Under-reporting bicycle accidents to police in the COST TU1101 international survey: Cross-country comparisons and associated factors.

Police crash reports are often the main source for official data in many countries. However, with the exception of fatal crashes, crashes are often underreported in a biased manner. Consequently, the countermeasures adopted according to them may be inefficient. In the case of bicycle crashes, this bias is most acute and it probably varies across countries, with some of them being more prone to reporting accidents to police than others. Assessing if this bias occurs and the size of it can be of great importance for evaluating the risks associated with bicycling. This study utilized data collected in the COST TU1101 action "Towards safer bicycling through optimization of bicycle helmets and usage". The data came from an online survey that included questions related to bicyclists' attitudes, behaviour, cycling habits, accidents, and patterns of use of helmets. The survey was filled by 8655 bicyclists from 30 different countries. After applying various exclusion factors, 7015 questionnaires filled by adult cyclists from 17 countries, each with at least 100 valid responses, remained in our sample. The results showed that across all countries, an average of only 10% of all crashes were reported to the police, with a wide range among countries: from a minimum of 0.0% (Israel) and 2.6% (Croatia) to a maximum of a 35.0% (Germany). Some factors associated with the reporting levels were type of crash, type of vehicle involved, and injury severity. No relation was found between the likelihood of reporting and the cyclist's gender, age, educational level, marital status, being a parent, use of helmet, and type of bicycle. The significant under-reporting - including injury crashes that do not lead to hospitalization - justifies the use of self-report survey data for assessment of bicycling crash patterns as they relate to (1) crash risk issues such as location, infrastructure, cyclists' characteristics, and use of helmet and (2) strategic approaches to bicycle crash prevention and injury reduction.

Powered two wheelers in a changing world-challenges and opportunities.

Powered two wheelers (PTWs) come in diverse forms and are used for a range of purposes in very different parts of the world. In many parts of the world, the forms and uses of PTWs are changing, influenced by social, economic and demographic changes. Most of the challenges associated with PTWs relate to safety, while the majority of the opportunities relate to mobility. The challenges for improving safety relate to the PTW user, other road users, the road environment, the vehicle, data and research, and socio-political dimensions. The relative importance of particular challenges varies between developed and developing countries, and among developing countries according to whether PTWs are largely used for recreation or for transport. PTWs present a range of psychological, transport, economic and environmental opportunities to individuals and societies. The fun and excitement of riding PTWs is a major motivator for their purchase and use for recreational purposes, both off-road and on-road. The transport and economic advantages to the individual also need to be considered. At a societal level, research has examined the potential for increasing PTW volumes to reduce fossil fuel use and traffic congestion in busy cities. The future of PTWs may differ greatly between countries and environmental and technological changes are leading to an evolution in the form of PTWs to encompass new modes of personal transportation.

Effectiveness of motorcycle protective clothing: riders' health outcomes in the six months following a crash.

BACKGROUND: Little is known about the contribution of protective clothing worn in motorcycle crashes to subsequent health-related outcomes, impairment and quality of life. METHODS: A prospective cohort of 212 adult motorcyclists were recruited following presentations to hospitals or crash repair services in a defined geographic area in Australia between June 2008 and July 2009. Data was obtained from participant interviews and medical records at baseline, then by mailed survey two and six months post-crash (n=146, 69%). The exposure factor was usage of protective clothing classified as full protection (motorcycle jacket and pants), partial protection (motorcycle jacket) and unprotected (neither). Outcomes of interest included general health status (Short Form SF-36), disability (Health Assessment Questionnaire) treatment and recovery progress, quality of life and return to work in the six months post-crash. Odds ratios (OR) were estimated for categorical outcomes using multiple logistic regression to assess differences in outcomes associated with levels of protection adjusted for potential confounders including age, sex, occupation, speed and type of impact. Non-parametric procedures were used for data that was not normally distributed. RESULTS: Compared to unprotected riders, both fully and partially protected riders had fewer days in hospital and reported less pain immediately post-crash; at two months both protection groups were less likely to have disabilities or reductions in physical function. By six months there were no significant differences in disability or physical function between groups, but both protection groups were more likely to be fully recovered and returned to pre-crash work than unprotected riders. Fully protected riders achieved better outcomes than either partially or unprotected riders on most measures. There were few significant differences between the full and partial protection groups although the latter showed greater impairment in physical health two months post-crash. CONCLUSIONS: We found strong associations between use of protective clothing and mitigation of the consequences of injury in terms of post-crash health and well-being. Given this evidence it seems likely that the use of protective clothing will confer significant benefits to riders in the event of a crash.

Knowledge, attitudes and beliefs towards injury prevention: a population-based telephone survey.

