Investigation of speed and trajectory of motorcycle riders at curved road sections of two-lane rural roads under diverse lighting conditions

INTRODUCTION

Vehicular accidents at horizontal curves are over-represented compared to accidents that occur at tangent sections. Investigations have been conducted aimed at identifying the major causes that result in higher accident risk, both in terms of severity and rate, at curved road sections. Excessive or abrupt changes in speeding and improper vertical position are cited as major factors of lane departure, whereas other factors (either human or environmental) have also been documented. However, most research involves 4-wheel vehicles rather than other modes of transport that behave differently. More specifically, while motorcyclist fatalities occur more frequently than passenger vehicles, when accounting for vehicle distance traveled only a limited number of research studies address their behavior at curved road sections.

METHOD

This paper presents the findings of field operational tests carried out by motorcyclists along two-lane rural roads with a wide range of horizontal curves using an instrumented motorcycle. Key objectives of the research included the conditions under which the motorcyclists differentiate their trajectory in regards to the direction of the horizontal curves, the correlation between the trajectory and the geometry of the road, and the impact of the lighting conditions on riders' behavior.

RESULTS

The research showed that motorcyclists tend to ride closer to the centerline of the road, neglect the hazards associated with dim lighting conditions, and maintain constant speed in the left hand and the right-hand horizontal curves.

Deriving a joint risk estimate from dynamic data collected at motorcycle rides

Making motorcycle rides safer by advanced technology is an ongoing challenge in the context of developing driving assistant systems and safety infrastructure. Determining which section of a road and which driving behaviour is "safe" or "unsafe" is rarely possible due to the individual differences in driving experience, driving style, fitness and potentially available assistant systems. This study investigates the feasibility of a new approach to quantify motorcycle riding risk for an experimental sample of bikers by collecting motorcycle-specific dynamic data of several riders on selected road sections. Comparing clustered dynamics with the observed dynamic data at known risk spots, we provide a method to represent individual risk estimates in a single risk map for the investigated road section. This yields a map of potential risk spots, based on an aggregation of individual risk estimates. The risk map is optimized to include most of the previous accident sites, while keeping the overall area classified as risky small. As such, with data collected on a large scale, the presented methodology could guide safety inspections at the highlighted areas of a risk map and be the basis of further studies into the safety relevant differences in driving styles.

Pediatric Traffic Injuries on Halloween in the United Kingdom: Prevalence and Injury Severity

The study results serve as a reminder for parents, children, and drivers to be alert to the danger of traffic crashes on Halloween. The aim of this study was to examine whether Halloween is associated with a higher incidence of traffic injuries and whether traffic injuries sustained on Halloween are more severe than those sustained on other days. The U.K. STATS19 database, including the data of all road traffic crashes occurring from 1990 to 2017, was employed. A total of 73,587 pediatric traffic casualties (involving pedestrians, cyclists, and moped riders) were included. Between 17:00 and 19:00 (17:00~18:59) on Halloween, the number of casualties was higher than that on other public holidays and usual days. The logistic regression model revealed that, between 17:00 and 18:00 (17:00~17:59), the risk of being killed or seriously injured on Halloween was 34.2% higher (odds ratio = 1.342; 95% CI = 1.065–1.692) than that on other days. Pediatric crashes occurring on Halloween are associated with a higher number of injuries and increased injury severity.

Motorcycle Autonomous Emergency Braking (MAEB) employed as enhanced braking: Estimating the potential for injury reduction using real-world crash modeling

OBJECTIVE

Recent field-tests on Motorcycle Autonomous Emergency Braking system (MAEB) showed that higher levels of deceleration to improve its effectiveness were feasible. However, the potential of MAEB in mitigating rider injuries is not well understood, particularly in scenarios where the efficacy of standard MAEB is limited because the rider is manually braking. The purpose of this study was first, to assess the injury mitigation potential of MAEB and second, to test MAEB as an enhanced braking system applied in circumstances where the rider is braking before a crash.

METHODS

Data from previously investigated motorcycle injury crashes that occurred on public roads in Victoria, Australia were reconstructed using a 2D model. The intervention of MAEB was applied in the simulations to test both MAEB standard and MAEB working as enhanced braking system. The effects of MAEB in mitigating crashes were separated by crash configuration and evaluated based on the modeled reductions in impact speed and injury risk, employing injury risk functions available in the literature.

RESULTS

After modeling was applied, MAEB was found to be applicable in 30 cases (91% of those in which was estimated as "possibly applicable"). The modeled Impact Speed Reduction (ISR) among the 30 cases averaged 5.0 km/h. In the cases without manual braking, the mean ISR due to standard MAEB was 7.1 km/h, whereas the relative injury risk reduction ranged from 10% for MAIS2+ to 22% for fatal injuries. In the 14 cases with manual braking, the modeled application of MAEB as enhanced braking led to an average ISR ranging from 5.3 km/h to 7.3 km/h. This resulted in an injury risk reduction ranging from 9% to 12% for MAIS2+ and from 16% to 21% for fatal injuries, depending on the different modes of MAEB.

CONCLUSIONS

This study modeled the potential benefits of the highest levels of intervention for MAEB field-tested to date. The findings estimate the degree to which MAEB could mitigate motorcycle crashes and reduce injury risks for motorcyclists. New strategies for MAEB intervention as enhanced braking were modeled through crash simulations, and suggest improvements in the benefits of MAEB when riders are braking before the crash. This highlighted the requirement to perform new field-based tests to assess the feasibility of MAEB deployed as enhanced braking system.

Mortality following severe liver trauma is declining at Auckland City Hospital: a 14-year experience, 2006-2020

INTRODUCTION

Liver injuries sustained in blunt and penetrating abdominal trauma may cause serious patient morbidity and even mortality.

AIM

To review the recent experience of liver trauma at Auckland City Hospital, describing the mechanism of injury, patient management, outcomes and complications.

METHODS

A retrospective cohort study was performed, including all patients admitted to Auckland City Hospital with liver trauma identified from the trauma registry. Patient clinical records and radiology were systematically examined.

RESULTS

Between 2006-2020, 450 patients were admitted with liver trauma, of whom 92 patients (20%) were transferred from other hospitals. Blunt injury mechanisms, most commonly motor-vehicle crashes, predominated (87%). Stabbings were the most common penetrating mechanism. Over half of liver injuries were low risk American Association for the Surgery of Trauma (AAST) grade I and II (56%), whereas 20% were severe grade IV and V. Non-operative management was undertaken in 72% of patients with blunt liver trauma and 92% of patients with penetrating liver trauma underwent surgery. Liver complications occurred in 11% of patients, most commonly bile leaks (7%), followed by delayed haemorrhage (2%). Thirty-two patients died (7%), with co-existing severe traumatic brain injury as the leading cause of death. There was a significant reduction in death from haemorrhage in patients with grade IV and V liver trauma between the first and second half of the study period (p=0.0091).

CONCLUSION

Although the incidence and severity of liver trauma at Auckland City Hospital remained stable, there was a reduction in mortality, particularly death as a result of haemorrhage.

Muscle Fatigue When Riding a Motorcycle: A Case Study

This case study was conducted to assess muscle pattern, as measured by surface electromyography (sEMG), and its changes during a controlled superbike closed-road track training session. The sEMG signals were recorded unilaterally from biceps brachii (BB), triceps brachii (TB), anterior and posterior part of the deltoid (DA and DP respectively), flexor digitorum superficialis (FS), extensor carpi radialis (CR), extensor digitorum communis (ED) and pectoralis major (PM) during three rounds of 30 min. sEMG signals selected for analysis came from the beginning of the braking action to the way-out of the curves of interest. Considering the laps and rounds as a whole and focusing on the forearm muscles, ED was more systematically (84%) assigned to a state of fatigue than FS (44%) and CR (39%). On the opposite, the TB and DP muscles showed a predominant state of force increase (72%). Whereas the BB showed alternatively a state of fatigue or force increase depending on the side of the curve, when taking into account only the sharpest curves, it showed a predominant state of force increase. In conclusion, the fact that forearm muscles must endure a long-lasting maintenance of considerable activity levels explains why they easily got into a state of fatigue. Moreover, TB and DA are particularly relevant when cornering.

Reconstruction of Posttraumatic Nasal Defect Through Paramedian Frontal Flap

ABSTRACT

Facial injuries caused by motorcycle accidents represent a challenge for reconstructions. Currently, the most indicated treatment for facial fractures is anatomical reduction and internal fixation, however, this procedure is not exempt from complications, such as infection and exposure of osteosynthesis material, thus requiring a new surgical procedure and repair. In this study, the authors describe a case of a 60-year-old woman who was the victim of a motorcycle accident and developed exposure of osteosynthesis material on the nasal dorsum after treatment of facial fractures. The patient underwent surgical treatment with objective of removing the osteosynthesis material and associated infected tissue, as well as reconstruction using a paramedian frontal flap, which resulted in a harmonic relationship and skin color similar to the recipient area. This case shows the importance of anatomical knowledge and reconstructive techniques for hard and soft tissues.

