Motor Vehicle Accident Victims Research Articles

Security issues and challenges in V2X: A Survey

In its latest report, the United States National Highway Traffic Safety Administration (NHTSA) registered some 37,300 fatalities for the yearly victims of motor vehicle accidents in 2017. Vehicle-to-everything (V2X) is playing an important role in improving road safety, traffic efficiency and infotainment systems. With the growth of the connected vehicle technology, V2X is emerging as a key component in the rapid rise of this technology. Therefore, researchers think that development of robust wireless communication through efficient V2X technologies can significantly improve the vehicular environment. The highly dynamic environment and the mobility factor appear to be challenging for implementation of V2X technology. Similar to other wireless technology, the security issues are also key concerns in V2X.In this survey, we highlight and discuss the main security issues of V2X. Particularly, the main objective of this survey is providing for a comprehensive and structured outline of different research directions and approaches, mostly emphasizing on the security issues and challenges in V2X communication technologies. At first, we discuss the key features of V2X and focus on the standardization techniques used for communication technologies. Then, we introduce the security challenges and requirements of V2X. We also classify present state-of-the-art works dealing with implementing different secured techniques in V2X. We further discuss the project implementation that concentrated on the various applications in V2X. Finally, we identify possible future research directions of V2X, particularly in the area of security.

The Automated and Electric Vehicles Act 2018 Part 1 and Beyond: A Critical Review

Abstract On 19 July 2018, the Automated and Electric Vehicles Act 2018 (AEVA) received Royal Assent. As motor vehicles are becoming increasingly technologically based, with driving aids having taken over many of the more mundane (and possibly dangerous) aspects of driving from the driver, it is imperative that legislation keeps pace to determine the responsibilities of the parties. Motor insurance provides protection for those involved with vehicles and who may suffer harm, injury, and loss due to the negligence of the actors. This is most frequently driver error, but may also include manufacturing defects, which result in deaths and less serious injuries. It is also here where the intersection between torts and insurance laws needs careful management. It would be particularly unfair to ask drivers or third-party victims of motor vehicle accidents to seek redress from a manufacturer for losses incurred during the actions of an autonomous vehicle. Consumer law has historically removed this burden from affected consumers and it is entirely sensible for the law to protect individuals in an emerging field—and perhaps even more so given the trajectory of vehicles with driver-enabled qualities and the numbers of vehicles currently featuring such innovations. Yet, the AEVA consists of aspects which are troubling in respect of the motor insurance industry’s dominance of this market, the application of compulsory insurance, and exclusions and limitations to responsibility which expose policy holders and victims to EU-breaching levels of risk.

Left atrial thrombosis secondary to blunt cardiac injury in two dogs

Two dogs, victims of motor vehicle accidents, were hospitalised at our Veterinary Teaching Hospital with multiple injuries. Electrocardiographic abnormalities were observed in both dogs: case 1 showed ventricular arrhythmias, while...

Case Report: Arthroscopic Fixation of Type V Acromioclavicular Joint Dislocation

Acromioclavicular Joint (ACJ) dislocation is a common injury. It is common among athletes involved in contact sports and victims of motor vehicle accidents. High-grade (ACJ) dislocation (Type IV-VI) is managed surgically through different procedures. These range from a simple plate and screw fixation to more complex procedures involving ligament repair, transfer and reconstruction. The rationale for an arthroscopic approach to treat a dislocated AC joint is to minimize the soft tissue injury through preserving as much blood supply as possible to support post-operative healing. Also, to decrease the risk of surgical site infections and better postoperative outcomes. On the other hand, the arthroscopic technique needs an experienced surgeon. In this case, report our aim to encourage fixing (ACJ) with this technique.

Cortical surface area reduction in identification of subjects at high risk for post-traumatic stress disorder: A pilot study.

