Firearm Storage Behaviors - Behavioral Risk Factor Surveillance System, Eight States, 2021-2022.

Secure firearm storage might help reduce access by children and other unauthorized users and the related risk for injury or death. Information about state-specific prevalence of firearm storage practices can be used to develop secure storage messages and programs; however, such information is often unavailable. Data from the Behavioral Risk Factor Surveillance System, by respondent characteristics, were used to estimate prevalence of keeping firearms in or around the home and related storage practices for eight states that administered the firearm safety module in 2021 or 2022. Overall, 18.4% (California) to 50.6% (Alaska) of respondents reported that a firearm was kept in or around their home. Among those with a firearm in or around the home, 19.5% (Minnesota) to 43.8% (North Carolina) reported that a firearm was stored loaded. Across all eight states, approximately one half of those with a loaded firearm stored at least one loaded firearm unlocked. Among respondents with a child and a loaded firearm in the home, 25.2% (Ohio) to 41.4% (Alaska) reported that a loaded firearm was stored unlocked. Variability in firearm storage practices highlights the importance of local data and suggests opportunities to tailor prevention efforts to specific population groups to reduce risk for firearm handling by children without adult supervision, and other unauthorized persons.

Safety and Efficacy of 90Y Selective Internal Radiation Therapy Using Glass Microspheres in Hepatocellular Carcinoma: A Southeast Asian Single-Institution Initial Experience.

Our objective was to demonstrate primarily the safety and secondarily the efficacy of 90Y glass microspheres in selective internal radiation therapy (SIRT) for hepatocellular carcinoma (HCC) in a local Southeast Asian hospital. Methods: Eleven consecutive patients with small, unresectable, nonmetastatic HCC and referred for locoregional therapy with SIRT with a curative intention were followed up for 6 mo after the procedure by way of interviews, blood tests, and anatomic scans. Results: Although 5 patients had deranged liver function tests after the procedure, in only 1 patient did this constitute a grade 1 toxicity (in alkaline phosphatase) by the Common Terminology Criteria for Adverse Events. Half the patients showed a reduction in serum α-fetoprotein measurements, and 6 of 11 patients demonstrated an objective response (complete or partial) on imaging. Conclusion: SIRT with 90Y glass microspheres is a safe and efficacious locoregional therapy for unresectable HCC. There are similar articles published in the West; however, the patient population there comprises far fewer Asians and the underlying cause for HCC is different from that in the Asian population. Despite these differences, SIRT is an equally effective and safe option for such patients.

A Rapid Response System for Elderly Safety Monitoring Using Progressive Hierarchical Action Recognition.

The global trend of population aging presents an urgent challenge in ensuring the safety and well-being of elderly individuals, especially those living alone due to various circumstances. A promising approach to this challenge involves leveraging Human Action Recognition (HAR) by integrating data from multiple sensors. However, the field of HAR has struggled to strike a balance between accuracy and response time. While technological advancements have improved recognition accuracy, complex algorithms often come at the expense of response time. To address this issue, we introduce an innovative asynchronous detection method called Rapid Response Elderly Safety Monitoring (RESAM), which relies on progressive hierarchical action recognition and multi-sensor data fusion. Through initial analysis of inertial sensor data using Kernel Principal Component Analysis (KPCA) and multi-class classifiers, we efficiently reduce processing time and lower the false-negative rate (FNR). The inertial sensor identification serves as a pre-filter, enabling the identification of filtered abnormal signals. Decision-level data fusion is then executed, incorporating skeleton image analysis based on ResNet and the inertial sensor data from the initial step. This integration enables the accurate differentiation between normal and abnormal behaviors. The RESAM method achieves an impressive 97.4% accuracy on the UTD-MHAD database with a minimal delay of 1.22 seconds. On our internally collected database, the RESAM system attains an accuracy of 99%, ranking among the most accurate state-of-the-art methods available. These results underscore the practicality and effectiveness of our approach in meeting the critical demand for swift and precise responses in healthcare scenarios.