Improving motorcycle motion perception by using innovative motorcycle headlight configurations: Evidence from simulator and test-track experiments

Many motorcycle accidents occur at intersections and are caused by other vehicle drivers who misperceive the speed and time-to-arrival of an approaching motorcycle. The two experiments reported here tested different motorcycle headlight configurations likely to counteract this perceptual failure. In the first experiment, conducted on a driving simulator, car drivers turned left in front of cars and motorcycles approaching an intersection under nighttime lighting conditions. The motorcycles were equipped with either a standard white central light, or one of three vertical configurations of white and yellow lights. The results showed that the standard configuration led to significantly more unsafe accepted gaps than the vertical configurations. In the second experiment, conducted on a test track using a similar task, the most promising motorcycle headlight configuration, i.e., the vertical yellow-white light arrangement (one central white light, plus one yellow light on the helmet and two yellow lights on the fork) was evaluated and compared to a standard configuration and a car. The vertical yellow-white headlight configuration again provided significant safety benefits as compared to the standard configuration. These findings demonstrate that motorcycle safety can be improved by headlight ergonomics that accentuate the vertical dimension of motorcycles. They also suggest that the driving simulator is a valid tool for conducting research on motorcycle headlight design.

SPECTRAL DOMAIN OPTICAL COHERENCE TOMOGRAPHY FINDINGS IN A CASE OF WHIPLASH MACULOPATHY WITH INCOMPLETE RESOLUTION

PURPOSE

To report spectral domain optical coherence tomography (OCT) findings of a patient who experienced bilateral visual loss after a motorcycle accident.

METHODS

A 51-year-old man presented to the emergency department complaining of bilateral visual loss after a motorcycle falling down. A complete ophthalmologic examination and OCT testing were made on the same day of the accident. Follow-up was made at 2 days, 2 weeks, 5 months, and 12 months adding central visual field assessment using Humphrey automated perimetry.

RESULTS

At presentation, best-corrected visual acuity was 20/200 in both eyes, anterior segment was normal, and fundus examination showed a bilateral macular edema confirmed by OCT. After 2 days, visual acuity recovered to 20/25. Optical coherence tomography findings showed foveal detachment, hyperreflective clump below external limiting membrane, and hyperreflectivity of Henle layer nasally to the fovea. After 15 days, visual acuity was 20/20, but vision was altered by a paracentral scotoma and some irregularities of OCT findings persisted. At 1 year of follow-up, best-corrected visual acuity was 20/20, and paracentral scotoma was very tiny in the right eye, whereas larger and deeper in the left eye. Optical coherence tomography was normal in the right eye, whereas some fragmentations of interdigitation zone were still evident in the left eye.

CONCLUSION

We report a case of bilateral whiplash maculopathy from vitreoretinal traction subsequent to road traffic accident. After 1 year of follow-up, visual acuity was restored but paracentral scotoma persisted. Optical coherence tomography appearance of the left eye was still abnormal.

Sphenoid sinus pseudoaneurysm with carotid cavernous fistula presenting with delayed subarachnoid hemorrhage: A case report

RATIONALE

Sphenoid sinus pseudoaneurysm arising from the cavernous segment of the internal carotid artery (ICA) caused by traumatic vessel injury is rare, and rarer is a concomitant carotid-cavernous fistula (CCF). In particular, delayed subarachnoid hemorrhage (SAH) due to pseudoaneurysm rupture has not been reported to-date in literature. Here, we report a case of sphenoid sinus pseudoaneurysm with CCF presenting with delayed SAH.

PATIENT CONCERNS

A 73-year-old man presented with traumatic brain injury due to motorcycle accident.

DIAGNOSES

Twenty-four days after admission, the patient's neurological status suddenly deteriorated. Brain computed tomography (CT) showed acute SAH along interhemispheric cisterns and suprasellar intracerebral hematoma. Brain CT angiography and digital subtraction angiography revealed giant sphenoid sinus pseudoaneurysm with CCF and the daughter sac of the pseudoaneurysm extended to the intracranial part via fracture in the superior wall of the sphenoid sinus.

INTERVENTIONS

As the sphenoid sinus pseudoaneurysm and CCF shared one rupture point, endovascular treatment with intraarterial approach using coil and liquid embolic material by balloon assisted technique was performed simultaneously.

OUTCOMES

The origin of the pseudoaneurysmal sac and CCF was sufficiently blocked after injection of liquid embolic material and the lesions completely resolved immediately after endovascular treatment.

LESSONS

Sphenoid sinus pseudoaneurysm and CCF rarely occur following head trauma through a series of processes involving fracture of the lateral wall of the sphenoid sinus and ICA cavernous segment injury. Sphenoid sinus pseudoaneurysm may present as SAH through intracranial rupture with concomitant superior wall fracture of the sphenoid sinus. Therefore, early diagnosis using CT or magnetic resonance angiography and appropriate treatment through understanding the disease mechanism is necessary.

Investigation of the speeding behavior of motorcyclists through an innovative smartphone application

OBJECTIVE

The objective of the present study is twofold: (i) to explore the riding behavior of motorcyclists while speeding, based on detailed riding analytics collected by smartphone sensors, and (ii) to investigate whether personalized feedback can improve motorcyclist behavior.

METHODS

In order to achieve the objective, a naturalistic riding experiment with a sample of 13 motorcyclists based on a smartphone application developed within the framework of the BeSmart project was conducted. Using risk exposure and riding behavior indicators calculated from smartphone sensor data, Generalized Linear Mixed-Effects Models are calibrated to correlate the percentage of riding time over the speed limit with other riding behavior indicators. An overall model was developed for all trips, as well as separate models for the parts of trips realized on different road types (urban and rural).

RESULTS

Results indicate that the parameters of trip duration, distance driven during risky hours, morning peak hours and the number of harsh accelerations are all determined as statistically significant and positively correlated with the percentage of speeding time. Additionally, the provision of rider feedback and riding during afternoon peak hours are statistically significant and correlated with decreased percentages of speeding time.

CONCLUSIONS

The outcomes of this study entail both scientific and social impacts. The present research contributes a preliminary example of the quantitative documentation of the impact of personalized rider feedback on one of the most important human risk factors; speeding. The ultimate objective when providing feedback to riders is to: (i) trigger their learning and self-assessment process, thus enabling them to gradually improve their performance and (ii) monitor the shift of riding behavior as the application provides feedback. The present results capture and quantify the positive effects of rider feedback, thus providing needed impetus for larger-scale applications as well as relevant policy interventions.

The Pattern of Injuries Among Motorcyclists in Fatal Road Traffic Accidents: An Autopsy-Based Study

INTRODUCTION

In recent years, there has been a significant increase in mortality among motorcyclists, which warrants a need to analyze the epidemiology and pattern of injuries among road users in Malaysia. Hence, prioritizing road safety in the government policy by implementing targeted actions is justified to reduce injury and fatality.

MATERIALS AND METHODS

Cases of road accident deaths in motorcyclists received by UKM Medical Centre were studied over a period of 10 years, that is, between 2010 and 2019. This study was based on forensic autopsy records database and forensic autopsy.

RESULTS

The most affected age group by road fatalities were young men. The most common injuries were intracranial hemorrhage (74%), thoracic hemorrhage (73%), and lung laceration (85.7%). About 39 (31%) fatally injured riders were positive for illicit drug and/or alcohol.

CONCLUSIONS

This study showed that men in the third decade of life are the major victims of motorcycle fatalities. Hence, urgent measures are necessary to establish road safety policy to reduce such fatalities.

Risky behaviors, psychological failures and kinematics in vehicle-to-powered two-wheeler accidents: Results from in-depth Chinese crash data

As the use of powered two-wheeler (PTW) becomes increasingly prevalent, PTW accidents are emerging as a major threat to the people's life and property in China. Understanding the risky behaviors, psychological failures and kinematics in vehicle-to-PTW accidents is an important first step in addressing this issue. Here 69 vehicle-to-PTW accidents captured on video from the Traffic Accident Investigation and Research in China (TAIRC) database are selected and reconstructed. All accidents are categorized into different crash scenarios using a harmonized method. Accident causations are identified from the perspectives of praxeology and psychology. Kinematics characteristics, such as impact speed and relative position, are also analyzed. The results show the crossing accident bundle is the most frequent followed by rear, oncoming and run-up accident bundles, with proportions of 43.48 %, 27.54 %, 11.59 % and 17.39 % respectively. Accident causations of different crash scenarios have great differences whether in accident responsibilities or in psychological failures. For instance, the PTW riders who violate the traffic regulations need to be mainly responsible for most crossing accidents, whereas most rear accidents are blamed on drivers who fail to properly check their mirrors when they turn, turn around or change lanes. From the perspective of psychology, the perception failures encountered by both drivers and riders are a typical causation in crossing accidents, while it is a contributing factor in rear accidents that a failure of prognosis from the rider combined with a failure of perception from the driver. Visual obstruction exists widely in crossing and oncoming accident bundles. The impact speeds of vehicles and PTWs are often less than 40 km/h in all accident bundles. A wider sensing area (field of view = 90°, view detection range = 35 m) should be achieved to more effectively detect the conflict PTWs. These findings about vehicle-PTW accidents provide a stronger support for the development of prevention countermeasures and advanced driver assistance system.