Victims of motor vehicle accidents often develop post-traumatic stress disorder, which causes significant social function loss. For the difficulty in treating post-traumatic stress disorder, identification of subjects at high risk for post-traumatic stress disorder is essential for providing possible intervention. This paper aims to examine the cortical structural traits related to susceptibility to post-traumatic stress disorder. To address this issue, we performed structural magnetic resonance imaging study in motor vehicle accident victims within 48 hours from the accidents. A total of 70 victims, available for both clinical and magnetic resonance imaging data, enrolled in our study. Upon completion of 6-month follow-up, 29 of them developed post-traumatic stress disorder, while 41 of them didn't. At baseline, voxelwise comparisons of cortical thickness, cortical area and cortical volume were conducted between post-traumatic stress disorder group and trauma control group. As expected, several reduced cortical volume within frontal-temporal loop were observed in post-traumatic stress disorder. For cortical thickness, no between-group differences were observed. There were three clusters in left hemisphere and one cluster in right hemisphere showing decreased cortical area in post-traumatic stress disorder patients, compared with trauma controls. Peak voxels of the three clusters in left hemisphere were separately located in superior parietal cortex, insula and rostral anterior cingulate cortex. The finding of reduced surface area of left insula and left rostral anterior cingulate cortex suggests that shrinked surface area in motor vehicle accident victims could act as potential biomarker of subjects at high risk for post-traumatic stress disorder.

An index of decline or recovery following nonimpact and impact mTBI

ABSTRACTThis study investigated the degree to which litigants/insurance claimants sustaining Nonimpact mild traumatic brain injury (mTBI) in motor vehicle accidents differed from compensation-seeking motor vehicle accident victims that suffered Impact mTBI in terms of neuropsychological decline/recovery, using as a control litigants/insurance claimants that did not experience mTBI in motor vehicle accidents. A clinical index (C-Voc) was employed as the dependent measure for decline/recovery, consisting of T-score algebraic differences between a highly sensitive neurocognitive measure (Category Test) and a relatively insensitive “hold” measure (Wechsler Adult Intelligence Scale Vocabulary subtest). Nonimpact mTBI subjects showed significantly greater neurocognitive decline than Impact mTBI participants and, interestingly, Impact mTBI individuals did not differ significantly from individuals with no diagnosis of mTBI. These findings suggest that Nonimpact subjects may experience significantly greater persistent neurocognitive residua of mTBI than Impact participants.

Age As Moderator of Emotional Stroop Task Performance in Posttraumatic Stress Disorder (PTSD).

Emotional Stroop task (EST) has been extensively used to investigate attentional processes in posttraumatic stress disorder (PTSD). Even though aging significantly changes the dynamics of emotion-cognition interactions, very little is known about its role in shaping EST performance in PTSD patients. In the present study we tested a uniquely large sample of motor vehicle accident victims. Data of 194 participants (75.3% female; mean age = 36.64 years, SD = 12.3) were included in the analysis, out of which 136 (70.1%) were diagnosed with PTSD. Prior to the psychiatric assessment, participants completed the pictorial version of EST (neutral, positive, negative, and accidents photos were presented). Comparison of the PTSD and control groups revealed a specific increase in reaction times (RTs) related to the exposure of trauma-related material. At the same time, previously unreported, moderating effects of age were also discovered. Older participants, in contrast to the younger group, showed no increase in RTs and interference scores in trials where accident photos were presented. Our study points to the key role of age as a previously understudied factor modifying EST performance in PTSD patients.

Effect of private versus emergency medical systems transportation in motor vehicle accident victims: Trauma Center Experience in Saudi Arabia.