Child pedestrian safety training in virtual reality: How quickly do children achieve adult functioning and what individual differences impact learning efficiency?

INTRODUCTION: Pedestrian injuries represent a leading cause of child death globally. One prevention strategy is teaching children street-crossing skills. Virtual reality (VR) has emerged as a strategy to offer repeated street-crossing practice and overcome ethical barriers of training children in live traffic. This study addressed two questions pertinent to implementation of child pedestrian safety training within VR: (a) how much training do children require to achieve adult street-crossing competency, and (b) what individual differences might facilitate children to acquire that competency more efficiently? METHODS: Five hundred 7- and 8-year-olds were recruited. Children completed pedestrian safety training within VR for up to 25 thirty-minute training sessions until they achieved adult levels of mastery. At baseline, four cognitive-perceptual skills (visual memory, visual perception, processing speed, working memory) and parent-reported externalizing symptomatology were assessed. RESULTS: On average, children achieved adult pedestrian safety competency after 10.0 training sessions (SD = 4.8). Just one child (<1%) failed to achieve adult pedestrian functioning after 25 training sessions. In univariate analyses, boys took slightly longer than girls to achieve adult functioning, and visual memory, visual perception, processing speed, working memory, and fewer externalizing symptoms were all positively associated with shorter time to mastery. In a multivariable model, only child age was a statistically significant predictor. CONCLUSION: Almost all participants achieved adult street-crossing skills competency through VR training, although they required about 10 sessions on average. Analysis of predictor variables confirmed that nearly all 7- and 8-year-olds are trainable. PRACTICAL APPLICATION: Implementation of VR pedestrian safety training is recommended, but must be conducted cautiously to ensure children are not permitted to engage independently in traffic until they are assessed and demonstrate sufficient skills.

Safety is the preservation of value.

INTRODUCTION: The questions 'what is safety?' and 'what is it that safety researcher's study?' are at the very core of safety research as an academic discipline. One might therefore assume that the discipline is based on clear answers to these questions, answers that are unanimously shared among the great majority of safety researchers. Strangely enough, this is not the case, and this lack of consensus is a major problem, because, as Leveson (2020) points out, without it "everyone starts from a different definition of safety and communication is inhibited." By 2014 this lack of clarity and consensus had become so obvious that there was an entire journal special issue dedicated to the topic. That discussion led to a clarification of the problems, but failed to solve them. Several contributors have since proposed solutions, none of which have gained widespread support. METHOD: This paper argues that there is still a gap in our theoretical conceptualization, and proposes that safety fundamentally refers to positive value: specifically, the quality of experiences and objects that make people desire them. It is not operations, or persons, or objects that are safe, it is the various valuable qualities that can be lost and that are safe as long as they are preserved. As the future is fundamentally uncertain, all attempts at preserving values or valuables for a desired duration can only rest on assessments of the probability that one will manage to preserve them. Hence, this study proposes the following definition: Safety is the material, emotional and mental state that obtains when it is highly probable that all relevant positive values will be preserved for a desired duration, and the knowledge supporting this probability assessment is strong.

Effectiveness of signs for pedestrian-railroad crossings: Colors, shapes, and messaging strategies.