The effectiveness of different types of motorcycle helmets - A scoping review

BACKGROUND

Protective helmets may reduce the risk of death and head injury in motorcycle collisions. However, there remains a large gap in knowledge regarding the effectiveness of different types of helmets in preventing injuries.

OBJECTIVE

To explore and evaluate the effectiveness of different types of motorcycle helmets; that is the association between different helmet types and the incidence and severity of head, neck, and facial injuries among motorcyclists. Also, to explore the effect of different helmet types on riders.

METHODS

A systematic search of different scientific databases was conducted from 1965 to April 2019. A scoping review was performed on the included articles. Eligible articles were included regarding defined criteria. Study characteristics, helmet types, fixation status, retention system, the prevention of injury or reduction of its severity were extracted.

RESULTS

A total of 137 studies were included. There was very limited evidence for the better protection of full-face helmets from head and facial injury compared to open-face and half-coverage helmets. There was however scarce evidence for the superiority of a certain helmet type over others in terms of protection from neck injury. The retention system and the fixation status of helmets were two important factors affecting the risk of head and brain injury in motorcyclists. Helmets could also affect and limit the riders in terms of vision, hearing, and ventilation. Multiple solutions have been discussed to mitigate these effects.

CONCLUSION

Full-face helmets may protect head and face in motorcycle riders more than open-face and half-coverage helmets, but there is not enough evidence for better neck protection among these three helmet types. Helmets can affect the rider's vision, hearing, and ventilation. When designing a helmet, all of these factors should be taken into account.

A comparative study of machine learning classifiers for injury severity prediction of crashes involving three-wheeled motorized rickshaw

Motorcycles and motorcyclists have a variety of attributes that have been found to be a potential contributor to the high liability of vulnerable road users (VRUs). Vulnerable Road Users (VRUs) that include pedestrians, bicyclists, cycle-rickshaw occupants, and motorcyclists constitute by far the highest share of road traffic accidents in developing countries. Motorized three-wheeled Rickshaws (3W-MR) is a popular public transport mode in almost all Pakistani cities and is used primarily for short trips to carry passengers and small-scale goods movement. Despite being an important mode of public transport in the developing world, little work has been done to understand the factors affecting the injury severity of three-wheeled motorized vehicles. Crash injury severity prediction is a promising research target in traffic safety. Traditional statistical models have underlying assumptions and predefined associations, which can yield misleading results if flouted. Machine learning(ML) is an emerging non-parametric method that can effectively capture the non-linear effects of both continuous and discrete variables without prior assumptions and achieve better prediction accuracy. This research analyzed injury severity of three-wheeled motorized rickshaws (3W-MR) using various machine learning-based identification algorithms, i.e., Decision jungle (DJ), Random Forest (RF), and Decision Tree (DT). Three years of crash data (from 2017 to 2019) was collected from Provincial Emergency Response Service RESCUE 1122 for Rawalpindi city, Pakistan. A total of 2,743 3W-MR crashes were reported during the study period that resulted in 258 fatalities. The predictive performance of proposed ML models was assessed using several evaluation metrics such as overall accuracy, macro-average precision, macro-average recall, and geometric means of individual class accuracies. Results revealed that DJ with an overall accuracy of 83.7 % outperformed the DT and RF-based on a stratified 10-fold cross-validation approach. Finally, Spearman correlation analysis showed that factors such as the lighting condition, crashes involving young drivers (aged 20-30 years), facilities with high-speed limits (over 60 mph), weekday, off-peak, and shiny weather conditions were more likely to worsen injury severity of 3W-MR crashes. The outcomes of this study could provide necessary and essential guidance to road safety agencies, particularly in the study area, for proactive implementation of appropriate countermeasures to curb road safety issues pertaining to three-wheeled motorized vehicles.

Ptosis after motorcycle accident

A motorcycle accident precipitated by a health emergency led to loss of eye function. Advanced imaging revealed the diagnosis.

Osteomuscular symptoms on motorcycles in the city of Rio Branco, Acre, Brazil, West Amazon

ABSTRACT

Musculoskeletal disorders gradually affect workers in different parts of the world, compromising their occupational health and quality of life. Professionals exposed to these symptoms include the motorcycle taxi driver, whose pain is due to the overuse of the musculoskeletal system and little time to recover it.To identify the prevalence of musculoskeletal symptoms in motorcycle taxi drivers in the city of Rio Branco, Acre, Brazil, West Amazon.Cross-sectional study, involving 296 motorcycle taxi drivers in the city of Rio Branco-Acre, Brazil, male, from December 2016 to February 2017. The Nordic Musculoskeletal Questionnaire was used to collect information related to symptoms (pain, discomfort, or numbness) in the last 7 days of work. For the exclusion criteria were, being female; not reside outside the city of Rio Branco, Acre; having less than 3 months of work activity; not be carrying out their work activities at the time of application of the protocol; be limited by clinical or physical issues at the time of application of the protocol. The data obtained in the questionnaire were entered into the Epidata program (Epidata Association, Odense, Denmark) and then transferred to the STATA 10 statistical program (Stata Corp., College Station), for categorization and statistical analysis.The study population is over 36 years old; most reported having a partner and a higher education level. The average daily working hours of the participants were 12 hours, with the majority working over 12 hours daily. Most of the epidemiological variables factors were associated with musculoskeletal pain when the prevalence and prevalence ratio analyzes were performed. Higher prevalence of musculoskeletal symptoms in the lumbar region is with 17.9%. In the lower limbs, the most affected joint was the ankle (5.7%), followed by the hip (5.07%) and knee (5.07%), respectively. Insomnia was present in 55.35% and self-reported headache in 49.4% of participants.The musculoskeletal disorders generated by the daily service of motorcycle taxi drivers are directly affecting the quality of life of these professionals.

Assessment of Benchmark Dose in BEAS-2B Cells by Evaluating the Cell Relative Viability with Particulates in Motorcycle Exhaust via the Air-liquid Interface Exposure

OBJECTIVE

This study aimed to use an air-liquid interface (ALI) exposure system to simulate the inhalation exposure of motorcycle exhaust particulates (MEPs) and then investigate the benchmark dose (BMD) of MEPs by evaluating cell relative viability (CRV) in lung epithelial BEAS-2B cells.

METHODS

The MEPs dose was characterized by measuring the number concentration (NC), surface area concentration (SAC), and mass concentration (MC). BEAS-2B cells were exposed to MEPs at different concentrations via ALI and CRV was determined using Cell Counting Kit (CCK-8) assay. BMD software was applied to calculate BMD and the lower limit of benchmark dose (BMDL) according to Akaike Information Coefficient (AIC), with P-value based on Hill, Linear, Polynomial, and Power model.

RESULTS

Our results reveal that BMD of NC and SAC were estimated by the best-fitting Hill model, while MC was estimated by Polynomial model. The BMDL for CRV following ALI exposure to MEPs were as follows: 364.2#/cm ³ for NC; 0.662 × 10 ⁷ nm ²/cm ³ for SAC; and 0.278 μg/m ³ for MC.

CONCLUSION

These results indicate that MEPs exposure via ALI system induces a dose-dependent decrease of CRV and provides the potential exposure threshold of MEPs in a lung cell model.

Prioritizing Injury Prevention: Cause of Injury Text Analysis

BACKGROUND

Motor vehicle (MVCs) and motorcycle crashes (MCCs) continue to be among the most prevalent mechanisms of trauma injury and mortality. We sought to identify specific populations and factors associated with MVCs and MCCs for local injury prevention efforts. A novel, yet easily performed, research method was utilized-a qualitative content analysis of text narratives describing each patient's cause of injury.

OBJECTIVE

To determine target populations for local MVC and MCC injury prevention.

METHODS

A retrospective descriptive analysis was performed using registry data from a Level I trauma center. The registry was queried for all trauma patients presenting with MVC or MCC injuries between June 8, 2014, and June 7, 2019. Cases were then reviewed via their respective text narratives of injury causation. Common themes were identified, coded by independent raters, and assessed for interrater reliability using Cohen's κ. Frequencies and proportions are reported for each preventable factor and patient characteristic.

RESULTS

There were a total of 2,861 cases studied, of which 2,330 (81.4%) were MVC and 531 (18.6%) were MCC. Demographics varied by mechanism of injury. Driver drug or alcohol use was involved in 97 (3.4%), protective devices were not used in 776 (27.1%), distracted driving was involved in 30 (1%), excessive speeding was involved in 152 (5.3%), and driver sleeping/syncope/medical condition was present in 113 (3.9%) cases.

CONCLUSIONS

Content analysis of cause of injury text narratives can detect target populations and preventable factors to direct injury prevention efforts specific to the local population.

