Pedestrian injuries in the United States: Shifting injury patterns with the introduction of pedestrian protection into the passenger vehicle fleet

OBJECTIVE

Between 2010 and 2020, an annual average of more than 70,000 pedestrians were injured in U.S. motor vehicle crashes. Pedestrian fatalities increased steadily over that period, outpacing increases in vehicle occupant fatalities. Strategies for reducing pedestrian injuries include pedestrian crash prevention and improved vehicle design for protection of pedestrians in the crashes that cannot be prevented. This study focuses on understanding trends in injuries sustained in U.S. pedestrian crashes to inform continuing efforts to improve pedestrian crash protection in passenger vehicles.

METHODS

More than 160,000 adult pedestrians injured in motor vehicle crashes who were admitted to U.S. trauma centers between 2007 and 2016 were drawn from the National Trauma Data Bank (NTDB) Research Data Sets. The injuries in those cases were used to explore the shifting patterns of pedestrian injuries.

RESULTS

The proportion of pedestrians with thorax injuries increased 3.0 percentage points to 30.7% of trauma center-admitted NTDB pedestrian cases over the 10 years studied, and the proportion with pelvis/hip injuries increased to 21.2%. The proportion of cases with head injuries fell to 48.6%, and the percentage of pedestrians with lower extremity injury (44%) did not change significantly over the 10 year period. Assessment of possible reasons for the shifts suggested that increasing numbers of sport utility vehicles, population increases among the oldest age groups, and improvements in pedestrian protection in U.S. passenger vehicles likely contributed to, but did not completely account for, the relative changes in injury frequency in each body region.

CONCLUSIONS

More important than the reasons for the shifts in the relative frequency of injury to each body region are the conclusions that can be drawn regarding priorities for pedestrian protection research. Though head/face and lower extremity injuries remained the most frequently injured body regions in adult pedestrians admitted to NTDB trauma centers, the relative frequency of thorax and pelvis/hip injuries increased steadily, underlining the increasing importance of pedestrian protection research on these body regions.

Biofidelity assessment of the GHBMC M50-O in a rear-facing seat configuration during high-speed frontal impact

The objective of this study was to assess the biofidelity of the Global Human Body Models Consortium (GHBMC) 50th male (M50-O) v6.0 seated in an upright (25-degree recline) all-belts-to-seat (ABTS) in a 56 km/h rear-facing frontal impact. The experimental boundary conditions from the post-mortem human subjects (PMHS) tests were replicated in the computational finite element (FE) environment. The performance of the rigidized FE ABTS model obtained from the original equipment manufacturer was validated via simulations using a Hybrid III FE model and comparison with experiments. Biofidelity of the GHBMC M50-O was evaluated using the most updated NHTSA Biofidelity Ranking System (BRS) method, where a biofidelity score under 2 indicates that the GHBMC response varies from the mean PMHS response by less than two standard deviations, suggesting good biofidelity. The GHBMC M50-O received an occupant response score and a seat loading score of 1.71 and 1.44, respectively. Head (BRS = 0.93) and pelvis (BRS = 1.29) resultant accelerations, and T-spine (avg. BRS = 1.55) and pelvis (BRS = 1.66) y-angular velocities were similar to the PMHS. The T-spine resultant accelerations (avg. BRS = 1.93) and head (BRS = 2.82), T1 (BRS = 2.10) and pelvis (BRS = 2.10) Z-displacements were underestimated in the GHBMC. Peak chest deflection in the anterior-posterior deflection in the GHBMC matched with the PMHS mean, however, the relative upward motion of abdominal contents and subsequent chest expansion were not observed in the GHBMC. Updates to the GHBMC M50-O towards improved thorax kinematics and mobility of abdominal organs should be considered to replicate PMHS characteristics more closely.

Abdominal biofidelity assessment of 5th percentile female ATD responses relative to recently developed belt and bar loading corridors

OBJECTIVE

The objective of this study was the quantitative evaluation and comparison of the responses of the Hybrid III 5th percentile female (HIII-05F) and the 5th percentile female Test Device for Human Occupant Restraint (THOR-05F) anthropomorphic test devices (ATDs) subjected to abdominal loading conditions.

METHOD

The HIII-05F and THOR-05F were subjected to 3 different abdominal loading conditions: fixed-back belt pull (low compression), fixed-back belt pull (high compression), and free-back rigid bar impact at 6 m/s. The stroke of the impact was controlled to represent injurious and noninjurious loading conditions as observed in the experiments with postmortem human subjects (PMHS). Quantitative comparisons were made between the ATD abdominal force and compression responses and biofidelity corridors obtained from matched-pair PMHS tests under identical loading conditions, using the most recent version of the NHTSA Biofidelity Ranking System (BRS).