OBJECTIVE:To assess the effect of the mode of transportation of trauma patients (emergency medical service [EMS] vs. non-EMS) on their final clinical outcome in terms of mortality and length of hospital stay.MATERIALS AND METHODS:A retrospective study included all patients who were involved in motor vehicle crashes, and who were transferred immediately to an emergency department of a trauma care center from December 2008 to December 2012. Patients were classified into two groups: those brought through EMS and those brought by non-EMS (private transport). Information on demographic characteristics including age and gender was recorded and medical data such as blood pressure, pulse, oxygen saturation, temperature, initial Glasgow Coma Score (GCS), saturation, temperature, initial Glasgow Coma Score (GCS), injury severity score (ISS), and final outcome (discharged or expired) were obtained. Descriptive statistics, mean and standard deviation (SD) were computed for continuous variables and statistical significance was tested by t-test or Mann-Whitney U-test. Categorical variables were described by frequency distribution and percentages; Chi-square or Fisher's exact test as appropriate were employed to test for statistical significance. Logistics regression was performed with mortality as dependent variable and mode of transport and all demographic and prehospital variables as independent variables. A general linear model analysis was performed to test whether the mode of transport was significant to length of hospital stay in EMS and non-EMS clients.RESULTS:Out of 308 patients identified during the study period, 232 were transported through EMS and 76 through non-EMS. The two groups were similar with regard to mortality and length of stay. The crude mortality rate was 30.6% (95% confidence interval [CI]: 24.64–36.53) in the EMS group and 28.9% (95% CI: 18.44–38.76) in the non-EMS group (p = 0.785). The average length of hospital stay was 9 days (interquartile range [IQR] = 8, 95% CI: 7.3–10.1) for the EMS group and 8 days (IQR = 9.5, 95% CI: 6.7–10.9) for the non-EMS group (p = 0.803). Multivariate analysis showed that of the study variables, only the injury severity score (ISS) and Glasgow coma score (GCS) were significant to mortality (p < 0.01), and GCS was more significant to the length of hospital stay (p < 0.01).CONCLUSIONS:There was no significant difference between the EMS and non-EMS groups as they relate to mortality and length of stay in hospital. However, the mortality and length of hospital stay was statistically significant to ISS and GCS.

Ligamentous integrity in Spinal Cord Injury without Radiographic Abnormality (SCIWORA): a case series

PURPOSE OF STUDY: Prolonged bracing following injury in patients with Spinal Cord Injury without Radiographic Abnormality (SCIWORA) remains controversial. Some authors claim that there is occult instability and a risk of recurrent injury whereas others propose that the spinal column will deform elastically, but will return to its baseline stability by elastic recoil. We aim to assess the presence of ligamentous injury on MRI and the incidence of recurrent instability following SCIWORA in order to determine the need for prolonged bracing. METHODS: A retrospective chart review was performed for a series of 12 patients with documented SCIWORA that presented to Red Cross Children's Hospital over the past 8 years. Details regarding mode of injury, age at presentation, neurological deficit at presentation, MRI findings and long-term prognosis were documented. RESULTS: There were nine males and three females. The median age was 4.35 years. All patients were victims of high energy motor vehicle accidents. In two patients there was disruption of the ligamentum flavum at the level of the injury. There were no episodes of recurrent instability or neurological compromise in those patients that had recovered. None of our patients had rigid bracing following the diagnosis of SCIWORA. CONCLUSION: Infrequently observed disruption of isolated stabilising structures in SCIWORA did not lead to early or delayed instability in our patients. We did not find evidence to support the practice of prolonged rigid bracing to prevent recurrence following SCIWORA. LEVEL OF EVIDENCE: Prognostic case study, level IV.

Risk factors for mental health problems and complicated grief in bereaved families of motor vehicle accident victims

This study examined the risk factors for mental health problems and complicated grief in bereaved families using a nationwide sample of 453 Japanese adults who had lost a family member to a motor vehicle accident within three years. The results indicate that 31.0% of participants had K6 scores > 13 and 61.0% had ICG (Inventory of Complicated Grief) scores > 26. A higher K6 score was associated with secondary victimization and support seeking, whereas a higher ICG score was associated with the death of a child. Dispute over the liability for the accident and the resulting anxiety, measured by the Japanese version of ECR (Experiences in Close Relationships), were common predictors of higher K6 and ICG scores. The results suggest that complicated grief is more dependent on the circumstances of the death, whereas mental health problems are more affected by a participant’s coping after the death, implying that effective support and interventions are necessary for mental health problems and complicated grief after a violent death.

