设计优化。经过欧洲新车评价规程(Euro NCAP)挥鞭试验得出结论:主动式座椅靠背控制系统、座椅骨架和泡沫设计优化,均能提高Euro NCAP挥鞭试验成绩,降低对乘员的挥鞭伤害。     

Urban crash-related child pedestrian injury incidence and characteristics associated with injury severity

Objective

Describe age-based urban pedestrian versus auto crash characteristics and identify crash characteristics associated with injury severity.

Materials and methods

Secondary analysis of the 2004–2010 National Highway and Traffic Safety Administration database for Illinois. All persons in Chicago crashes with age data who were listed as pedestrians (n = 7175 child age ≤19 yo, n = 16,398 adult age ≥20 yo) were included. Incidence and crash characteristics were analyzed by age groups and year. Main outcome measures were incidence, crash setting, and injury severity. Multivariate logistic regression analysis was performed to estimate injury severity by crash characteristics.

Results

Overall incidence was higher for child (146.6 per 100,000) versus adult (117.3 per 100,000) pedestrians but case fatality rate was lower (0.7% for children, 1.7% for adults). Child but not adult pedestrian injury incidence declined over time (trend test p < 0.0001 for <5 yo, 5–9 yo, and 10–14 yo; p < 0.05 for 15–19 yo, p = 0.96 for ≥20 yo). Most crashes for both children and adults took place during optimal driving conditions. Injuries were more frequent during warmer months for younger age groups compared to older (χ²p < 0.001). Midblock crashes increased as age decreased (p < 0.0001 for trend). Most crashes occurred at sites with sub-optimal traffic controls but varied by age (p < 0.0001 for trend). Crashes were more likely to be during daylight on dry roads in clear weather conditions for younger age groups compared to older (χ²p < 0.001). Daylight was associated with less severe injury (child OR 0.93, 95% CI 0.87–0.98; adult OR 0.90, 95% CI 0.87–0.93).

Conclusion

The incidence of urban pedestrian crashes declined over time for child subgroups but not for adults. The setting of pedestrian crashes in Chicago today varies by age but is similar to that seen in other urban locales previously. Injuries for all age groups tend to be less severe during daylight conditions. Age-based prevention efforts may prove beneficial.     

依达拉奉对大鼠缺血再灌注心肌的保护作用

目的 探讨依达拉奉对心肌缺血再灌注的保护作用及机制.方法 将50只成年SD大鼠按随机数字表法分为假手术组、再灌注组、低剂量组、中剂量组和高剂量组,每组10只.建立大鼠急性缺血再灌注模型,描记术中心电图变化.假手术组：开胸,分离左冠状动脉并穿线,不结扎,旷置225 min;再灌注组：缺血45 min,再灌注3 h,灌注前1 min将生理盐水按0.2 mL·kg-1经右股静脉注入;低剂量组：再灌注前1 min,将依达拉奉按3 mg·kg-1经右股静脉注入;中剂量组：灌注前1 min将依达拉奉按6 mg·kg-1经右股静脉注入;高剂量组：灌注前1 min将依达拉奉按9 mg·kg-1经右股静脉注入.于再灌注末测定血清肌钙蛋白、心肌组织Ca2＋、SOD、MDA及Na＋-K＋-ATPase 、Ca2＋-ATPase的含量或活性.结果 再灌注组与低剂量组、中剂量组、高剂量组相比,再灌注后ST段回落程度较低、室性心律失常发作例数稍高,但4组间比较差异均无统计学意义（均P＞0.05）.低剂量组、中剂量组和高剂量组的血清肌钙蛋白明显低于再灌注组（均P＜0.05）;中剂量组、高剂量组及再灌注组血清肌钙蛋白明显高于假手术组（P＜0.05或P＜0.01）.与假手术组比较,再灌注组心肌组织MDA活性、Ca2＋含量明显增高,SOD活力及Na＋-K＋-ATP酶、Ca2＋-ATP酶活性明显降低（均P＜0.05）;与再灌注组比较,低剂量组、中剂量组和高剂量组的MDA活力及Ca2＋含量降低,SOD活力及Na＋-K＋-ATP酶、Ca2＋-ATP酶活性明显增加（均P＜0.05）.结论 在再灌注前注射依达拉奉可减轻心肌缺血再灌注损伤.其作用机制是有效地清除氧自由基、提高机体抗氧化应激能力.