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Active transport, including cycling, is promoted as an effective way of increasing children's physical activity and health. Parents can support children's riding by riding with them and it is important to address relevant safety issues. Little is known about parents' experience of safety-relevant aspects of riding with children. Participants in the Safer Cycling Study in New South Wales, Australia, who reported that they had ridden with children in the last 12 months were questioned about how they ride with children, and their experience of safety issues and crashes. Among the 187 respondents who had ridden with children on their bicycle, the most common form of carrier was a rear-mounted seat (48%) followed by a trailer (29%). Many respondents (79%) identified risks specific to riding carrying children, including those linked with specific carrier types and with use of footpaths. Most (92%) indicated that they change their behaviour when carrying a child on their bicycle; for example, riding more slowly, more carefully, and away from roads. Among crashes with a child on the bicycle, most were falls. Among the 345 participants who had ridden to accompany a child on a bicycle, approximately three quarters identified risks specific to accompanying children, such as managing the child's limited skill, awareness and predictability. Ninety-seven percent reported behavioural changes including positioning themselves as a barrier for their child and caution crossing roads. Findings suggest strategies to support parents in riding safely with children.

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This paper investigates events in which cyclists perceive a cycling crash is narrowly avoided (henceforth, a near miss). A cohort of 2038 adult transport and recreational cyclists from New South Wales (Australia) provided self-reported prospectively collected data from cycling diaries to allow the calculation of an exposure-based rate of near misses and investigation of near miss circumstances. During 25,971days of cycling, 3437 near misses were reported. For a given time cycling, cyclists who rode mainly for transport (compared with those who rode mainly for recreation), and cyclists with less experience (compared to those with more experience) were more likely to report a near miss; older cyclists (60+ years) were less likely to report a near miss than younger cyclists (25-59 years). Where type of near miss was recorded, 72.0% involved motor vehicles, 10.9% involved pedestrians and 6.9% involved other cyclists. Results indicate some similarities between near misses and crashes reported by this cohort during the same reporting period. A bias toward reporting near misses with motor vehicles was suggested, which likely reflects cyclists' perceptions that crashes involving motor vehicles are particularly serious, and highlights their impact on perceived safety. Given the relative rarity of crashes, and the limited breadth and depth of administrative data, collection of near miss data may contribute to our understanding of cycling safety by increasing the volume and detail of information available for analysis. Addressing the causes of near misses may offer an opportunity to improve both perceived and actual safety for cyclists.

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OBJECTIVES: The ability to determine risk management controls for quad bike use is confounded by limitations in crash and injury information. The aim of this article is to identify the injury mechanisms, crash characteristics, and contributing factors in fatal quad bike incidents in Australia by activity (recreation and work). METHODS: An in-depth case series study was undertaken of 106 Australian quad bike fatalities that had occurred between 2000 and 2013. All case material held by Australian coroners was obtained and reviewed. RESULTS: One hundred and six cases were categorized as occurring during recreation (53) and work (53). Fifty-two of the work cases occurred during farmwork. The mean age for those killed during a work activity was 56 years compared to 27 years for recreational riders. Two children under 16 years died while performing farmwork and 13 children under 16 years during recreational activities. The analyses show a very clear pattern for farmwork-related deaths: quad bike rolls or pitches over (farmworker, 85%; recreational rider, 55%), rider becomes pinned under quad bike (farmworker, 68%; recreational rider, 30%), and death by asphyxia (farmworker, 42%; recreational rider, 11%). In contrast, recreational riders suffered complex impact injuries to the head and chest that occurred when the rider was traveling at speed, lost control, was ejected, and collided with an object in the environment and/or interacted with the moving quad bike. CONCLUSIONS: The analyses support the need to improve safe quad bike operation through consideration of the age of the rider, training, helmet use, reducing the propensity of quad bikes to roll, and improving handling so that loss of control events are reduced and to prevent crushing and pinning by the vehicle during and after a rollover crash.