Public knowledge and beliefs about injury prevention are currently poorly understood. A total of 1030 residents in the State of Queensland, Australia, responded to questions about injury prevention in or around the home, on the roads, in or on the water, at work, deliberate injury and responsibility for preventing deliberate injury allowing for comparison with reported injury prevalence data. Overall, the youngest members of society were identified as being the most vulnerable to deliberate injury with young adults accounting for 59% of responses aligning with reported data. However, younger adults failed to indicate an awareness of their own vulnerability to deliberate injury in alcohol environments even though 61% of older respondents were aware of this trend. Older respondents were the least inclined to agree that they could make a difference to their own safety in or around the home but were more inclined to agree that they could make a difference to their own safety at work. The results are discussed with a view to using improved awareness of public beliefs about injury to identify barriers to the uptake of injury prevention strategies (e.g. low perceived injury risk) as well as areas where injury prevention strategies may receive public support.

"Forbidden" disulfides: their role as redox switches.

Seminal studies by Richardson and Thornton defined the constraints imposed by protein structure on disulfide formation and flagged forbidden regions of primary or secondary structure seemingly incapable of forming disulfide bonds between resident cysteine pairs. With respect to secondary structure, disulfide bonds were not found between cysteine pairs: A. on adjacent beta-stands; B. in a single helix or strand; C. on non-adjacent strands of the same beta-sheet. In primary structure, disulfide bonds were not found between cysteine pairs: D. adjacent in the sequence. In the intervening years it has become apparent that all these forbidden regions are indeed occupied by disulfide-bonded cysteines, albeit rather strained ones. It has been observed that sources of strain in a protein structure, such as residues in forbidden regions of the Ramachandran plot and cis-peptide bonds, are found in functionally important regions of the protein and warrant further investigation. Like the Ramachandran plot, the earlier studies by Richardson and Thornton have identified a fundamental truth in protein stereochemistry: "forbidden" disulfides adopt strained conformations, but there is likely a functional reason for this. Emerging evidence supports a role for forbidden disulfides in redox-regulation of proteins.

Evaluating the stability of disulfide bridges in proteins: a torsional potential energy surface for diethyl disulfide.

Disulfide bonds formed by the oxidation of cysteine residues in proteins are the major form of intra- and inter-molecular covalent linkages in the polypeptide chain. To better understand the conformational energetics of this linkage, we have used the MP2(full)/6-31G(d) method to generate a full potential energy surface (PES) for the torsion of the model compound diethyl disulfide (DEDS) around its three critical dihedral angles (χ2, χ3, χ2'). The use of ten degree increments for each of the parameters resulted in a continuous, fine-grained surface. This allowed us to accurately predict the relative stabilities of disulfide bonds in high resolution structures from the Protein Data Bank. The MP2(full) surface showed significant qualitative differences from the PES calculated using the Amber force field. In particular, a different ordering was seen for the relative energies of the local minima. Thus, Amber energies are not reliable for comparison of the relative stabilities of disulfide bonds. Surprisingly, the surface did not show a minimum associated with χ2 ∼ - 60°, χ3 ∼ 90, χ2' ∼ - 60°. This is due to steric interference between Hα atoms. Despite this, significant populations of disulfides were found to adopt this conformation. In most cases this conformation is associated with an unusual secondary structure motif, the cross-strand disulfide. The relative instability of cross-strand disulfides is of great interest, as they have the potential to act as functional switches in redox processes.

Neurological involvement in hemolytic-uremic syndrome.

Of 44 children with hemolytic-uremic syndrome seen at Milwaukee Children's Hospital, 15 (34%) had neurological involvement. This group contained 8 boys and 7 girls, with a mean age of 3 1/4 years. Twelve patients had seizure within 48 hours of admission. Seizures were associated with hypertension, fever, hyponatremia, or hypocalcemia. Other neurological symptoms included altered consciousness, behavioral changes, diplopia, and dizziness. Hemiparesis (4 patients), eye involvement (7 patients), decerebrate posturing (2 patients), and ataxia (1 patient) were present on physical examination. Cerebrospinal fluid examination showed increased protein in 4 of 11 patients. Electroencephalograms were abnormal in all 9 patients tested. Computed tomographic and radionuclide scans showed evidence of vascular abnormalities in 4 of the 14 patients studied. Complete neurological recovery occurred in only 6 of the 15 children, while the remaining 6 demonstrated residual hemiparesis, seizures, and cortical visual defect. In those children with neurological involvement, there was a higher incidence of residual hypertension (49% versus 11%), chronic renal damage (40% versus 3.5%), and death (28% versus 0%), suggesting that central nervous system involvement indicates severe hemolytic-uremic syndrome.