Epidemiology of upper limb chronic exertional compartment syndrome (CECS) in the French Motorcycle Federation racers: Results of a national questionnaire-based study

Upper limb chronic exertional compartment syndrome (CECS) has been described in amateur and professional motorcycle racers, but there is no published data about its prevalence. The purpose of this study was to define the awareness, prevention and prevalence of this syndrome in licensed motorcycle racers in competition in France. Secondary purposes were to determine the functional impact of CECS and post-treatment outcomes. The 20,641 licensed racers in competition of the French Motorcycle Federation were sent a self-assessment questionnaire about upper limb pain and CECS physical examination findings, functional impact and treatment outcomes. The satisfaction level was assessed after each type of treatment. Acceptability rate was 6.35% with 1311 racers responding. CECS was unknown by 29% of racers. Prevention methods were unknown by 10% of racers. Less than 50% of racers modified their bikes. The prevalence of upper limb CECS in competitive racers was 9%: 8.7% forearm, 0.2% thenar, 0.1% hypothenar and 0.4% first dorsal interosseus compartments. The prevalence was 16% in international level racers, 11% in national level racers and 7.3% in regional level racers. A quarter of racers were satisfied or very satisfied with the outcomes of conservative therapy and rehabilitation. Only 67 racers underwent surgical treatment for their upper limb CECS: 31 by open fasciotomy, 23 by minimally invasive fasciotomy and 13 by endoscopy-assisted compartment release. In these 67 racers, the mean visual analog score for pain improved significantly (p < 0.001 95% CI [3.1-4.5]) with 81% satisfied or very satisfied with surgery outcomes. This epidemiologic self-assessment questionnaire for upper limb CECS is a new concept. This study screened for CECS and offer information regarding evaluation, treatment, and management.

A spatiotemporal analysis of motorcyclist injury severity: Findings from 20 years of crash data from Pennsylvania

Motorcyclists face higher risks of severe injuries in crashes compared to motor vehicle drivers who are often protected by seatbelts and airbags during collisions. A report by the National Highway Traffic Safety Administration reveals that motorcyclists have 27 times the risk of fatality in traffic crashes as much as motor vehicle drivers. Previous studies have identified a list of risk factors associated with motorcyclist injury severity and generated valuable insights for countermeasures to protect motorcyclists in crashes. These studies have shown that wearing helmets and/or motorcycle-specific reflective clothing and boots, driving alcohol/drug-free, and obeying traffic regulations are good practices for safe motorcycling. However, these practices and other risk factors are likely to interact with local geographic, socio-economic, and cultural contexts, leading to diversified correlations with motorcyclist injury severity, which remains under-explored. Such correlations may exhibit variations across space and time. The objective of this study is to revisit the correlates of motorcyclist injury severity with a focus on the spatial and temporal variations of correlations between risk factors and injury severity. This study employed an integrated spatiotemporal analytical approach to mine comprehensive statewide 20 years' motorcycle-involved traffic crashes (N = 50,823) in Pennsylvania. Non-stationarity tests were performed to examine the significance of variations in spatially and temporally local correlations. The results show that most factors, such as helmet, engine size, vehicle age, pillion passenger, at-fault striking, and speeding, hold significant non-stationary relationships with motorcyclist injury severity. Furthermore, cluster analysis of estimations reveals the regional similarities of correlates, which may help practitioners develop regional motorcyclist safety countermeasures.

Defining crash configurations for Powered Two-Wheelers: Comparing ISO 13232 to recent in-depth crash data from Germany, India and China

The motorcyclist safety standard ISO 13232, based on crash data from Europe and the USA from the 1970s, still sets the direction for the development and evaluation of protective measures today. However, it is unclear how relevant the crash configurations in the standard are to present-day motorcycle crashes in Europe, the USA and other parts of the world. We analyzed recent in-depth crash data from Germany, India and China, examining powered two-wheeler (PTW) crash configurations in which at least one police-reported serious injury was present. After assessing the relevance of the ISO's PTW crash configurations to those we found in each country, we suggested new configurations to guide the development of safety systems that would be more effective at reducing PTW-related fatalities and serious injuries. In all three databases, passenger cars were among the top two most frequent collision partners and a car front impacting the side of the PTW was the most common configuration. Notably, although collisions with trucks constituted the most common scenario in India and ground impact (primary collision) was a common scenario in both Germany and India, the ISO did not include either configuration. Further, in three of the seven ISO crash configurations, one of the collision partners is stationary, although stationary collision partners were rare in our data. Our results show that the ISO crash configurations do not represent the most frequent PTW road crashes in Germany, India or China. However, the Chinese database was confined to crashes with a collision partner with four or more wheels. Further, weighting factors for these data were not available, so we could not extrapolate the frequency of the Chinese crash configurations across the entire population. A revised version of the ISO could serve as a basis for a full-scale PTW crash test program. However, the observed differences between countries imply that a single global standard may not be feasible. To optimize the evaluation of a PTW safety system, we recommend the inclusion of configurations which are frequent in the region or country of interest-in addition to common configurations occurring frequently all around the world.

Skull Fracture Patterns and Morphologies Among Fatal Motorcycle Traffic Accident Victims in Vietnam

ABSTRACT

We aim to describe morphological structures of skull fractures and relevant factors in motorcycle accident victims in Vietnam. This work represents a retrospective cross-sectional study based on forensic reports of fatal motorcycle accident victims. Between January 2013 and August 2019, a total of 226 fatal motorcycle accident patients with skull fracture diagnoses were enrolled. Linear and depressed fractures were the common patterns (46.0% and 37.2% of cases, respectively), whereas stellate (11.5%) fractures were rare. Fractures of the temporal bone (68.6% of cases) and basilar skull (60.6%) were the most common, whereas fractures of the parietal bone were the least common (9.7%). Two or more patterns of skull fracture were recorded in 25.5% of cases, and 2 or more fracture locations were recorded in 76.6% of cases. Fractures of the parietal bone were associated with victims not wearing a helmet. In addition, fractures of the basilar skull were more likely to occur among victims with alcohol consumption. We found the common pattern of skull fractures was linear and depressed fractures, and the common location of skull fractures was temporal and basilar bone. Further studies that include larger sample sizes and collect more information should be conducted to better understand relationships between skull fractures and related factors.

A Motorcyclist-Injury Severity Analysis: A Comparison of Single-, Two-, and Multi-Vehicle Crashes Using Latent Class Ordered Probit Model

Motorcycle crashes increasingly become a high proportion of the overall motorized vehicle fatalities. However, limited research has been conducted to compare the injury severity of single-, two- and multi-vehicle crashes involving a motorcycle. This study aims to investigate the effects of rider characteristics, road conditions, pre-crash situations, and crash features on motorcycle severities with respect to different numbers of vehicles involved. The crash data used was obtained through a comprehensive Motorcycle Crash Causation Study (MCCS) by the Federal Highway Administration. An anatomic injury severity indicator, the New Injury Severity Score (NISS), is utilized to calculate a total score as the sum of squared the abbreviated injury scale scores of each of the rider's three most severe injuries. A hybrid approach integrating Latent Class Clustering (LCC) and Ordered Probit (OP) models was used to uncover the unobserved heterogeneity and to explore the major factors which significantly affect the injury severities resulting from single-, two- and multi-vehicle crashes involving a motorcycle. The results show that the significant differences in severity exist between different numbers of vehicles involved. More importantly, they also indicate dividing motorcycle crashes into homogeneous classes before modelling helps to discover insightful information. Pre-speed of the motorcycle is found to be a main factor associated with serious and critical injuries in most types of crashes. Findings of the study provide specific and insightful countermeasures targeting at the contributing factors of motorcycle crashes.

Forearm muscles fatigue induced by repetitive braking on a motorcycle is best discriminated by specific kinetic parameters

Maneuvering a motorcycle in racing conditions or for prolonged time is sufficiently demanding that on many occasions forearm muscles reach a state of functional failure when riders cannot properly brake or operate the throttle. This study intends to discriminate which ones of the several dynamometric parameters used in the literature to characterize the Force-time (F-t) curve during voluntary contractions are more sensitive to neuromuscular fatigue in simulated motorcycle-riding conditions. Thirty-three adults performed an intermittent fatiguing protocol (IFP) that simulated the brake-pulling and throttle-twisting actions, by using a hydraulic system equipped with a pressure sensor. Sixty pressure-time (P-t) curve parameters, including the rate of pressure development (RPD) and area under the curve were measured to characterize the time course of the braking maximal voluntary contraction (MVC). Two types of variables were used to analyze the P-t curve: 1) Times interval (from 0 to 30-50-100-500-1000 and 2000 ms); 2) Percentages of MVC (10-30-60-90%MVC). Overall significant (p ≤ 0.05) fatigue-related declines were observed only at time intervals longer than 100 ms and contraction intensities higher than 30%MVC. Strong and significant linear declines (p < 0.001) were observed at 500 ms and 1 s for normalized pressures, as well as for the ratio RPD_60%MVC/MVC (p < 0.003) throughout the IFP. Our results suggest considering RPD at time windows of 0–500 ms and 0–1 s, and contraction intensities comprised between 30% and 60% of MVC, as more suitable criteria to study fatigue-related decrements in performance rather than the classical MVC force.