INTRODUCTION: Train-pedestrian conflicts result in a substantial number of serious and fatal injuries annually. Signs indicating safe and permissible behaviors near railroad rights of way are commonly relied upon to mitigate collisions. However, the effectiveness of these signs in preventing accidents often depends on clarity and interpretation of the sign. The objective of this study was to evaluate the (1) effectiveness of sign messaging strategies and designs at pedestrian-railroad crossings, and (2) effects of context and risk-taking propensity on decisions to cross tracks. METHOD: A survey study (N = 1011) was conducted comparing likeliness to cross for a variety of pedestrian-railroad scenarios. The DOSPERT scale was included to estimate an individuals' risk-taking. RESULTS: Findings reveal that action-conveying and emotionally-motivated signs are more effective in discouraging railroad crossing in high-risk situations (i.e., train present, crossing gates down, or warning lights flashing), compared to information-only signs. However, decisions to cross are primarily influenced by the presence of a train and crossing gates' status, followed by sign type. MaxDiff analysis show that yellow signs with black symbols and square shaped signs are perceived as the clearest in conveying safety information, compared to black on white, red on white, and circular signs. Additionally, individuals who cross railroad tracks as pedestrians more frequently exhibit higher risk-taking tendencies, while there is no relationship between driving across tracks and risk-taking propensity. Males and younger individuals also have higher risk-taking tendencies. CONCLUSIONS AND PRACTICAL APPLICATIONS: These findings have implications for policy and practice, such as revising manuals to incorporate more effective sign designs and targeted educational campaigns for high-risk groups. It is also crucial to conduct ongoing monitoring of implemented interventions, which could follow the framework presented in this paper. The study emphasizes collaboration across sectors to improve overall safety at pedestrian-railroad crossings, contributing to safer transportation infrastructure for all.

Effect of eco-driving on commercial motor vehicle driver collision risk.

INTRODUCTION: This study investigates the effect among commercial motor vehicle (CMV) drivers of the adoption of fuel-efficient driving techniques (commonly known as eco-driving) on the odds of being involved in safety-related events. METHOD: For 2,637 long-haul class 8 drivers employed by four carriers in Canada, information on driving style, total distance driven, and safety-related events like collisions, hard-braking, hard-turning, and stability control events were collected for each trip. Three carriers provided driving style-related data from the ISAAC instrument, which provides a score on a 0 to 100 scale that measures the degree to which a driver is using an appropriate amount of engine power according to driving conditions. The fourth carrier provided data on driving style characteristics, including fuel consumption, use of cruise control, and use of top gear. Depending on the carrier, information on speeding, driver age, and years of experience driving a commercial vehicle was also collected. Logit statistical models were developed to estimate the change in odds of a driver experiencing a safety-related event dependent on the measures of driving style. RESULTS: A one-unit increase in the ISAAC score was associated with a 7%, 8%, 8%, and 4% reduction in the odds of having a hard-braking event, hard left-turn event, hard right-turn event, and collision, respectively. For the carrier not employing the ISAAC system, an increase of 10% in the time spent driving in top gear with steady speed near 100 km per hour (km/h) was associated with a substantial 34% decrease in stability control events. In addition, a year increase in the driver's age, as well as a 1% increase in the amount of time spent driving using cruise control, reduced the number of hard-braking events by 9% and 3%, respectively. Conclusion/Practical Applications: The adoption of fuel-efficient driving techniques enhances the safety of CMV drivers.

Evaluation and comparison of administrative division-level road traffic safety indices of Egypt, England, Turkey, and the United States.

INTRODUCTION: There is regional diversity inside countries regarding road safety indices (RSIs), and countries rarely have been compared based on these indicators. Thus, regional RSIs of England, the United States, Egypt, and Turkey were evaluated. Regional data were collected from the statistical center of each country. The adopted regional RSIs include road fatalities, health risk (HR) or fatalities per population, and traffic risk (TR) or fatalities per number of vehicles. The associations between variables were examined using correlation and regression analysis. The spatial distributions of subdivisions were evaluated using Moran's I, the local Moran index. RESULTS: Considerable differences between the countries were observed, including differences in the spatial distribution of regions and associations between RSIs. Significant relationships were detected between road fatality, population, and the number of motor vehicles. Higher exposure rates mean higher fatalities in regions. A robust linear relationship between the HR and TR indices was identified in developed countries. There is a nonlinear and significant association between motorization rates and TR indices of regions, and fatality risk decreases as the motorization rate increases. There is a considerable gap between developed and developing countries regarding regional RSIs, and the transferability of road safety models from one country to another is challenging. Huge hotspots regarding RSIs were observed in Turkey and the United States. The locations of hot spots in terms of the risk indices were identical in the developed countries.