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OBJECTIVE: Serious head and cervical spine injuries have been shown to occur mostly independent of one another in pure rollover crashes. In an attempt to define a dynamic rollover crash test protocol that can replicate serious injuries to the head and cervical spine, it is important to understand the conditions that are likely to produce serious injuries to these 2 body regions. The objective of this research is to analyze the effect that impact factors relevant to a rollover crash have on the injury metrics of the head and cervical spine, with a specific interest in the differentiation between independent injuries and those that are predicted to occur concomitantly. METHODS: A series of head impacts was simulated using a detailed finite element model of the human body, the Total HUman Model for Safety (THUMS), in which the impactor velocity, displacement, and direction were varied. The performance of the model was assessed against available experimental tests performed under comparable conditions. Indirect, kinematic-based, and direct, tissue-level, injury metrics were used to assess the likelihood of serious injuries to the head and cervical spine. RESULTS: The performance of the THUMS head and spine in reconstructed experimental impacts compared well to reported values. All impact factors were significantly associated with injury measures for both the head and cervical spine. Increases in impact velocity and displacement resulted in increases in nearly all injury measures, whereas impactor orientation had opposite effects on brain and cervical spine injury metrics. The greatest cervical spine injury measures were recorded in an impact with a 15° anterior orientation. The greatest brain injury measures occurred when the impactor was at its maximum (45°) angle. CONCLUSIONS: The overall kinetic and kinematic response of the THUMS head and cervical spine in reconstructed experiment conditions compare well with reported values, although the occurrence of fractures was overpredicted. The trends in predicted head and cervical spine injury measures were analyzed for 90 simulated impact conditions. Impactor orientation was the only factor that could potentially explain the isolated nature of serious head and spine injuries under rollover crash conditions. The opposing trends of injury measures for the brain and cervical spine indicate that it is unlikely to reproduce the injuries simultaneously in a dynamic rollover test.

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This paper examines self-reported retrospective data for a 12 month period from 2038 adult cyclists from New South Wales (Australia), and compares cyclists according to whether they self-identify as riding mainly for transport or mainly for recreation. Statistically significant differences were found in the demographic characteristics, cycling patterns, and crash experiences between these two groups of cyclists. Transport cyclists tended to be younger, travel more days per week, and within morning and evening peak hours than recreational cyclists; recreational cyclists were more likely to identify fitness as a purpose for cycling. The proportion of cyclists experiencing a crash or crash-related injury in the previous 12 months was similar for transport and recreational cyclists, but there were differences in crash types and location which likely reflect different cycling environments. Heterogeneity within transport and recreational cyclists was also found, based on self-reported riding intensity. An understanding of the different cycling patterns and experiences of various types of cyclists is useful to inform road safety, transport and health promotion policy.

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This paper examines self-reported prospectively collected data from 2038 adult transport and recreational cyclists from New South Wales (Australia) to determine exposure-based incident crash and injury rates. During 25,971 days of cycling, 198 crashes were reported, comprising approximately equal numbers of falls and collisions. The overall crash rate was 0.290 (95% CI, 0.264-0.319) per 1000km or 6.06 (95% CI, 5.52-6.65) per 1000h of travel. The rate of crashes causing any injury (self-treated, or medically attended without overnight hospital stay) was 0.148 (95% CI, 0.133-0.164) per 1000km or 3.09 (95% CI, 2.79-3.43) per 1000h of travel. The rate of crashes causing a medically attended injury (without overnight hospital stay) was 0.023 (95% CI, 0.020-0.027) per 1000km or 0.49 (95% CI, 0.43-0.56) per 1000h of travel. No injuries requiring an overnight stay in hospital were reported on days meeting the inclusion criteria. After adjustment for exposure in hours, or for the risks associated with different infrastructure utilisation, the rates of crashes and medically attended injuries were found to be greater for females than males, less experienced than more experienced cyclists, and for those who rode mainly for transport rather than mainly for recreation. Comparison of estimated crash and injury rates on different infrastructure types were limited by the small number of events, however findings suggest that the separation of cyclists from motorised traffic is by itself not sufficient to ensure safe cycling.