Applying machine learning and geolocation techniques to social media data (Twitter) to develop a resource for urban planning

With all the recent attention focused on big data, it is easy to overlook that basic vital statistics remain difficult to obtain in most of the world. What makes this frustrating is that private companies hold potentially useful data, but it is not accessible by the people who can use it to track poverty, reduce disease, or build urban infrastructure. This project set out to test whether we can transform an openly available dataset (Twitter) into a resource for urban planning and development. We test our hypothesis by creating road traffic crash location data, which is scarce in most resource-poor environments but essential for addressing the number one cause of mortality for children over five and young adults. The research project scraped 874,588 traffic related tweets in Nairobi, Kenya, applied a machine learning model to capture the occurrence of a crash, and developed an improved geoparsing algorithm to identify its location. We geolocate 32,991 crash reports in Twitter for 2012–2020 and cluster them into 22,872 unique crashes during this period. For a subset of crashes reported on Twitter, a motorcycle delivery service was dispatched in real-time to verify the crash and its location; the results show 92% accuracy. To our knowledge this is the first geolocated dataset of crashes for the city and allowed us to produce the first crash map for Nairobi. Using a spatial clustering algorithm, we are able to locate portions of the road network (<1%) where 50% of the crashes identified occurred. Even with limitations in the representativeness of the data, the results can provide urban planners with useful information that can be used to target road safety improvements where resources are limited. The work shows how twitter data might be used to create other types of essential data for urban planning in resource poor environments.

Severity of e-scooter rider injuries associated with trip characteristics

INTRODUCTION

E-scooter rider injuries have been growing, but little is known about how trip and incident characteristics contribute to their severity.

METHOD

We enrolled 105 adults injured while riding e-scooters who presented to an emergency department in Washington, DC, during 2019. Enrolled participants completed an interview during the emergency department visit, and their charts were abstracted to document their injuries and treatment. Logistic regression examined the association of incident location and circumstances with the likelihood of sustaining an injury on the Abbreviated Injury Scale (AIS) ≥ 2, while controlling for rider characteristics.

RESULTS

The most common locations of e-scooter injuries in our study sample occurred on the sidewalk (58%) or road (23%). Accounting for other trip and rider attributes, e-scooter riders injured on the road were about twice as likely as those injured elsewhere to sustain AIS ≥ 2 injuries (RR, 1.96; 95% CI, 1.23-2.36) and those who rode at least weekly more often sustained AIS ≥ 2 injuries compared with less frequent riders (RR, 1.86; 95% CI, 1.11-2.32).

CONCLUSIONS

Greater injury severity for riders injured on the road may reflect higher travel speeds. Practical applications: Injury severity associated with riding in the road is one factor that jurisdictions can consider when setting policy on where e-scooters should be encouraged to ride, but the risk of any crash or fall associated with facilities should also be examined. Although injuries are of lower severity on sidewalks, sharing sidewalks with slower moving pedestrians could potentially lead to more conflicts.

A robust method for collecting and processing the on-road instantaneous data of fuel consumption and speed for motorcycles

Using the laboratory-based fuel consumption models for predicting real-world fuel consumption requires the measurement of data under certain conditions to obtain high accuracy of predicted result. Therefore, it is necessary to develop a logging device for measuring the real-time fuel consumption and speed of vehicle on the road. This article presents a study on developing the on-board data logging device to collect real-world data of fuel consumption and speed for motorcycles with the update rate of 1 Hz. The instantaneous speed of the motorcycle was determined based on the rotational speed of the wheel and the wheel radius. Another module was used to determine the instantaneous fuel consumption rate (FR) though measuring the duration injection pulse. The relationship between the duration injection pulse and the injected amount of fuel was established with high correlation coefficient of 0.997. In addition, a filter was designed to remove noise in the dataset collected using the data logging device. The random errors in the speed and the FR profiles were detected and replaced, the percentage of these errors is 1.8% and 2.4%, respectively. The developed method is a precise one for transient fuel consumption and speed measurement. In chassis dynamometer test, the average deviation between steady speed measured by the chassis and the data logging device is only approximately 0.35%. At transient state, the biggest deviation between these two datasets is less than 3.5%. The average FR at steady speed measured by the developed method is slightly different from the one measured by the carbon balance method. The difference is 0.9%, 2.5%, and 0.25% at the speeds of 30 km/h, 50 km/h, and 70 km/h, respectively. Following the transient test cycle, the fuel consumption measured by the developed method is 4.35% lower than that determined by the carbon balance method. Implications: A robust method for collecting and processing the on-road instantaneous data of fuel consumption and speed was developed for motorcycles. The proposed method can record well the real-world driving data for motorcycles, including the fuel consumption and speed, with the update rate of 1 Hz. The filter was designed to minimize noise while maintaining data integrity of the collected dataset, the percentage of errors in the the speed and the FR profiles is 1.8% and 2.4%, respectively. The proposed method, therefore, can be used as effective tools for future studies relating to the fuel consumption and emission of motorcycles on the road.

Severe blunt renal injury after motorcycle accident: failure of the conservative management

We report the case of a patient who presented after a motorcycle accident a grade IV kidney lesion primarily treated with a NOM, which failed. We discuss the possibility at admission to select a subgroup of patients with a high grade (IV and V) kidney trauma in whom NOM might fail. KEY WORDS: Kidney Trauma, High grade renal trauma, Non operative management.

Vehicle fatalities involving collisions with kangaroos

A search was undertaken of the Forensic Science South Australia (FSSA), Australia, autopsy database over a 20-year period from 2000 to 2019 for all cases where vehicle crashes had involved kangaroos. There were six cases with an age range of 18-62 years (M=42 years) and a male-to-female ratio of 5:1. There were three crashes involving motor vehicles and three involving motorcycles. The three motor-vehicle crashes were initiated by impact with a kangaroo followed by a head-on crash with a truck (n=1) and a tree (n=2). In two of the motorcycle crashes, the cycle hit a kangaroo, resulting in the rider being unseated. In the third case, following impact with the animal, the cyclist hit a tree. In one of the latter cases, the only evidence of impact with a kangaroo was fur found by investigating officers adherent to the front-right indicator. Lethal injuries were located in the chest in six cases, the cranio-cervical region in five cases and the abdomen in three cases. Thus, in the majority of cases (n=5), death was due to multiple injuries. In the remaining case, death was caused by blunt chest trauma. This study shows that kangaroo-vehicle impacts may result in very significant blunt-force trauma. Motorcycle riders are particularly vulnerable. It may be only by careful examination of the vehicle/motorcycle for animal residues that the nature of the incident will be clarified.

Relation between riding pleasure and vehicle dynamics - Results from a motorcycle field test

Powered two-wheelers are a common means of transport all over the world. In several countries, primary motorcycles with high displacement involve another purpose, namely motorcycling is a leisure activity. Motorcycles are used as tools of transport pleasure as opposed to being purely used for individual commuting purposes. The aim of the current study involves investigating the relation between experienced riding pleasure and riding behavior in a field test. Specifically, N = 12 motorcyclists between 21 and 66 years of age were observed while riding for approximately 8 h on public roads. The measurement setup included a logger for vehicle dynamics and vehicle handling data, GNSS data, video data, and subjective measures recorded as audio comments at predefined points of interest along the round course. A comprehensive dataset with more than 6000 km of motorcycling was gathered. The results indicate that parameters of lateral vehicle behavior, such as the maximum lean angle, reflected riding pleasure. Interestingly, this is applicable for curvy sections as well as straight roads. High ratings of riding pleasure correlated with riding in snaky lines as a type of self-stimulation on straight sections. Longitudinal vehicle dynamics, such as the range of accelerations, tend to increase with the riding pleasure in curves. Hence, the effects are smaller than those for lateral vehicle behavior and not visible on straight sections. Generally, curvy sections on rural roads produce higher pleasure than straight roads. On a global level, riding pleasure increases during the first few hours of riding and subsequently decreases with respect to the time on task. The results are discussed in the context of studies on driving pleasure from the automotive sector and more fundamental psychological theories that explain pleasure as a physiological stimulation or flow. Several individuals ride motorcycles to experience pleasure. A better understanding of rider behavior in these situations can aid in deriving proper assistance and to provide individual support to a rider, thereby increasing riding pleasure as well as safety.

Socio-demographic determinants of motorcycle speeding in Maha Sarakham, Thailand

Thailand has the highest road traffic fatality rate in Southeast Asia, making road safety a critical public health concern. A 2015 World Health Organization (WHO) Report showed that speeding behavior was the most important determinant for road traffic crashes in Thailand. Here, we aimed to examine associations of socio-demographic factors (gender, age, socioeconomic status) with self-reported motorcycle speeding behavior. Additionally, we examined a potential role of time discounting and risk preference as mediators in the association of socio-demographic factors with speeding. We used data obtained from the Mahasarakham University Social Network Survey 2018 (MSUSSS) (N = 150). We ran linear network autocorrelation models (lnam) to account for the data's social network structure. We found that males are more likely than females to engage in speeding behavior (β = 0.140, p = 0.001) and to discount the future (β = 5.175, p = 0.017). However, further causal mediation analysis showed that time discounting does not mediate the gender-speeding association (p for mediation = 0.540). Although socioeconomic status (subjective social class) was not associated with speeding (β = 0.039, p = 0.177), age was marginally associated with speeding (β = 0.005, p = 0.093). Future studies may consider using a larger sample.