Different but also alike? Ingroup-outgroup phenomena among cyclists and e-scooter riders.

PROBLEM: In many countries, a new road user group, e-scooter riders, share the existing cycling infrastructure. The study aimed to investigate if an individual's status as a cyclist or e-scooter rider affects their social identity and whether it results in ingroup favoritism or outgroup discrimination. METHOD: An online experiment involving 179 cyclists and 64 e-scooter riders was conducted, where they rated the behavior of ingroup or outgroup members in six traffic scenarios. RESULTS: Participants rated dispositional attributions as more causally relevant than situational ones across all traffic scenarios. Cyclists and e-scooter riders were inclined to judge ingroup members' rule violations more harshly than those of outgroup members in terms of dispositional attribution ratings and punishment severity. For situational attributions, few indications of ingroup favoritism were observed for the e-scooter rider group. SUMMARY: Findings suggest initial indications of considerate coexistence, from the perspective of social identity theory, between the two modes of transport, supporting current regulations on the use of cycling infrastructure by e-scooter riders. Indications of ingroup discrimination, however, suggest that safety campaigning may target to promote courtesy within the cyclist and e-scooter rider groups.

Perceptions of vulnerable roadway users on autonomous vehicle regulations.

INTRODUCTION: Development and implementation of autonomous vehicle (AV) related regulations are necessary to ensure safe AV deployment and wide acceptance among all roadway users. Assessment of vulnerable roadway users' perceptions on AV regulations could inform policymakers the development of appropriate AV regulations that facilitate the safety of diverse users in a multimodal transportation system. METHOD: This research evaluated pedestrians' and bicyclists' perceptions on six AV regulations (i.e., capping AV speed limit, operating AV in manual mode in the sensitive areas, having both pilot and co-pilot while operating AVs, and three data-sharing regulations). In addition, pedestrians' and bicyclists' perceptions of testing AVs in public streets were evaluated. Statistical testing and modeling techniques were applied to accomplish the research objectives. RESULTS: Compared to the other AV regulations assessed in this research, strong support for AV-related data sharing regulations was identified. Older respondents showed higher approval of AV testing on public roadways and less support for regulating AVs. AV technology familiarity and safe road sharing perceptions with AVs resulted in lower support for AV regulations. CONCLUSIONS: Policymakers and AV technology developers could develop effective educational tools/resources to inform pedestrians and bicyclists about AV technology reliability and soften their stance, especially on AV regulations, which could delay technology development. PRACTICAL APPLICATIONS: The findings of this research could be used to develop informed AV regulations and develop policies that could improve pedestrians' and bicyclists' attitudes/perceptions on regulating AVs and promoting AV technology deployments.

Differences in route choice behavior when riding shared e-scooters vs. bicycles - A field study.

PROBLEM: The surge in popularity of electric kick scooters (e-scooters) poses new challenges for traffic planning, demanding a comprehensive understanding of route choice behavior to see how e-scooters are used, how they affect traffic flow, and where improvements can be made to the road infrastructure. Therefore, this study aimed to analyze route choices and preferences of e-scooter riders and cyclists in a quasi-experimental setup with both user groups having the same trip destinations. METHOD: Two groups of participants (n = 52) completed a ride with either a shared e-scooter or bicycle to reach four predefined destinations in Dresden, Germany. The riders were supposed to choose their routes and subsequently reported the difficulty of decision-making and the importance of several route choice factors related to the ride. RESULTS: E-scooter riders rated road surface and safety as significantly more important for route choice than cyclists and tended to perceive the decision-making as more difficult. Riding data revealed broad comparability between the groups, with e-scooter riders tendentially having longer routes for complex decisions (unknown destinations, scenic routes, more turns required). DISCUSSION: The study suggests that the route preferences of e-scooter riders may be influenced by a combination of road surface and safety considerations, highlighting the need for high-quality cycling infrastructure. Limitations exist regarding the naturally occurring differences in riding experience in e-scooter riding versus cycling. Practical implications indicate that planning for e-scooter riders can benefit from insights drawn from activities designed for cyclists. The provision of real-time road quality information is proposed, considering its potential impact on overall road safety. SUMMARY: This study contributes to a better understanding of how e-scooter riders navigate through cities and delivers a valuable foundation for transport planners and engineers considering the rise in cycling and micro-mobility use.