RESULTS

The overall THOR-05F BRS scores across all tests (BRS score = 1.84) indicated good biofidelity. For the belt loading test conditions, the average BRS scores for both THOR-05F (BRS scores = 1.45 and 1.34) and HIII-05F (BRS scores = 1.42 and 1.01) showed good biofidelity. For the rigid bar loading condition, the THOR-05F (BRS score = 2.74) showed better biofidelity compared to HIII-05F (BRS score = 10.63), with the HIII-05F exhibiting poor performance in this condition. The average pressures recorded by the abdomen pressure twin sensors (APTS) in the current study ranged from 45 to 130 kPa, increasing proportionally with higher stroke and loading rate.

CONCLUSIONS

Overall, the THOR-05F BRS scores were better than the HIII-05F BRS scores, which suggests improved biofidelity of the THOR-05F abdomen. The abdominal insert in the HIII-05F did not provide enough room for compression, leading to higher stiffness and occupant motion as observed in the rigid bar tests. Because of practical challenges in measuring abdomen deflection in a soft ATD abdomen component, use of APTS in THOR-05F provides the ability to measure the restraint loading to the abdomen and assess the risk of abdominal injury. With good BRS scores observed in this study for THOR-05F, pressure and other measurements included in the THOR-05F may be used to develop abdominal injury risk functions in the future.

Development of a Strain-Based Model to Predict Eviscerated Thoracic Response From Dynamic Individual Rib Tests

The objective of this study was to develop an analytical model using strain-force relationships from individual rib and eviscerated thorax impacts to predict bony thoracic response. Experimental eviscerated thorax forces were assumed to have two distinct responses: an initial inertial response and subsequently, the main response. A second order mass-spring-damper model was used to characterize the initial inertial response of eviscerated thorax force using impactor kinematics. For the main response, equivalent strains in rib levels 4-7 were mapped at each time point and a strain-based summed force model was constructed using individual rib tests and the same ribs in the eviscerated thorax test. A piecewise approach was developed to join the two components of the curve and solve for mass, damping, stiffness parameters in the initial response, transition point, and scale factor of the strain-based summed force model. The final piecewise model was compared to the overall experimental eviscerated thorax forces for each PMHS (n=5) and resulted in R2 values of 0.87-0.96. A bootstrapping approach was utilized to validate the model. Final model predictions for the validation subjects were compared with the corridors constructed for the eviscerated thorax tests. BRSS values were approximately 0.71 indicating that this approach can predict eviscerated responses within one standard deviation from the mean response. This model can be expanded to other tissue states by quantifying soft tissue and visceral contributions, therefore successfully establishing a link between individual rib tests and whole thoracic response.

Evaluation of LATCH vs. non-LATCH installations for boosters in frontal impacts

OBJECTIVES

The objective was to understand how the use or nonuse of the Lower Anchors and Tethers for Children (LATCH) system affects the performance of booster seats during frontal impacts.

METHODS

Sixteen frontal impact sled tests were conducted at 24.8 ± 0.3 g and 50.1 ± 0.2 kph. A production vehicle seat buck was attached to the sled. Four high-back boosters or combination seats in high-back booster mode and two backless booster models were tested. Each booster model was installed two different ways: using the LATCH system ("LATCH" installation) and without using the LATCH system ("non-LATCH" installation). All installations used a 3-point seat belt with retractor in emergency locking mode (ELR) to restrain a Hybrid III 6-year-old anthropomorphic test device (ATD). The retractor, belt webbing, buckle, vehicle seat cushion, and booster were replaced after each test. Some conditions were tested twice to establish repeatability. ATD and booster responses were compared between LATCH and non-LATCH tests.

RESULTS

Using LATCH reduced the forward movement of the booster itself by 32.3% to 71.5% compared to non-LATCH installations. Differences in most other metrics were small and often within the range of normal test-to-test variation. Forward movements of the ATD head and heel were similar between LATCH and non-LATCH tests (typically less than 10% difference). HIC36 values trended slightly higher for LATCH installations compared to non-LATCH installations (0.8% to 17.2%). Chest resultant accelerations were typically 7.3% to 21.2% higher for LATCH installations, except for one booster for which it was lower with LATCH. Chest deflections trended higher for LATCH installations compared to non-LATCH installations for the backless boosters (6.9% to 14.1%). For high-back boosters, chest deflection was similar between installation conditions (less than 5% difference). Shoulder belt loads showed the greatest reductions when LATCH installations included a top tether (12.9% to 20.8%). Instances of the ATD submarining under the lap belt were not observed in these tests.

CONCLUSIONS

Overall, the differences in kinematics and injury metrics were small between boosters installed using LATCH vs. non-LATCH.