Analysis of motorcycle accidents using association rule mining-based framework with parameter optimization and GIS technology

INTRODUCTION

Analyzing key factors of motorcycle accidents is an effective method to reduce fatalities and improve road safety. Association Rule Mining (ARM) is an efficient data mining method to identify critical factors associated with injury severity. However, the existing studies have some limitations in applying ARM: (a) Most studies determined parameter thresholds of ARM subjectively, which lacks objectiveness and efficiency; (b) Most studies only listed rules with high parameter thresholds, while lacking in-depth analysis of multiple-item rules. Besides, the existing studies seldom conducted a spatial analysis of motorcycle accidents, which can provide intuitive suggestions for policymakers.

METHOD

To address these limitations, this study proposes an ARM-based framework to identify critical factors related to motorcycle injury severity. A method for parameter optimization is proposed to objectively determine parameter thresholds in ARM. A method of factor extraction is proposed to identify individual key factors from 2-item rules and boosting factors from multiple-item rules. Geographic information system (GIS) is adopted to explore the spatial relationship between key factors and motorcycle injury severity.

RESULTS AND CONCLUSIONS

The framework is applied to a case study of motorcycle accidents in Victoria, Australia. Fifteen attributes are selected after data preprocessing. 0.03 and 0.7 are determined as the best thresholds of support and confidence in ARM. Five individual key factors and four boosting factors are identified to be related to fatal injury. Spatial analysis is conducted by GIS to present hot spots of motorcycle accidents. The proposed framework has been validated to have better performance on parameter optimization and rule analysis in ARM. Practical applications: The hot spots of motorcycle accidents related to fatal factors are presented in GIS maps. Policymakers can refer to those maps straightforwardly when decision making. This framework can be applied to various kinds of traffic accidents to improve the performance of severity analysis.

Treatment of purely ligamentous dorsoulnar radiocarpal dislocation with ulnar translation of the carpus: A case report

RATIONALE

Radiocarpal fracture-dislocations are extremely infrequent injuries caused by high-energy trauma and involve significant osseous and ligamentous injuries. If not treated properly, it can lead to serious complications such as ulnar translation of the carpus, multidirectional instability, loss of motion, and post-traumatic arthritis. Purely ligamentous injuries are rarer than fracture-dislocation injuries. Because previous studies have reported small patient cohorts, there has been no standardized treatment strategy for purely ligamentous radiocarpal dislocation.

PATIENT CONCERNS

A 24-year-old man suffered a left wrist injury in a motorcycle accident. Plain radiographs revealed dorso-ulnar radiocarpal dislocation without radial fracture and Carpal-ulnar distance ratio (CUDR) was 0.16. MRI scans showed the disruption of the dorsal ligaments and capsules and avulsed from the proximal insertion of the volar radiocarpal ligaments.

DIAGNOSIS

Dorsoulnar radiocarpal dislocation with purely ligamentous injury.

INTERVENTION

We removed the interposing chondral fragment from the radiocarpal joint and repaired the radioscaphocapitate (RSC) and radiolunate (RL) ligaments with the Jugger Knot Soft Anchor Suture (Biomet, Inc, Warsaw, IN) and applied additional radiocarpal K-wires and an external fixator to maintain reduction and optimal ligament tension.

OUTCOMES

The patient showed good clinical results although ulnar translation of the carpus recurred in radiological follow-up.

LESSONS

Aggressive surgical management is needed earlier in the treatment of purely ligamentous radiocarpal dislocation, especially if the ulnar translation of the carpus was observed in the initial radiographs.

Prevalence of unprotected motorcycle riding and its association with other risk behaviors among adolescents in Chiang Mai, Thailand

OBJECTIVES

To determine the prevalence of helmet use in Chiang Mai province in Thailand and identify the association between helmet use, externalized behaviors, and other risk-taking behaviors.

METHODS

A cross-sectional study was conducted using the Youth Risk Behavior Survey, Thai version. Risky motor vehicle behaviors and other risk-taking behaviors of 4,372 adolescents were measured. Behavioral problems from the Youth Self-Report were also obtained from all participants.

RESULTS

A total of 2,981 adolescents (68.2%) reported motorcycle riding, of which, 36.3% reported unprotected riding. Females, younger age, attending secondary school, and those with academic underachievement were related to the unprotected riding group. Unprotected riding was significantly associated with other risky traffic behaviors and also related to other risk-taking behavior such as violence and substance use. Significantly higher behavioral problems scores were found in unprotected riding adolescents (p < 0.001).

CONCLUSIONS

The prevalence of unprotected riding and other risk behaviors in Thai adolescents were high. Safety traffic riding campaigns should start in late primary school focusing on those females with poor academic achievement.

[Pattern of bone fractures in motorcycle accidents in a High Specialty Hospital]

INTRODUCTION

Motorcycle accidents are one of the leading causes of death and disability in Mexico's young population. There are no local studies describing the pattern of AO-based injuries.

OBJECTIVE

Define the pattern and type of most common bone fractures in a Regional Hospital of High Specialty, from January to August 2017.

MATERIAL AND METHODS

Descriptive, cross-sectional, observational, quantitative study of 98 patients who suffered motorcycle accidents and who merited surgical orthopedic treatment (94% men, 6% women, average age 29.7 years).

RESULTS

The most frequent accidents included the following features: male drivers, motorcycle < 150 cm3, rural area, without helmet use (75.5%) collision against a moving object. The most common fractures corresponded to: tibia and fibula (28.9%), open fractures (52.3%), femur (25%) forearm (10.5%). Considering the AO classification the most common fractures were AO 42 B 3.3, AO 32A3.2 and AO 23B1.2.

CONCLUSION

Motorcyclists use few protective measures. The injury pattern showed differences with what was reported nationally. According to the AO rating, much of the cases correspond to those of worst prognosis.

Descriptive Kinematic Analysis of the Potentially Tragic Accident at the 2020 Austrian MotoGP Grand Prix Using Low-Cost Instruments: A Brief Report

BACKGROUND

During the first Austrian MotoGP Grand Prix of 2020, following a serious accident involving the riders J. Zarco and F. Morbidelli, Morbidelli's riderless bike cartwheeled across turn 3, narrowly missing V. Rossi and M. Viñales by just a few centimeters. As is the case with ordinary traffic accidents, analyzing the dynamics of motorcycle racing accidents can help improve safety; however, to date, the literature lacks studies that analyze the causes and severity of such accidents. Hence, the purpose of this study was to analyze the main causes that led to the accident at the 2020 Austrian MotoGp Grand Prix, to quantify the speeds and distances of the bikes and riders involved, and to hypothesize several alternative scenarios using a low-cost method.

METHOD

Kinovea and Google Earth Pro software were used to identify markers along the racetrack and to measure the distances and calculate the time it took the motorcycles to cover those distances. The analyses were carried out on three 30-fps (frames per second) videos.

RESULTS

Zarco's average speed as he was overtaking Morbidelli on the straightaway before turn 2 was 302 ± 1.8 km/h, higher than that of Rins and Rossi (299.7 ± 1.7 and 296 ± 1.7 km/h, respectively). The speed of Zarco and Rossi's bikes 44.5 m before the crash was the same (267 ± 7.9 km/h). Immediately after overtaking Morbidelli, Zarco moved 2.92 m towards the center of the racetrack from point A to B, crossing Morbidelli's trajectory and triggering the accident. Morbidelli's riderless bike flew across turn 3 at a speed of about 76 km/h, missing V. Rossi by just 20 cm. The consequences could have been catastrophic if Rossi had not braked just 0.42 s before encountering Morbidelli's bike in turn 3.

CONCLUSION

Through a low-cost quali-quantitative analysis, the present study helps us to gain a deeper understanding of the dynamics of the accident and its main causes. Furthermore, in light of our findings regarding the dynamics and severity of the accident and the particular layout of the Red Bull Ring circuit, racers should be aware that overtaking at the end of turn 2, following the same trajectory as the riders involved in the crash, could be very risky.