Enhancing rail safety through real-time defect detection: A novel lightweight network approach.

The rapid detection of internal rail defects is critical to maintaining railway safety, but this task faces a significant challenge due to the limited computational resources of onboard detection systems. This paper presents YOLOv8n-LiteCBAM, an advanced network designed to enhance the efficiency of rail defect detection. The network designs a lightweight DepthStackNet backbone to replace the existing CSPDarkNet backbone. Further optimization is achieved through model pruning techniques and the incorporation of a novel Bidirectional Convolutional Block Attention Module (BiCBAM). Additionally, inference acceleration is realized via ONNX Runtime. Experimental results on the rail defect dataset demonstrate that our model achieves 92.9% mAP with inference speeds of 136.79 FPS on the GPU and 38.36 FPS on the CPU. The model's inference speed outperforms that of other lightweight models and ensures that it meets the real-time detection requirements of Rail Flaw Detection (RFD) vehicles traveling at 80 km/h. Consequently, the YOLOv8n-LiteCBAM network is with some potential for industrial application in the expedited detection of internal rail defects.

Evaluating the reliability of automatically generated pedestrian and bicycle crash surrogates.

Vulnerable Road Users (VRUs), such as pedestrians and bicyclists, are at a higher risk of being involved in crashes with motor vehicles, and crashes involving VRUs also are more likely to result in severe injuries or fatalities. Signalized intersections are a major safety concern for VRUs due to their complex dynamics, emphasizing the need to understand how these road users interact with motor vehicles and deploy evidence-based safety countermeasures. Given the infrequency of VRU-related crashes, identifying conflicts between VRUs and motorized vehicles as surrogate safety indicators offers an alternative approach. Automatically detecting these conflicts using a video-based system is a crucial step in developing smart infrastructure to enhance VRU safety. However, further research is required to enhance its reliability and accuracy. Building upon a study conducted by the Pennsylvania Department of Transportation (PennDOT), which utilized a video-based event monitoring system to assess VRU and motor vehicle interactions at fifteen signalized intersections in Pennsylvania, this research aims to evaluate the reliability of automatically generated surrogates in predicting confirmed conflicts without human supervision, employing advanced data-driven models such as logistic regression and tree-based algorithms. The surrogate data used for this analysis includes automatically collectable variables such as vehicular and VRU speeds, movements, post-encroachment time, in addition to manually collected variables like signal states, lighting, and weather conditions. To address data scarcity challenges, synthetic data augmentation techniques are used to balance the dataset and enhance model robustness. The findings highlight the varying importance and impact of specific surrogates in predicting true conflicts, with some surrogates proving more informative than others. Additionally, the research examines the distinctions between significant variables in identifying bicycle and pedestrian conflicts. These findings can assist transportation agencies to collect the right types of data to help prioritize infrastructure investments, such as bike lanes and crosswalks, and evaluate their effectiveness.

Safety effects of bypass lanes at unsignalized three-leg junctions.