Traumatic Pneumorrhachis in a Young Male Motor Vehicle Accident Victim

Traumatic Pneumorrhachis in a Young Male Motor Vehicle Accident Victim

How do people cope with post traumatic distress after an accident? The role of psychological, social and spiritual coping in Malaysian Muslim patients

Introduction: Post traumatic distress, acute stress disorder and even post traumatic stress disorder may occur following traumatic events such as a motor vehicle accident (MVA). Instead of presenting to mental health service, many turn to psychosocial and spiritual strategies to cope with symptoms. The objective of this study is to explore the psychosocial and spiritual coping strategies utilised by MVA victims to deal with the distressing post traumatic symptoms.Methods: An exploratory qualitative study using individual in-depth interview was conducted from May to September 2015. Purposive sampling was done to optimise wide exploration. Only Muslim participants were included. The interviews were recorded, transcribed verbatim and analysed using thematic approach.Results: All participants interviewed employed psychological, social and spiritual coping strategies to help manage their post traumatic stress symptoms. Positive thinking and rationalisation are examples of psychological coping mechanisms used. Many have supportive families. Common spiritual coping strategies practised include the use of different Quranic verses and prayers.Conclusion: Psychosocial and spiritual coping strategies are popular, highly tolerable and useful for post traumatic distress. Psycho-socio-spiritual therapy may be an effective treatment for post traumatic stress in Muslim Malaysian patients. Further research is needed in this area.

Inhibition of Endocannabinoid Degradation Improves Outcomes from Mild Traumatic Brain Injury: A Mechanistic Role for Synaptic Hyperexcitability.

Traumatic brain injury (TBI) is an increasingly prevalent condition affecting soldiers, athletes, and motor vehicle accident victims. Unfortunately, it currently lacks effective therapeutic interventions. TBI is defined as a primary mechanical insult followed by a secondary cascade involving inflammation, apoptosis, release of reactive oxygen species, and excitotoxicity, all of which can cause synaptic changes, altered neuronal signaling, and, ultimately, behavioral changes. Previously we showed that preventing degradation of the endocannabinoid (EC) 2-acylglycerol (2-AG) with JZL184 after mild TBI attenuated neuroinflammation and improved recovery of neurobehavioral function during the early 24 h post-TBI period. The aim of this study was to extend the timeline of observations to 2 weeks post-injury and to investigate JZL184's impact on synaptic transmission, which we view as a potential mechanism for TBI-induced cellular and behavioral pathology. Adult male rats underwent mild TBI (mTBI) followed by a single intraperitoneal injection of JZL184 or vehicle 30 min post-injury. JZL184 administered-TBI animals showed improved neurobehavioral recovery compared with vehicle-injected TBI animals beginning 24 h post-injury and persisting for 2 weeks. JZL184-treated animals had significantly diminished gray and white matter astrocyte activation when compared with vehicle-treated animals at day 7 post-TBI. JZL184 administration significantly attenuated the increased pGluR1S845/GluR1 and pERK 1/2/ERK and the increases in miniature excitatory postsynaptic potential (mEPSC) frequency and amplitude observed in layer 5 pyramidal neurons at 10 days post-TBI. These results suggest a neuroprotective role for ECs in ameliorating the TBI-induced neurobehavioral, neuroinflammatory, and glutamate dyshomeostasis from mTBI. Further studies elucidating the cellular mechanisms involved are warranted.

Can the dissociative PTSD subtype be identified across two distinct trauma samples meeting caseness for PTSD?

For over a century, the occurrence of dissociative symptoms in connection to traumatic exposure has been acknowledged in the scientific literature. Recently, the importance of dissociation has also been recognized in the long-term traumatic response within the DSM-5 nomenclature. Several studies have confirmed the existence of the dissociative posttraumatic stress disorder (PTSD) subtype. However, there is a lack of studies investigating latent profiles of PTSD solely in victims with PTSD. This study investigates the possible presence of PTSD subtypes using latent class analysis (LCA) across two distinct trauma samples meeting caseness for DSM-5 PTSD based on self-reports (N=787). Moreover, we assessed if a number of risk factors resulted in an increased probability of membership in a dissociative compared with a non-dissociative PTSD class. The results of LCA revealed a two-class solution with two highly symptomatic classes: a dissociative class and a non-dissociative class across both samples. Increased emotion-focused coping increased the probability of individuals being grouped into the dissociative class across both samples. Social support reduced the probability of individuals being grouped into the dissociative class but only in the victims of motor vehicle accidents (MVAs) suffering from whiplash. The results are discussed in light of their clinical implications and suggest that the dissociative subtype can be identified in victims of incest and victims of MVA suffering from whiplash meeting caseness for DSM-5 PTSD.