Characteristics of pedestrian injuries caused due to impacts with powered 2-wheelers in India

Objective: This study aims to understand the nature, severity, and sources of injuries sustained by pedestrians involved in crashes with powered 2-wheelers (PTWs) in India. Further, it aims to understand the pedestrian injury pattern and injury mechanism based on the pedestrian contact location on the PTW. Methods: Eight years of field data from the Road Accident Sampling System-India (RASSI) database were considered for the study. Analyses were performed using both weighted and unweighted RASSI data. A sample of 57 crashes between pedestrians and PTWs was analyzed to determine the pedestrian injury characteristics, pedestrian orientation with PTW, and PTW contact zone (PCZ) or the pedestrian contact location on PTW. The PCZs were classified into 3 types. The risk of sustaining a Maximum Abbreviated Injury Scale (MAIS) injury to the head and pedestrian injury mechanism across the 3 PCZs was analyzed. Results: The results of both weighted and unweighted RASSI data were consistent. About 67% of pedestrians who were killed sustained MAIS 3+ head injuries and 52% of pedestrians with nonfatal injuries sustained MAIS 2+ lower extremity injuries. The risk of MAIS 3+/fatal head injury is notably higher (86%) for pedestrians struck from behind compared to pedestrians struck from the side (36%). Of the 3 PCZs, about 80% of the pedestrians contacting PCZ-1 (corner of the PTW front end) sustained fatal head injuries and only 5% contacting PCZ-2 (center of the PTW front end) sustained fatal head injuries. About 40% contacting PCZ-3 (combination of PCZ-1 and PCZ-2) sustained fatal head injuries. Of all AIS 3+ head injuries, 88% were associated with ground impacts. Of all AIS 2+ lower extremity injuries, 96% were associated with impacts to PTW front-end parts. Conclusions: The results show that head injuries account for most pedestrian fatalities in crashes with PTWs and lower extremity injuries account for most nonfatal injuries. Head injuries are associated with ground contacts and lower extremity injuries are associated with contacting PTW front-end parts. Pedestrians contacting the corner of the PTW are highly prone to MAIS 3+ head injuries, whereas pedestrians contacting the center of the PTW are less prone to MAIS 3+ head injuries. This difference is predominantly because of the varied injury mechanisms seen across PCZs.

Motorcycle safety after-dark: The factors associated with greater risk of road-traffic collisions

The effect of ambient light level on road traffic collisions (RTCs) involving a motorcycle was investigated. Data were drawn from the STATS19 database of UK reported RTCs for the period 2005-2015. To isolate the effect of ambient light (daylight vs darkness) an odds ratio was used to compare RTCs at specific times of day in the weeks either side of the Spring and Autumn clock changes. This work extended previous studies by using a more precise method for distinguishing between RTCs in daylight and after dark, thus avoiding the ambiguity of twilight. Data for four-wheel motor vehicle (FWMV) RTCs were also investigated to provide a datum. As expected, the risk of an RTC occurring was significantly higher after dark compared to daylight for both motorcycles and FWMVs. Investigation of contextual factors suggests that risk after dark is significantly higher for motorcycles compared to FWMVs for RTCs with two-vehicles, on roads with low speed limits (≤30 mph), at T-junctions, and junctions controlled by a give way sign. These are the situations where visual aids for increasing conspicuity after dark have the greater potential for reducing motorcycle RTCs.

Influences of impact scenarios and vehicle front-end design on head injury risk of motorcyclist

Motorcycle to vehicle collision is one of the most common accidents in the world and usually leads to serious or fatal head injuries to motorcyclists. This study aims to investigate the influences of impact scenarios and vehicle front-end design parameters on head injury risk of the motorcyclist. Five general vehicle types and different impact scenarios were selected for a parametric analysis. Impact scenarios were set according to ISO, 13232 regulation considering impact angles and impact speeds. Five vehicle types of Sedan, MPV (Multi-Purpose Vehicle), SUV (Sport Utility Vehicle), EV (Electric Vehicle) and 1-Box vehicle were included. HIC₁₅ (Head Injury Criterion), head angular acceleration and CSDM (Cumulative Strain Damage Measure) were calculated to evaluate head injury risk of the motorcyclist. The results show that the critical impact speed for HIC₁₅ and head angular acceleration was around 15 m/s, while the critical speed for CSDM was approximately 10 m/s. Impact angle of 45° show extremely high injury risk to the motorcyclist head. Bonnet leading edge height and its combination with other parameter present high influences on motorcyclist head injuries, and the increasing the bonnet leading edge height can potentially reduce head injury risk of motorcyclists. In summary, the present research results provide some theoretic bases for determining the test speed in motorcycle-vehicle crash regulation and design consideration for typical vehicle front end shape.

Reconstruction of motorcycle spokes wheel injury fingertip amputations with reposition flap technique: a report of 40 cases

PURPOSE AND BACKGROUND

Replantation of the distal fingertip amputation poses a technical challenge to the treating hand surgeon especially dealing with motorcycle spokes wheel injury causing Allen's type III and IV amputation. The reason being the pulp charred and severely crushed. Various reconstructive options have been described in the literature. We analyze the surgical option of repositioning the amputated stump with local pedicle flaps in such injuries and interpreting the results and functional outcome.

METHODS

Forty patients with motorcycle spokes wheel fingertip amputations involving thumb (60%) and index, middle, and ring fingers were operated by reposition flap between 2017 and 2019. Group I was Allen's type III amputations (n = 20). Group II was type IV amputations (n = 20). Range of movements, 2-point discrimination, sensation, intolerance to cold, nail aesthetics outcome, VAS, quick DASH score and return to work were analyzed in these two groups and evaluated.

RESULTS

The average follow-up of our study in group I and group II was 24.6 and 24.4 months, respectively. All patients returned to work in an average of 13.4 weeks with a good radiological bone union and an excellent range of movements. All had an average 2-point discrimination of 8.5 mm and 8.3 mm; VAS as 0.2, mean quick DASH score 5.4 and 5.0, respectively in both groups. 15% dysplastic nail and 30% had cold intolerance; all had satisfactory sensation in the final follow-up with an average finger shortening of 4.7 and 5 mm. No finger stiffness and donor site morbidity seen.

CONCLUSIONS

Reposition of the amputated distal phalanx, free nailbed graft with cross finger flap in motorcycle spokes wheel injury is safe, and effective. It preserves the pulp contour and gives a good functional outcome. It is a viable alternative option to replantation in Allen's type III and IV fingertip amputations especially in motorcycle spokes wheel injury with pulp loss.

LEVEL OF EVIDENCE

IV.

Understanding take-over performance of high crash risk drivers during conditionally automated driving

Understanding driver behavior of conditionally automated driving is necessary to ensure a safe transition from automated to manual driving. This study aimed to examine the difference in take-over performance between high crash risk (HCR) and lower crash risk (LCR) drivers in emergency take-over situations during conditionally automated driving. In the current simulator study, a 3 × 3 (within-subjects) factorial design was used, including the task factors (no task, reading the news, and watching a video) and time budget factors (time budget = 3 s, 4 s, and 5 s). Forty-eight participants completed a test drive on an approximately 10 km long two-way six-lane urban road. The participants firstly were in manual control and then switched to the automated driving mode at a speed of 50 km/h. The automated driving system was able to detect a broken car in the ego-lane and requested the driver to take over the control of the vehicle. There are at least one or two other vehicles or motorcycles on each side of the ego-vehicle, resulting in fewer escape paths. For the two non-handheld non-driving-related tasks (NDRTs), the participants were asked to be fully engaged in a task without any need to monitor the road environments. Each participant completed nine emergency take-over situations. The participants were classified into two groups that were labeled LCR (N ≤ 2) and HCR drivers (N ≥ 3) according to the number of accidents per driver. The results show that LCR drivers had shorter brake reaction time compared to HCR drivers. For all drivers, the engagement in a task led to longer response times, and the time budget affected the longitudinal vehicle control. In addition, the task affected the response times for LCR and HCR drivers, but only the time budget affected the longitudinal vehicle control for LCR drivers. For all drivers, LCR and HCR drivers, the time budget and task affected the safety of take-over. Especially, the two non-handheld everyday tasks seem to have a similar effect on the drivers' workload. Therefore, the HCR drivers had a lower hazard perception compared to the LCR drivers, and the factor regarding the individual difference of driving ability in take-over situations should be considered to design safe take-over concepts for automated vehicles.

Association Between Trauma Center Level and Outcomes of Adult Patients with Motorcycle Crash-Related Injuries in the United States

BACKGROUND

Motorcycle crash-related injury mechanism is a criterion in the Centers for Disease Control and Prevention field triage guidelines of injured patients, with a recommendation to transport affected patients to a trauma center need not be the highest level.

OBJECTIVE

This study examines the evidence behind this recommendation because severe injuries can result from motorcycle crashes and patients can benefit from treatment at higher-level trauma centers.

METHODS

This retrospective cohort study used the National Trauma Data Bank 2015 dataset. We conducted descriptive analyses (univariate and bivariate) followed by adjusted multivariate analysis to examine the association between trauma center designation levels and survival to hospital discharge.

RESULTS

A total of 28,821 patients with motorcycle injuries were included. Most patients were men (n = 25,361; 88%) and aged between 16 and 64 years (n = 26,989; 93.6%). Survival rates were higher in level II (n = 10,658; 95.3%) and III (n = 2,129; 95.5%) trauma centers compared to level I centers (n = 14,498; 94.6%). After adjusting for confounders, decreased survival to hospital discharge was noted for patients treated at level III trauma centers compared to those at level I centers (odds ratio 0.543; 95% confidence interval 0.390-0.729). No difference in survival was noted between level I and II centers.

CONCLUSIONS

Patients with motorcycle crash-related injuries treated at higher-level trauma center (I or II) had increased survival. This warrants a re-evaluation and adjustment of the field triage criterion for such patients. Examining the evidence behind field triage guidelines in trauma systems is needed for improved patient outcomes.

A combination of bimalleolar fracture and fracture on talar body and neck: A rare case report

RATIONALE

Talar fracture accompanied with malleolar fracture is rare, and its management is complex. Ankle soft tissue is much thinner than other parts of the human body, and the shape of the ankle makes wounds difficult to close immediately after surgery, which may result in poor skin condition if the wound tension is too high. However, joint congruity and osteonecrosis are the main concerns of talar fracture.