Biomechanical Responses and Injury Assessment of Post Mortem Human Subjects in Various Rear-facing Seating Configurations

The objective of this study was to generate biomechanical corridors from post-mortem human subjects (PMHS) in two different seatback recline angles in 56 km/h sled tests simulating a rear-facing occupant during a frontal vehicle impact. PMHS were placed in a production seat which included an integrated seat belt. To achieve a repeatable configuration, the seat was rigidized in the rearward direction using a reinforcing frame that allowed for adjustability in both seatback recline angle and head restraint position. The frame contained instrumentation to measure occupant loads applied to the head restraint and seatback. To measure PMHS kinematics, the head, spine, pelvis, and lower extremities were instrumented with accelerometers and angular rate sensors. Strain gages were attached to anterior and posterior aspects of the ribs, as well as the mid-shaft of the femora and tibiae, to determine fracture timing. A chestband was installed at the mid sternum to quantify chest deformation. Biomechanical corridors for each body and seat location were generated for each recline angle to provide data for quantitatively evaluating the biofidelity of ATDs and HBMs. Injuries included upper extremity injuries, rib fractures, pelvis fractures, and lower extremity injuries. More injuries were documented in the 45-degree recline case than in the 25-degree recline case. These injuries are likely due to the excessive ramping up and corresponding kinematics of the PMHS. Biomechanical corridors and injury information presented in this study could guide the design of HBMs and ATDs in rigid, reclined, rear-facing seating configurations during a high-speed frontal impact.

Molecular screening of antimalarial, antiviral, anti-inflammatory and HIV protease inhibitors against spike glycoprotein of coronavirus

Coronavirus outbreak in December 2019 (COVID-19) is an emerging viral disease that poses major menace to Humans and it's a crucial need to find the possible treatment strategies. Spike protein (S2), a envelop glycoprotein aids viral entry into the host cells that corresponds to immunogenic ACE2 receptor binding and represents a potential antiviral drug target. Several drugs such as antimalarial, antibiotic, anti-inflammatory and HIV-protease inhibitors are currently undergoing treatment as clinical studies to test the efficacy and safety of COVID-19. Some promising results have been observed with the patients and also with high mortality rate. Hence, there is a need to screen the best CoV inhibitors using insilico analysis. The Molecular methodologies applied in the present study are, Molecular docking, virtual screening, drug-like and ADMET prediction helps to target CoV inhibitors. The results were screened based on docking score, H-bonds, and amino acid interactions. The results shows HIV-protease inhibitors such as cobicistat (-8.3kcal/mol), Darunavir (-7.4kcal/mol), Lopinavir (-9.1kcal/mol) and Ritonavir (-8.0 kcal/mol), anti-inflammatory drugs such as Baricitinib (-5.8kcal/mol), Ruxolitinib (-6.5kcal/mol), Thalidomide (-6.5kcal/mol), antibiotic drugs such as Erythromycin(-9.0kcal/mol) and Spiramycin (-8.5kcal/mol) molecules have good affinity towards spike protein compared to antimalarial drugs Chloroquine (-6.2kcal/mol), Hydroxychloroquine (-5.2kcal/mol) and Artemisinin (-6.8kcal/mol) have poor affinity to spike protein. The insilico pharmacological evaluation shows that these molecules exhibit good affinity of drug-like and ADMET properties. Hence, we propose that HIVprotease, anti-inflammatory and antibiotic inhibitors are the potential lead drug molecules for spike protein and preclinical studies needed to confirm the promising therapeutic ability against COVID-19.

Human Response and Injury Resulting from Head Impacts with Unmanned Aircraft Systems

Unmanned aircraft systems (UAS), commonly known as drones, are part of a new and budding industry in the United States. Economic and public benefits associated with UAS use across multiple commercial sectors are driving new regulations which alter the stringent laws currently restricting UAS flights over people. As new regulations are enacted and more UAS populate the national airspace, there is a need to both understand and quantify the risk associated with UAS impacts with the uninvolved public. The purpose of this study was to investigate the biomechanical response and injury outcomes of Post Mortem Human Surrogates (PMHS) subjected to UAS head impacts. For this work, PMHS were tested with differing UAS vehicles at multiple impact angles, locations and speeds. Using a custom designed launching device, UAS vehicles were accelerated into the frontal, parietal, or vertex portions of subjects' craniums at speeds up to 22 m/s. Of the 35 UAS impacts carried out, one AIS 2+ injury was observed: a 13 cm linear skull fracture resulting from a Phantom 3 impact. Additionally, injury risk curves used in automotive testing were found to over predict the risk of injury in UAS impact scenarios. Finally, localized skull deformation was observed during severe impacts; the effect that this deformation had on measured kinematics should be further evaluated. Overall, the study found that AIS 2+ head injuries may occur as a result of UAS impacts and that automotive injury metrics may not be able to accurately predict head injury risk in UAS impact scenarios.