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OBJECTIVE: Roadside barriers are often deployed between road users and fixed hazards to protect users from injury. However, the United States and Australian Roadside Design Guides do not consider motorcyclists in the risk-based decision process for the deployment of a barrier, because the severity indices for barriers and fixed hazards were developed for passenger vehicles. The aim of the present article is to quantify the protective effect of barriers with regards to motorcyclist injury and to thereby inform the Roadside Design Guides as to the relative severity of roadside hazards and infrastructure for motorcyclists. METHOD: A retrospective case series study, using linked police-reported road crash and hospital admission data in New South Wales, Australia, from 2001 to 2009 was performed. Crude and adjusted relative risks of motorcyclist serious injury were determined for various fixed objects compared to barriers, using serious injury rates and multiple variable logistic regression. Calculated relative risks compared with guardrail for motorcyclists were compared with those determined from the United States and Australian Roadside Design Guides for passenger vehicle occupants. RESULTS: The study identified 1364 motorcyclists injured as a result of single-vehicle collisions with roadside barriers, trees, utility poles, and other fixed roadside infrastructure. Trees, posts, and utility poles were shown to provide significantly higher risks of serious injury to motorcyclists compared to barriers. This was also found to be true for serious injuries to particular body regions, such as the head, spine, and torso. The results for motorcyclists were in reasonable agreement with those derived from severity indices in the United States and Australian Roadside Design Guides for passenger vehicle occupants. CONCLUSIONS: Roadside barriers provide a significant reduction in the risk of serious injury to motorcyclists compared to various roadside hazards. The provisions in the United States and Australian Roadside Design Guides for passenger vehicle occupants are generally applicable to motorcyclists and support the prior and ongoing use of such guides for designing roadsides that reduce the risk of injury to motorcyclists. However, a more realistic estimation might be derived by increasing the severity indices for barriers by around 25 percent for motorcyclists.

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OBJECTIVE: Studies performed previously of seat-belted occupants in real-world passenger vehicle rollover-only crashes have identified the head as one of the body regions most often seriously injured. However, there have been few studies investigating how these head injuries occur in any detail. This study aims to investigate the characteristics and patterns of head injury to seat-belted occupants in real-world rollover-only crashes and to identify possible biomechanical mechanisms responsible for head injury to aid in the development of a dynamic rollover test protocol. METHODS: National Automotive Sampling System-Crashworthiness Data System (NASS-CDS) data were used to generate summary statistics and perform logistic regression analysis of restrained and contained occupants in U.S. pure trip-over rollover crashes. Specific information from selected CDS cases focused on identifying potential mechanisms and patterns of serious head injury and the rollover conditions under which the injury occurred are also presented. RESULTS: Twenty-one percent of seriously injured occupants in pure trip-over rollovers had a serious head injury. On average, occupants seated on the far side of the rollover sustained serious head injuries more frequently and were more likely to receive injuries to the inboard side of the head than near-side occupants. Serious head injuries appear to be decoupled from serious injuries to other body regions except for a relationship found between basal skull fractures and cervical spine fractures. Serious head injuries were sustained by some occupants who had less than 15 cm of roof crush above their seated position. CONCLUSIONS: Serious brain injuries appear to occur frequently as a result of loading to the periphery of the head from contact with the roof assembly. Two mechanisms of injury for basal skull fractures in rollover crashes were identified. The injury patterns and locations of contact to the head are sensitive to the seated position of the occupant.

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There has been an ongoing debate in Australia and internationally regarding the effectiveness of bicycle helmets in preventing head injury. This study aims to examine the effectiveness of bicycle helmets in preventing head injury amongst cyclists in crashes involving motor vehicles, and to assess the impact of 'risky cycling behaviour' among helmeted and unhelmeted cyclists. This analysis involved a retrospective, case-control study using linked police-reported road crash, hospital admission and mortality data in New South Wales (NSW), Australia during 2001-2009. The study population was cyclist casualties who were involved in a collision with a motor vehicle. Cases were those that sustained a head injury and were admitted to hospital. Controls were those admitted to hospital who did not sustain a head injury, or those not admitted to hospital. Standard multiple variable logistic regression modelling was conducted, with multinomial outcomes of injury severity. There were 6745 cyclist collisions with motor vehicles where helmet use was known. Helmet use was associated with reduced risk of head injury in bicycle collisions with motor vehicles of up to 74%, and the more severe the injury considered, the greater the reduction. This was also found to be true for particular head injuries such as skull fractures, intracranial injury and open head wounds. Around one half of children and adolescents less than 19 years were not wearing a helmet, an issue that needs to be addressed in light of the demonstrated effectiveness of helmets. Non-helmeted cyclists were more likely to display risky riding behaviour, however, were less likely to cycle in risky areas; the net result of which was that they were more likely to be involved in more severe crashes.