Inhibition of Endocannabinoid Degradation Improves Recovery of Neurobehavioral Function and Resolution of Neuroinflammation and Synaptic Hyperexcitability in a Rodent Model of Traumatic Brain Injury

Traumatic brain injury (TBI) is an increasingly prevalent condition affecting soldiers, athletes, and motor vehicle accident victims. It is the most common cause of death for people under 30 and currently lacks effective therapeutic interventions. TBI is defined as a primary mechanical insult followed by a secondary cascade involving inflammation, apoptosis, release of reactive oxygen species, and excitotoxicity, all of which can cause neuronal death and poor recovery. Previously we showed that inhibition of monoacylglycerol lipase (MAGL), the enzyme involved in 2‐acylglycerol (2‐AG) degradation, with JZL184 following mild TBI attenuated neuroinflammation and improved recovery of neurobehavioral function during the early 72 h post‐TBI period. The aim of this study was to examine if common pathologies resulting from the injury, including inflammation, neurobehavioral disruption, and synaptic excitability, could be reversed during the acute recovery period up to 10 days post‐injury. Adult male Wistar rats underwent a 5‐mm left lateral craniotomy, and TBI was induced three days later by lateral fluid percussion. Thirty minutes post‐TBI, rats received intraperitoneal injections of vehicle (alcohol, emulphor, and saline; 1:1:18) or JZL184 (16 mg/kg). Neurobehavioral function, neuroinflammation (immunohistochemistry) and synaptic excitability (brain slice electrophysiological recordings) were assessed up to 10 days post‐TBI. JZL184 administered‐TBI animals had improved neurobehavioral recovery compared to vehicle‐injected TBI animals beginning 24 hours post‐injury and persisting for two weeks. JZL184 administration significantly improved both ipsilateral cortex (gray matter) and corpus callosum (white matter) neuroinflammation seven days post‐TBI. JZL184 administration significantly attenuated TBI‐induced increases in mEPSC frequency and amplitude at 10 days post‐TBI. Taken together these results show that EC degradation inhibition 30 minutes post‐TBI has potential therapeutic benefits that persist throughout the acute recovery period up to 10 days post‐injury. Current studies are investigating the mechanisms of EC degradation inhibition‐mediated improvements from TBI.Support or Funding InformationSupport T‐32 AA007577, DOD W81XWH‐11‐2‐0011

Nonfatal Cervical-Neck Lesion With a Wooden Foreign Body

Penetrating cervical lesions caused by a foreign body are rare events. The neck is a complex and delicate body region, given the important vascular structures it holds. The most frequent fatal complications often involve vascular injuries, and as a consequence, the mortality rate increases by approximately 50%. Civilian patients are mainly victims of violence or motor vehicle accidents and rural accidents involving neck are not very common. When a cervical lesion is because of a wooden foreign body, infectious risk increases for its organic peculiarity. The authors report a rural nonfatal cervical lesion in a civilian, and its management.

Detailed description of anatomy of the fracture line in hangman's injury: a retrospective observational study on motor vehicle accident victims.

To study the precise location of fracture line in hangman's fracture to determine the fracture patterns, symmetry and involvement of different vertebral elements. 32 cases of hangman's fractures were retrospectively evaluated. All patients presented with motor vehicle accidents. CT scans were studied to accurately localize the fracture lines. Symmetry of fracture lines on both sides was assessed, and involvement of the vertebral bodies, lamina, facet joints and foramen transversarium was also determined. 20 patients showed asymmetric fracture locations, 13 of them had a unilateral pedicle fracture and a contralateral pars fracture which comprised the most common injury pattern (40% of cases). Less frequent combinations for the two sides of asymmetric C2 ring disruption include pars-vertebral body (3 patients), pedicle-vertebral body (2 patients) and pedicle-lamina (2 patients). 12 patients showed symmetrical fractures (5 through the pars and 7 through the pedicles). Vertebral body and facet joint involvement were demonstrated in 15 (47%) and 16 (50%) cases, respectively. 18 cases had fractures extending into the foramen transversarium (56%). In total, 26 fracture lines primarily affected the pars (40%) and 31 affected the pedicles (49%). Asymmetric hangman's fracture is more common with the usual pattern being fracture pedicle on one side and pars on the other followed by the symmetric bilateral pedicle and bilateral pars fractures. Fracture lines running into the transverse foramen and facet joints are very frequent as well as those involving the vertebral bodies. There is controversy in literature regarding the fracture locations in hangman's injury owing to lack of studies that address this subject. This article is the first to describe precisely the anatomical locations and patterns of this injury.