Quantification of Skeletal and Soft Tissue Contributions to Thoracic Response in a Dynamic Frontal Loading Scenario

Thoracic injuries continue to be a major health concern in motor vehicle crashes. Previous thoracic research has focused on 50^th percentile males and utilized scaling techniques to apply results to different demographics. Individual rib testing offers the advantage of capturing demographic differences; however, understanding of rib properties in the context of the intact thorax is lacking. Therefore, the objective of this study was to obtain the data necessary to develop a transfer function between individual rib and thoracic response. A series of non-injurious frontal impacts were conducted on six PMHS, creating a loading environment commensurate to previously published individual rib testing. Each PMHS was tested in four tissue states: intact, intact with upper limbs removed, denuded, and eviscerated. Following eviscerated thoracic testing, eight individual mid-level ribs from each PMHS were removed and loaded to failure. A simplified model in which ribs of each thorax are treated as parallel springs was utilized to evaluate the ability of individual rib response data to predict each subject's eviscerated thoracic response. On average across subjects, denuded thoraces retained 89% and eviscerated thoraces retained 46% of intact force. Similarly, denuded thoraces retained 70% and eviscerated thoraces retained 30% of intact stiffness. The rib model did not adequately predict eviscerated thoracic response but provided a better understanding of the influence of connective tissue on a rib's behavior with-in the thorax. Results of this study could be used in conjunction with the database of individual rib test results to improve thoracic response targets and help assess biofidelity of current anthropomorphic test devices.

Biomechanical Responses of PMHS Subjected to Abdominal Seatbelt Loading

Past studies have found that a pressure based injury risk function was the best predictor of liver injuries due to blunt impacts. In an effort to expand upon these findings, this study investigated the biomechanical responses of the abdomen of post mortem human surrogates (PMHS) to high-speed seatbelt loading and developed external response targets in conjunction with proposing an abdominal injury criterion. A total of seven unembalmed PMHS, with an average mass and stature of 71 kg and 174 cm respectively were subjected to belt loading using a seatbelt pull mechanism, with the PMHS seated upright in a freeback configuration. A pneumatic piston pulled a seatbelt into the abdomen at the level of the umbilicus with a nominal peak penetration speed of 4.0 m/s. Pressure transducers were placed in the re-pressurized abdominal vasculature, including the inferior vena cava (IVC) and abdominal aorta, to measure internal pressure variation during the event. Jejunum tear, colon hemorrhage, omentum tear, splenic fracture and transverse processes fracture were identified during post-test anatomical dissection. Peak abdominal forces ranged from 2.8 to 4.7 kN. Peak abdominal penetrations ranged from 110 to 177 mm. A force-penetration corridor was developed from the PMHS tests in an effort to benchmark ATD biofidelity. Peak aortic pressures ranged from 30 to 104 kPa and peak IVC pressures ranged from 36 to 65 kPa. Updated pressure based abdominal injury risk functions were developed for vascular Ṗ_max and P_max*Ṗ_max.

Cytidine-5-diphosphocholine supplement in early life induces stable increase in dendritic complexity of neurons in the somatosensory cortex of adult rats

Cytidine-5-diphosphocholine (CDP-choline or citicholine) is an essential molecule that is required for biosynthesis of cell membranes. In adult humans it is used as a memory-enhancing drug for treatment of age-related dementia and cerebrovascular conditions. However the effect of CDP-choline on perinatal brain is not known. We administered CDP-choline to Long Evans rats each day from conception (maternal ingestion) to postnatal day 60 (P60). Pyramidal neurons from supragranular layers 2/3, granular layer 4 and infragranular layer 5 of somatosensory cortex were examined with Golgi–Cox staining at P240. CDP-choline treatment significantly increased length and branch points of apical and basal dendrites. Sholl analysis shows that the complexity of apical and basal dendrites of neurons is maximal in layers 2/3 and layer 5. In layer 4 significant increases were seen in basilar dendritic arborization. CDP-choline did not increase the number of primary basal dendrites on neurons in the somatosensory cortex. Primary cultures from somatosensory cortex were treated with CDP-choline to test its effect on neuronal survival. CDP-choline treatment neither enhanced the survival of neurons in culture nor increased the number of neurites. However significant increases in neurite length, branch points and total area occupied by the neurons were observed. We conclude that exogenous supplementation of CDP-choline during development causes stable changes in neuronal morphology. Significant increase in dendritic growth and branching of pyramidal neurons from the somatosensory cortex resulted in enlarging the surface area occupied by the neurons which we speculate will augment processing of sensory information.