Bypass lanes are a low-cost measure to increase capacity at unsignalized T-junctions without left-turn lanes that allow through-traffic to pass left-turning vehicles on the right. There is very limited knowledge about the safety effects of bypass lanes. We found six previous studies that could be summarized by means of meta-analysis, and the results show an average accident reduction of 10 percent. However, the results from previous studies are inconsistent and may be biased. Therefore, the present study has estimated safety effects of by-pass lanes in Norway, based on a sample of 2,227 T-junctions (incl. 94 with bypass-lanes) for which relevant data was available for a period of up to 10 years. We developed accident prediction models and conducted before-after analyses. The accident prediction models show that junctions with bypass lanes have 82 percent more accidents than junctions without bypass lanes, when controlling for endogeneity. Endogeneity occurs when the implementation of a measure is conditional on the frequency of crashes, as has been the case with bypass lanes. The before-after analysis shows that average accident numbers decrease after the installation of bypass lanes. However, when controlling for regression-to-the-mean (RTM), average accident numbers increase. RTM means that accident numbers would have been likely to decrease even without any measure because they had been exceptionally high in the before period. The control for potential biases in our study is likely to contribute to the discrepancy between results from our study and previous studies, most of which have not controlled for the same potential biases. We conclude therefore that bypass lanes, although favorable for capacity, are likely to be unfavorable for safety when compared to other unsignalized T-junctions without left-turn lanes. Unfavorable safety effects may partly be due to site specific conditions, such as road alignment and sight conditions, that contribute to rear-end collision risk or inappropriate driver behavior. However, this does not necessarily mean that bypass lanes never should be used. For example, at junctions where a bypass lane may solve capacity problems, and where site-specific conditions are favorable, bypass lanes may still be an acceptable solution.

A simulator study assessing the effectiveness of training and warning systems on drivers' response performance to vehicle cyberattacks.

Modern vehicles are vulnerable to cyberattacks and the consequences can be severe. While technological efforts have attempted to address the problem, the role of human drivers is understudied. This study aims to assess the effectiveness of training and warning systems on drivers' response behavior to vehicle cyberattacks. Thirty-two participants completed a driving simulator study to assess the effectiveness of training and warning system according to their velocity, deceleration events, and count of cautionary behaviors. Participants, who held a valid United States driving license and had a mean age of 20.4 years old, were equally assigned to one of four groups: control (n = 8), training-only (n = 8), warning-only (n = 8), training and warning groups (n = 8). For each drive, mixed ANOVAs were implemented on the velocity variables and Poisson regression was conducted on the normalized time with large deceleration events and cautionary behavior variables. Overall, the results suggest that drivers' response behaviors were moderately affected by the training programs and the warning messages. Most drivers who received training or warning messages responded safely and appropriately to cyberattacks, e.g., by slowing down, pulling over, or performing cautionary behaviors, but only in specific cyberattack events. Training programs show promise in improving drivers' responses toward vehicle cyberattacks, and warning messages show rather moderate improvement but can be further refined to yield consistent behavior.

Safety and Efficacy of 177 Lu-DOTATATE in Children and Young Adult Population : A Single-Center Experience.

PURPOSE: This single-center retrospective study explores the safety and efficacy of 177 Lu-DOTATATE in children and young adult population with metastatic/inoperable neuroendocrine tumors (NETs). PATIENTS AND METHODS: This study is a retrospective analysis of all children and young adult patients (≤29 years) with advanced inoperable/metastatic epithelial or nonepithelial NETs who were administered a median of 4 cycles of 177 Lu-DOTATATE therapy and low-dose oral capecitabine as a radiosensitizer every 8-12 weeks, except 2 patients who received CAPTEM chemotherapy. The radiological response was assessed using RECIST 1.1 on interim and end-of-treatment 68 Ga-DOTANOC PET/CT. The primary endpoint was objective response rate, whereas disease control rate, toxicity profile, progression-free survival, and overall survival were secondary endpoints. RESULTS: Nineteen biopsy-proven NET patients (median age, 22 ± 10 years) with 8 of them adolescents (10-18 years) and the remaining young adults (19-29 years) were included. Fourteen patients had gastroenteropancreatic neuroendocrine tumor (pancreas being most common primary site), whereas the rest had non-gastroenteropancreatic neuroendocrine tumor. A total of 65 cycles of 177 Lu-DOTATATE (range, 1-6 cycles) were administered with a median cumulative activity of 600 mCi (range, 100-1000 mCi). The objective response rate and disease control rate were 41% and 94%, respectively. Grade 1 and 2 adverse events were observed in 14 (74%) and 5 (26%) of 19 patients, respectively. In a total of 8 events (42%), 4 events each of disease progression and death occurred during a median follow-up of 80.1 months with an estimated 5-year progression-free survival and overall survival of 54% (95% confidence interval, 30-78) and 63% (95% confidence interval, 39-87), respectively. CONCLUSIONS: 177 Lu-DOTATATE appears safe and effective in children and young adults with metastatic/inoperable NETs. Large prospective trials are required to validate these results.

