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Outcomes after pediatric traumatic brain injury (TBI) are related to pre-treatment factors including age, injury severity, and mechanism of injury, and may be positively affected by treatment at trauma centers relative to non-trauma centers. This study estimated the proportion of children with moderate to severe TBI who receive care at trauma centers, and examined factors associated with receipt of care at adult (ATC), pediatric (PTC), and adult/pediatric trauma centers (APTC), compared with care at non-trauma centers (NTC) using a nationally representative database. The Kids' Inpatient Database was used to identify hospitalizations for moderate to severe pediatric TBI. Pediatric inpatients ages 0 to 17 years with at least one diagnosis of TBI and a maximum head Abbreviated Injury Scale score of ≥3 were studied. Multinomial logistic regression was performed to examine factors predictive of the level and type of facility where care was received. A total of 16.7% of patients were hospitalized at NTC, 44.2% at Level I or II ATC, 17.9% at Level I or II PTC, and 21.2% at Level I or II APTC. Multiple regression analyses showed receipt of care at a trauma center was associated with age and polytrauma. We concluded that almost 84% of children with moderate to severe TBI currently receive care at a Level I or Level II trauma center. Children with trauma to multiple body regions in addition to more severe TBI are more likely to receive care a trauma center relative to a NTC.

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Driver distraction can be described as the diversion of driver's attention from the primary task of driving and is one of the most common causes of crashes. Complex technologies that have either been introduced to the driving domain or are planned to be, raise the concern of high levels of distraction, by placing additional demands on drivers. Different mitigation strategies (e.g., warning and vehicle control) have been implemented in the vehicle to reduce driver distraction. However there has not been a clear defmition or categorization of these strategies. This paper, therefore, proposes a taxonomy of mitigation strategies for driver distraction and relates the strategies to accumulated research in the areas of automation and adaptive aiding to define important design tradeoffs with each strategy. This taxonomy provides a b e w o r k that can guide research and address the driver distraction problem systematically.

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Summary: Heart rate variability has been used as a measure of mental workload, stress, and fatigue in drivers. The main goal of this study was to evaluate whether drivers with obstructive sleep apnea syndrome (OSAS) may have significantly different heart rate variability from those who do not have OSAS. Such a condition may indicate lower stress levels and an increase in crash risk due to sleepiness. This study also evaluates whether significant deviations in HRV may occur as drivers become drowsier over time. Eleven drivers with OSAS were compared to twelve other drivers with no known sleep disorder. All were tested in a driving simulator over a 60-minute period that consisted of three uneventful drive segments on two-lane rural roads. Heart rates were collected using electrocardiogram (ECG). The variability of heart rate was computed for each subsequent five-minute interval by calculating the standard deviations of the R-R intervals (i.e., the time duration between two consecutive R waves of the ECG) within that time. Results showed that there were no significant differences in HRV over time for the comparison group. However, HRV for drivers with OSAS increased by each subsequent time interval. Drivers with OSAS also had significantly higher mean heart rate variability over the course of the drive. Specifically, based on the second regression model, the difference in heart rate variability between drivers with OSAS and the comparison group significantly increased after about 25 minutes of driving. This likely reflects the physiological effects of increased fatigue, which would lead to inattention to the driving environment and increased crash risk.

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