PATIENT CONCERNS

A 57-year-old man presented at the emergency department following a motorcycle accident.

DIAGNOSES

Physical examination revealed swelling and tenderness of the left ankle and midfoot. The patient had comminuted talar fracture and was indicated for dual-screw fixation or even plate with screw fixation.

INTERVENTIONS

We performed single screw fixation after assessing the soft tissue condition and employed a technique of using continuous longitudinal force to bring together fracture fragments (ankle ligamentotaxis) during surgery. Open reduction with a mini-hook plate and tension band wire was used for bimalleolar fracture repair using the combined anteromedial and anterolateral approach with extension of the incision. Kirschner wire for temporary fixation was performed using ligamentotaxis, and a 2.4 headless screw was inserted from the posteromedial to the anterolateral direction.

OUTCOMES

The patient was discharged with a standard short leg splint and was instructed not to bear weight on the affected ankle for 2 months. The patient walked well without discomfort, and the Hawkins sign was clearly visible. Single screw fixation preserves the integrity of the talus bone as minimal space is used for this operative technique. Single screw fixation preserves more bony stock when most of the internal fixator is located within the bone. Additionally, surgery time is shorter than multiple implantations even when performing the same procedure; as a result, there was less ankle soft tissue swelling.

LESSONS

This case provides evidence of using the single screw fixation technique for addressing both malleolar and talar fractures, and that talar fracture management can be less aggressive with limited weight bearing and initial limited range of motion given the presence of malleolar fracture. The alignment and stability of bony fragments also benefit from ankle ligamentotaxis.

Epidemiology, etiology, and types of severe adult brachial plexus injuries requiring surgical repair: systematic review and meta-analysis

The literature describing epidemiology, etiology, and types of serious brachial plexus injuries (BPIs) is sparse. The aim of this review was to investigate the epidemiological and etiopathogenetical data of serious BPIs undergoing surgical reconstruction. A systematic search was conducted from January 1985 to December 2017. All studies that reported data about prevalence of specific types and causes of BPIs in adults treated surgically were included and cumulatively analyzed. Ten studies including 3032 patients were identified. The pooled prevalence of closed BPIs was 93% (95% CI: 87-97%), lacerations accounted for 3% (95% CI: 1-6%), and gunshot wounds (GSWs) for 3% (95% CI: 0-7%). The prevalence of male patients was 93% (95% CI: 90-96%) and female cases 7% (95% CI: 4-10%). The most common cause of closed BPI was motorcycle accidents with 67% (95% CI: 49-82%) prevalence followed by car crashes with 14% (95% CI: 8-20%). Other causes were rare. Ninety percent (95% CI: 78-98%) of patients suffered from a supraclavicular or combined supra-/infraclavicular trauma, while 10% (95% CI: 2-22%) from isolated infraclavicular injury. The prevalence of complete lesions was 53% (95% CI: 47-58%) followed by upper plexus lesion with 39% (95% CI: 31-48%) and lower plexus injury with 6% (95% CI: 1-12%). This meta-analysis demonstrates that the typical patient suffering from severe BPI is a male after motorcycle accident with closed supraclavicular injury causing complete or slightly less commonly upper plexus palsy. Lacerations and GSWs of brachial plexus are rare.

Quantitative assessment of environmental exposure of delivery men in Wuhan

The take out industry is rapidly developing in China, but the environmental exposure of delivery men is neglected. "Ele.Me," an online food ordering platform, is one of the two largest catering online-to-offline platforms in China. From January 2018 to April 2018, data from 16,528 take out shops in Wuhan were crawled by using Python. The data included store name, average delivery time, delivery price, region, and store type. With the use of Baidu map's API batch reverse address resolution, the map locations of the take out shops were identified. Network service area was utilized to obtain the activity space of delivery men along the Wuhan traffic road network. Combined with the data on sulfur dioxide (SO₂), nitrogen dioxide (NO₂), carbon monoxide (CO), ozone (O₃), PM2.5, PM10, and noise provided by the Wuhan Environmental Protection Bureau, the spatial interpolation, regional analysis, superposition analysis, and other geographic information system spatial analysis methods were used to study the air and noise pollution within the activity space of delivery men in various take out shops. Results revealed the unbalanced environment faced by Wuhan delivery men. The exposure to NO₂, CO, and PM2.5 was mainly concentrated in the central city, whereas the exposure to SO₂, O₃, and PM10 was mainly noted far from the city. Noise pollution was mainly observed in the districts of Hannan, Caidian, and Dongxihu; and the most serious pollution was recorded in Shamao Street. The weighted comprehensive pollution index model was used to calculate the contribution weight of each evaluation factor to obtain the results of environmental exposure to air pollution. The influence of noise was further considered to obtain the consequences of comprehensive environmental exposure to pollution. The highly polluted regions were those in the central part of the city. Pollution was mainly concentrated in the third loop, whereas Zhucheng Street in the Xinzhou District provided the best environment. The results of this study can serve as a reference for the physical health risk assessment of delivery men.

Development and Validation of the Overall Foot Pain Questionnaire in Motorcycle Riders

Objectives: Our primary aim was to develop a transcultural adaptation of a cycling questionnaire using the Borg CR-10 scale as a tool to describe the discomfort among motorcyclists during the riding process in two trial sessions. Design: A transcultural adaptation and descriptive cross-sectional study. Settings: Jarama motorcycling circuit (Madrid, Spain). Participants: The participants were riders recorded across in a final motorcycling race. Interventions: The study design is based in two tools, the adapted Motorcyclist Questionnaire (MQ-21) with 21 items and Borg CR10 Scale^® was used to determine discomfort level during motorcycling performance. The translation procedure, reliability, and reproducibility were performed. Results: All items showed an almost perfect intraclass correlation coefficient (ICC) (ICC = 0.909–1.00), except for item 9 (ICC = 0.881). Almost perfect internal consistency was shown for the total score (Cronbach α = 0.899). No systematic differences existed among test and retest in all items (p > 0.05) according to Bland–Altman plots. Respondents experienced slight discomfort on their body parts during the test-retest 1 h riding process. Foot discomfort was scored as 1.20, being the eighth of the 12 studied body parts. Conclusions: Internal consistency and test-retest reliability of the MQ-21 questionnaire were excellent and this questionnaire may be recommended to be used in motorcycling sports and clinical settings to evaluate the discomfort.

Boda Bodas and Road Traffic Injuries in Uganda: An Overview of Traffic Safety Trends from 2009 to 2017

INTRODUCTION

Road traffic injuries (RTIs) are an important contributor to the morbidity and mortality of developing countries. In Uganda, motorcycle taxis, known as boda bodas, are responsible for a growing proportion of RTIs. This study seeks to evaluate and comment on traffic safety trends from the past decade.

METHODS

Traffic reports from the Ugandan police force (2009 to 2017) were analyzed for RTI characteristics. Furthermore, one month of casualty ward data in 2015 and 2018 was collected from the Mulago National Referral Hospital and reviewed for casualty demographics and trauma type.

RESULTS

RTI motorcycle contribution rose steadily from 2009 to 2017 (24.5% to 33.9%). While the total number of crashes dropped from 22,461 to 13,244 between 2010 and 2017, the proportion of fatal RTIs increased from 14.7% to 22.2%. In the casualty ward, RTIs accounted for a greater proportion of patients and traumas in 2018 compared to 2015 (10%/41% and 36%/64%, respectively).

CONCLUSIONS

Although RTIs have seen a gross reduction in Uganda, they have become more deadly, with greater motorcycle involvement. Hospital data demonstrate a rising need for trauma and neurosurgical care to manage greater RTI patient burden. Combining RTI prevention and care pathway improvements may mitigate current RTI trends.

Enhancement of unsafe behaviors in simulated moped-riding performance under the influence of low dose of alcohol

The effects of low levels of blood alcohol concentration (BAC) on motorcyclist performance are still not fully comprehended. The great majority of the studies are, in fact, focused on car driving. So far, it is known that even BAC levels below the legal limit negatively affect riding motor skills correlated with crash rate. In the present study, we used a moped riding simulator to investigate the effects of low alcohol dosages (under the limits established in Italy, and in most European countries) on the defensive riding ability of light drinkers, particularly focusing on the degree of danger characterizing their riding performance. We recruited 24 participants through a double-blind, random distribution, balanced, cross-over design. We administered moderate amounts of alcohol to participants during two sessions of moped riding simulation. The results showed that even though BAC levels were always below (mean value: 0.03 g/dL) the limit allowed by Italian traffic law (0.05 g/dL), alcohol induced a reduction in safe riding behaviors, as indicated by the greater amount of hazardous scenes faced with dangerous riding behaviors when participants were under the influence of alcohol than when they were sober. Moreover, low BAC levels had a greater detrimental influence when a certain amount of learning had already been achieved by the participants (i.e., in the last experimental session). The results suggest that the effect of a low dose of alcohol interacts with participants' self-confidence.