Case characteristics and injury mechanisms in motor vehicle accidents in South East Norway from 2000 to 2014: An autopsy study

To elucidate crash and injury patterns of vehicle occupants in fatal motor vehicle accidents (MVA). A retrospective study of fatal MVA victims based on data from post mortem examinations between 2000-2014 in South East Norway was conducted. Within the 15 year period, 561 vehicle occupants killed in traffic were identified, 373 were vehicle drivers and 158 passengers. Compared with data from official statistics, this represents an autopsy rate of 40%. In 30 of 561 cases (5,3 %) a natural cause of death was identified at autopsy, all of which were chauffeurs. Investigation of the autopsy and police reports revealed 531 deaths due to severe injuries or complications related to these injuries. The main causes of death were multiple injuries (41,4 %), isolated injuries to the head/neck (32,2 %), chest (15,6 %) or abdominal (1,7 %) organs. Blunt force trauma due to direct impact to the head or chest was the main fatal injury mechanism for both drivers and passengers. Furthermore, drowning was the cause of death in 4,9 % of the cases and burn injuries in 2,3 %. Most of the cases were found dead at the scene with non-survivable injuries. Collisions associated with driving off the road (203 MVA) and frontal collisions (244 MVA) were most commonly observed. The average victim age was 41 years, 73 % were men. Obesity, represented by Body Mass Index greater than 30, was observed in 123 (23 %) of the cases. Totally 76 (14 %) were known drug and alcohol abusers. Identifying mortality patterns in real-world traffic crashes may yield knowledge crucial for prevention of future MVA fatalities. The preliminary results indicate obesity may be a risk factor for fatal outcome in MVAs.

In a difficult access scenario, supraglottic airway devices improve success and time to ventilation.

The success of tracheal intubation (TI) is unacceptably low in unconventional positions. Supraglottic airway devices (SAD) have become an important alternative. An airway manikin was placed in a car, simulating an entrapped motor vehicle accident victim. The rescuer only had access through the driver's door. Participants were (n = 25) anaesthesiologists with experience in prehospital emergency medicine. They attempted to secure the airway by TI or an SAD (Ambu AuraOnce, iGel, laryngeal tube) in a random sequence. Performance was compared using the Wilcoxon signed-rank test. P values less than 0.05 were considered statistically significant. Fastest effective ventilation was achieved with iGel (11.5 ± 6.9 s, P < 0.001), followed by a laryngeal mask (15.1 ± 5.6 s, P < 0.001) and a laryngeal tube (17.6 ± 5.3 s, P < 0.001); TI was the slowest (42.8 ± 23.9 s, comparator). iGel (P < 0.001) and laryngeal mask (P = 0.01) also significantly outperformed the laryngeal tube. First ventilation was achieved significantly faster with SADs compared with TI. Success rates were also higher when using SADs.

Social support, posttraumatic cognitions, and PTSD: The influence of family, friends, and a close other in an interpersonal and non-interpersonal trauma group

Research has suggested that social support can shape posttraumatic cognitions and PTSD. However, research has yet to compare the influence of separate domains of support on posttraumatic cognitions. Multiple-group path analysis was used to examine a model in a sample of 170 victims of intimate partner violence and 208 motor vehicle accident victims in which support from friends, family, and a close other were each predicted to influence posttraumatic cognitions, which were in turn predicted to influence PTSD. Analyses revealed that support from family and friends were each negatively correlated with posttraumatic cognitions, which in turn were positively associated with PTSD. Social support from a close other was not associated with posttraumatic cognitions. No significant differences in the model were found between trauma groups. Findings identify which relationships are likely to influence posttraumatic cognitions and are discussed with regard to interpersonal processes in the development and maintenance of PTSD.