The development of a road safety policy index and its application in evaluating the effects of road safety policy.

The paper presents an exploratory study of a road safety policy index developed for Norway. The index consists of ten road safety measures for which data on their use from 1980 to 2021 are available. The ten measures were combined into an index which had an initial value of 50 in 1980 and increased to a value of 185 in 2021. To assess the application of the index in evaluating the effects of road safety policy, negative binomial regression models and multivariate time series models were developed for traffic fatalities, fatalities and serious injuries, and all injuries. The coefficient for the policy index was negative, indicating the road safety policy has contributed to reducing the number of fatalities and injuries. The size of this contribution can be estimated by means of at least three estimators that do not always produce identical values. There is little doubt about the sign of the relationship: a stronger road safety policy (as indicated by index values) is associated with a larger decline in fatalities and injuries. A precise quantification is, however, not possible. Different estimators of effect, all of which can be regarded as plausible, yield different results.

Overtaking maneuvers on two-lane highways under the microscope: Exploration of a multidimensional framework for the analysis of safety, comfort and efficiency using simulator data.

An unreasonable overtaking attempt on two-lane highways could cause drivers to suffer in terms of driving safety, comfort, and efficiency. Several external factors related to the traffic environment (e.g., speed and car type of surrounding vehicles), were found to be the significant factors in drivers' overtaking performance in the previous studies. However, the microscopic decision-making (e.g., the moments of the occupation of the opposite lane) mechanisms during overtaking, by means of which drivers react to changes in the external traffic environment and adjust their overtaking trajectories, are still need to be explored. Hence, this study had three goals: (i) To explore the spatial characteristics of micro-decisions (MDs) (such as the start and end point) in overtaking trajectories; (ii) To measure three types of performance indicators (i.e., safety, comfort, and efficiency) for the execution of overtaking maneuvers; (iii) To quantitatively explain the microscopic decision-making mechanism in overtaking. Data for overtaking trajectories were collected from driving a simulation experiment where 52 Chinese student drivers completed a series of overtaking maneuvers on a typical two-lane highway under different traffic conditions. Two analyses were conducted: firstly, the distributions of the relative distance between the ego and surrounding vehicles at four key points (i.e., the start, entry, back, and end) in the overtaking trajectory were investigated and clustered to uncover the spatial characteristics of the MDs. Secondly, the safety, comfort, and efficiency of the overtaking were measured by the aggregations of multi-targets collision risks, triaxial acceleration variances, and spatial consumptions respectively based on the Data Envelopment Analysis (DEA), which were further applied in a two-stage SEM model to reveal the quantitative interrelationships among the external factors, microscope decisions and performances in overtaking. We confirmed that the MDs could be considered as the mediating variables between the external factors and overtaking performances. In the presence of the more hazardous traffic environment (e.g., faster traffic flow and impeded by a truck), the safety, comfort and efficiency of overtaking would be deteriorated inevitably. But drivers would execute the overtaking under the longer passing sight distance, migrate their trajectories forward, and shorten the spatial duration to significantly improve the overtaking performances. Based on this mechanism, a overtaking trajectory optimization strategy for the advanced or automatic driving system, was confirmed and concluded that 1) the passing gap should be firstly planned according to the sight distance acceptance of different drivers, which directly determine the upper limit of the safety performance in the overtaking; 2) the trajectory forward migration and shortening the whole duration in overtaking could be effective to enhance the overtaking performances of the overtaking on the two-lane highway; 3) the guidance of the stable control of the steering wheel and gas/brake pedals is essential in the overtaking.