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Around one in three contained and restrained seriously injured occupants in single-vehicle pure rollover crashes receive a serious injury to the thorax. With dynamic rollover test protocols currently under development, there is a need to understand the nature and cause of serious thoracic injuries incurred in rollover events. This will allow decisions to be made with regards to adoption of a suitable crash test dummy and appropriate thoracic injury criteria in such protocols. Valid rollover occupant protection test protocols will lead to vehicle improvements that will reduce the high trauma burden of vehicle rollover crashes. This paper presents an analysis of contained and restrained occupants involved in single-vehicle pure rollover crashes that occurred in the United States between 2000 and 2009 (inclusive). Serious thoracic injury typology and causality are determined. A logistic regression model is developed to determine associations between the incidence of serious thoracic injury and the human, vehicle and environmental characteristics of the crashes. Recommendations are made with regards to the appropriate assessment of potential thoracic injury in dynamic rollover occupant protection crash test protocols.

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Around one third of serious injuries sustained by belted, non-ejected occupants in pure rollover crashes occur to the spine. Dynamic rollover crash test methodologies have been established in Australia and the United States, with the aims of understanding injury potential in rollovers and establishing the basis of an occupant rollover protection crashworthiness test protocol that could be adopted by consumer new car assessment programmes and government regulators internationally. However, for any proposed test protocol to be effective in reducing the high trauma burden resulting from rollover crashes, appropriate anthropomorphic devices that replicate real-world injury mechanisms and biomechanical loads are required. To date, consensus regarding the combination of anthropomorphic device and neck injury criteria for rollover crash tests has not been reached. The aim of the present study is to provide new information pertaining to the nature and mechanisms of spine injury in pure rollover crashes, and to assist in the assessment of spine injury potential in rollover crash tests. Real-world spine injury cases that resulted from pure rollover crashes in the United States between 2000 and 2009 are identified, and compared with cadaver experiments under vertical load by other authors. The analysis is restricted to contained, restrained occupants that were injured from contact with the vehicle roof structure during a pure rollover, and the role of roof intrusion in creating potential for spine injury is assessed. Recommendations for assessing the potential for spine injury in rollover occupant protection crash test protocols are made.

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Motorcyclists contribute significantly to road trauma around the world through the high incidence of serious injuries and fatalities. The role of roadside safety barriers in such trauma is an area of growing concern amongst motorcyclists, road authorities and road safety researchers and advocates. This paper presents a case series analysis of motorcyclists that were fatally injured following a collision with a roadside barrier during the period 2001-2006 in Australia and New Zealand. Injury profiles and severities are detailed, and associations with crash characteristics are investigated. It is shown that the thorax region had the highest incidence of injury and the highest incidence of maximum injury in fatal motorcycle-barrier crashes, followed by the head region. This is in contrast to fatal motorcycle crashes in all single- and multi-vehicle crash modes, where head injury predominates. The injury profiles of motorcyclists that slid into barriers and those that collided with barriers in the upright posture were similar. However, those that slid in were more likely to receive thorax and pelvis injuries.

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An analysis of 2000-2007 single vehicle rollover fatalities in three Australian states was carried out using data from the Australian National Coroners Information System. In this paper, successive selection criteria were applied to the initial dataset to analyse:overall, rollovers accounted for 35% of all occupant fatalities in a single vehicle transport injury event. For these fatalities, the occupant was ejected or stayed contained in equal proportions. However, results showed strong disparities between the more urban and densely populated states of New South Wales and Victoria, compared to the Northern Territory in terms of crash type distribution and containment of the occupant. Differences were also found in rollover initiation, speed at initiation and number of turns. Overall, the strongest association of fatal neck/thoracic spine injuries with head injuries was found for the contained, restrained occupant. This analysis of single vehicle rollover fatalities is consistent with previous findings. It also shows that in Australia, strategies for rollover injury risk mitigation will need to take into account a broad range of characteristics to be effective.