Translating global evidence into local implementation through technical assistance: a realist evaluation of the Bloomberg philanthropies initiative for global Road safety.

BACKGROUND: Traffic-related crashes are a leading cause of premature death and disability. The safe systems approach is an evidence-informed set of innovations to reduce traffic-related injuries and deaths. First developed in Sweden, global health actors are adapting the model to improve road safety in low- and middle-income countries via technical assistance (TA) programs; however, there is little evidence on road safety TA across contexts. This study investigated how, why, and under what conditions technical assistance influenced evidence-informed road safety in Accra (Ghana), Bogotá (Colombia), and Mumbai (India), using a case study of the Bloomberg Philanthropies Initiative for Global Road Safety (BIGRS). METHODS: We conducted a realist evaluation with a multiple case study design to construct a program theory. Key informant interviews were conducted with 68 government officials, program staff, and other stakeholders. Documents were utilized to trace the evolution of the program. We used a retroductive analysis approach, drawing on the diffusion of innovation theory and guided by the context-mechanism-outcome approach to realist evaluation. RESULTS: TA can improve road safety capabilities and increase the uptake of evidence-informed interventions. Hands-on capacity building tailored to specific implementation needs improved implementers' understanding of new approaches. BIGRS generated novel, city-specific analytics that shifted the focus toward vulnerable road users. BIGRS and city officials launched pilots that brought evidence-informed approaches. This built confidence by demonstrating successful implementation and allowing government officials to gauge public perception. But pilots had to scale within existing city and national contexts. City champions, governance structures, existing political prioritization, and socio-cultural norms influenced scale-up. CONCLUSION: The program theory emphasizes the interaction of trust, credibility, champions and their authority, governance structures, political prioritization, and the implement-ability of international evidence in creating the conditions for road safety change. BIGRS continues to be a vehicle for improving road safety at scale and developing coalitions that assist governments in fulfilling their role as stewards of population well-being. Our findings improve understanding of the complex role of TA in translating evidence-informed interventions to country-level implementation and emphasize the importance of context-sensitive TA to increase impact.

Major Traffic Safety Reform and Road Traffic Injuries Among Low-Income New York Residents, 2009-2021.

Objectives. To evaluate the effects of a comprehensive traffic safety policy-New York City's (NYC's) 2014 Vision Zero-on the health of Medicaid enrollees. Methods. We conducted difference-in-differences analyses using individual-level New York Medicaid data to measure traffic injuries and expenditures from 2009 to 2021, comparing NYC to surrounding counties without traffic reforms (n = 65 585 568 person-years). Results. After Vision Zero, injury rates among NYC Medicaid enrollees diverged from those of surrounding counties, with a net impact of 77.5 fewer injuries per 100 000 person-years annually (95% confidence interval = -97.4, -57.6). We observed marked reductions in severe injuries (brain injury, hospitalizations) and savings of $90.8 million in Medicaid expenditures over the first 5 years. Effects were largest among Black residents. Impacts were reversed during the COVID-19 period. Conclusions. Vision Zero resulted in substantial protection for socioeconomically disadvantaged populations known to face heightened risk of injury, but the policy's effectiveness decreased during the pandemic period. Public Health Implications. Many cities have recently launched Vision Zero policies and others plan to do so. This research adds to the evidence on how and in what circumstances comprehensive traffic policies protect public health. (Am J Public Health. 2024;114(6):633-641. https://doi.org/10.2105/AJPH.2024.307617).