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Much to the frustration of road safety researchers, practitioners, and advocates, road deaths and injuries have not been widely accepted as a major public health threat. Currently, road trauma is one of the biggest killers and causes of serious and disabling injuries in the world. Although there has been considerable research on the causes of road injury and ways of mitigating the problem, there is still reluctance to systematically and sufficiently do what can be done to reduce this problem globally. This paper takes a historical review of the road trauma problem and responses to it. In examining developments in road transport and road injury, it is clear that the main impediment to reducing road deaths and injury has been a misguided preference of economic advancement over public health risk management. It is misguided because road trauma has impeded and does still impede the capacity of economies to develop. The challenge for societies now is to look at this false dichotomy-that of road development and motorisation versus road safety-and begin to make the right choices in favour of human society advancement through the development and management of safe road-traffic systems. A new 'Safe Systems' approach is emerging in Australia and spreading globally as a guiding principle for road safety. The evolution of this approach is traced and illustrated in this article. The need for finding ways to engender a stronger global political commitment to road safety is demonstrated.

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The purpose of this paper is to present a protocol of inverted drop-tests using a 50th percentile Hybrid III Anthropomorphic Test Device (ATD) and investigate the influence of angle and velocity at impact on neck injury risk assessment. The tests were based on existing cadaveric experimental protocols for inverted seated positions. In this study selected ATD impact orientations were also assessed in both the sagittal and coronal planes. Twenty-six tests were performed at impact velocities from 1.4 to 3.1 m s(-1). The drop tests confirmed previously described behavior of the ATD in axial loading of its head/neck/thorax complex. They also showed a significant influence of the initial impact angle on neck injury criteria currently used by researchers in rollover crashworthiness tests. At 1.4 m s(-1), the peak upper neck axial force of 4350 N was reduced by an average 1760 +/- 80 N for configurations with 30 degrees initial impact angle in any plane, compared to a reference inverted vertical configuration. The N(ij) was also significantly influenced. For a given impact velocity, an out-of-both-planes initial configuration resulted in the highest combined outputs. Based on these results, similar dynamic conditions (intrusion velocity, impact duration) may result in significantly different loadings of the Hybrid III neck.

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OBJECTIVES: To investigate and quantify fall height, surface depth, and surface impact attenuation as risk factors for arm fracture in children who fall from playground equipment. DESIGN: Unmatched case control study. SETTING: Five case hospitals and 78 randomly selected control schools. PARTICIPANTS: Children aged less than 13 years in Victoria, Australia who fell from school playground equipment and landed on their arm. Cases sustained an upper limb fracture and controls had minor or no injury. A total of 402 cases and 283 controls were included. INTERVENTIONS: Children were interviewed in the playground as soon as possible after their fall. MAIN OUTCOME MEASURES: Falls were recreated on site using two validated impact test devices: a headform (measuring peak G and HIC) and a novel anthropometric arm load dummy. Equipment and fall heights, as well as surface depth and substrate were measured. RESULTS: Arm fracture risk was greatest for critical equipment heights above 1.5 m (OR 2.39, 95% CI 1.49 to 3.84, p<0.01), and critical fall heights above 1.0 m (OR 2.96, 95% CI 1.71 to 5.15, p<0.01). Peak headform deceleration below 100G was protective (OR 0.67, 95% CI 0.45 to 0.99, p = 0.04). Compliance with 20 cm surface depth recommendation was poor for both cases and controls. CONCLUSIONS: Arm fracture-specific criteria should be considered for future standards. These include surface and height conditions where critical headform deceleration is less than 100G. Consideration should also be given to reducing maximum equipment height to 1.5 m. Improved surface depth compliance and, in particular, guidelines for surface maintenance are required.

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OBJECTIVES: To present the development of a novel multidisciplinary method to investigate physical risk factors for playground related arm fracture. RATIONALE: Previous playground injury research has been limited in its ability to determine risk factors for arm fractures, despite their common and costly occurrence. Biomechanical studies have focused exclusively on head injury. Few epidemiological studies have quantified surface impact attenuation and none have investigated specific injury outcomes such as arm fracture. DESIGN: An unmatched case-control study design was developed. An instrumented child dummy and rig were designed to simulate real playground falls in situ. Validated output from the dummy was used to quantify arm load. Other field measurements included equipment height, fall height, surface depth, headform deceleration, and head injury criterion. DISCUSSION: Validated methods of biomechanics and epidemiology were combined in a robust design. The principle strength of this method was the use of a multidisciplinary approach to identify and quantify risk and protective factors for arm fracture in falls from playground equipment. Application of this method will enable countermeasures for prevention of playground related arm fracture to be developed.

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