This paper explores the role of mining activity, proxied by growth rates of electricity consumption and cost of mining, as a driver of pricing inefficiencies in Bitcoin. Utilizing alternative measures of crash risk proxied by the realized negative coefficient of skewness and realized down-to-up volatility, derived from 5-minute intraday Bitcoin data, causality tests, along with sign analysis, captured by the estimates of partial average derivatives, provide evidence that mining activity can, in general, predict an increase in the entire conditional distribution of crash risk, with the strongest impact associated over the normal (median) to moderately high (upper quantiles) levels of risk. Despite the emergence of cryptocurrencies in international transactions and as an investment vehicle, our results suggest that decentralized mining process can contribute to inefficiencies in the pricing of Bitcoin, putting further doubt into the role of these assets as a medium of exchange, alternative to conventional assets.
An eight-year-old boy sat upright on a stretcher in Exam Room 3, his damp swimsuit soaking through the disposable sheet beneath him. His face, pink and smiling, showed none of the drama unfolding around him. A few nurses paused to smile at his bright demeanor; this was hardly the scene they'd expected when the EMS call for a drowning patient had first crackled over the radio. His vital signs on the monitor were reassuringly bland: heart rate steady, at 84 beats per minute, oxygen saturation glued at 99%. His lungs were crisp and clear, devoid of even the faintest crackle or wheeze. Yet, just outside the door, two seasoned emergency physicians debated quietly. âIt's textbook,â said one physician, voice firm but hushed. âVitals normal, lung exam perfect. There's no medical reason to keep him.â The other doctor shifted uneasily. âWhat about secondary drowning?â she asked reflexively, knowing the phrase carried baggage but feeling its weight anyway. It was a term she'd heard since residency, repeated in hushed parental warnings and amplified online through frantic social media posts. âSecondary drowning isn't real,â the first physician responded gently but definitively. âIt's folklore. Patients who drown, drown in the water. No delayed reaction days later.â He paused, softening. âBut I get it. Tradition says hold them six hours, âjust in case.ââ The nurses glanced from physician to physician, awaiting instructions as monitors beeped rhythmically, indifferent to clinical uncertainty. Finally, one doctor sighed, understanding that habit often trumped logic in medicine. But tonight, the evidence would push back against fear. They knew the child looked perfect, but could they trust data over dogma? Drowning Data Revolution Medicine is no stranger to fear-driven myths, but few have been as persistently frustrating as the misconception of secondary drowning. For decades, clinicians have maintained an instinctive hesitation about discharging asymptomatic patients who experienced even brief immersion events. Tradition alone, unsupported by science, dictated prolonged observation periods for fear of unseen, delayed complications. Recent robust evidence, however, demands reconsideration of this clinical ritual. A recent study out of Australia, known as the Rapid Drowning Clearance (RDC) trial, directly challenged the dogmatic hold of secondary drowning.1 This rigorous prospective analysis included 255 pediatric patients evaluated immediately after water immersion episodes. Each child enrolled was asymptomatic at initial emergency department presentation: no abnormal vital signs, no respiratory distress, and pristine lung exams. Under the old rules, all would have faced hours of medically questionable observation. The results, however, were definitive. Among these 255 children, zero adverse events were observed during follow-up. The conclusion was clear: children who appear healthy after water immersion simply do not deteriorate unexpectedly hours later. Reinforcing these contemporary data is a classic 1997 beach surveillance series, still frequently cited as a foundational source on drowning outcomes.2 Researchers reviewed hundreds of open-water rescues and found that patients with clear lungs on initial evaluation had a mortality rate of 0%. Even decades-old data align cleanly with recent studies, reinforcing a consistent clinical truth: normal lungs at presentation predict universally favorable outcomes. This is not new thinking. In 2018, I wrote that âthere has never been a case reported in medical literature of an otherwise asymptomatic and healthy child who suddenly developed serious respiratory distress or died days after being in water.â3 That remains true. And yet, the myth of delayed deterioration still holds sway in too many emergency departments. Further support comes from a well-reviewed 2019 retrospective pediatric cohort study, which examined children who appeared well after submersion and were kept under observation purely out of caution.4 Among those who remained asymptomatic at six hours, not a single one went on to develop complications. Six-hour watches in these cases don't catch emergenciesâthey simply manufacture cost, anxiety, and delay. The medical literature is consistent. The supposed threat of secondary drowning in asymptomatic patients has never materialized. Not one credible report exists of a healthy child deteriorating after a normal exam. The absence of evidence here isn't a research gap; it's definitive proof. As I wrote back then, âdrowning is never dry.â It is immediate, visible, and physiologically obvious. The panic over hidden danger has never held up under scrutiny. Secondary drowning is not a precautionary diagnosis; it's a clinical superstition. And, like any superstition, it persists not because of data but because of habit, fear, and inertia. It's time to call it what it is and let evidence, not folklore, govern our decisions at the bedside. Emergency medicine has faced similarly entrenched fears before, particularly in the management of chest pain. Like drowning patients, those with chest pain historically faced extensive observation periods driven more by medicolegal anxiety than by clinical data. Yet here, too, compelling evidence eventually pushed back against outdated, overly cautious practice. In my first-ever In Focus column, I discussed the unnecessary hospital stays imposed by outdated chest pain protocols.5 Highlighting multiple landmark trials, the column called on physicians to trust contemporary data, which overwhelmingly support the safe, immediate discharge of many low-risk patients with chest pain. Foremost among these studies was the HiSTORIC trial of 2021, a pivotal multicenter analysis involving thousands of patients who presented to emergency departments with chest pain.6 In this study, a remarkable 71% of participants were safely discharged after brief evaluations, with no subsequent increase in heart attacks or deaths within 30 days. Outcomes improved, beds were freed, and patient satisfaction soared. Other influential research has established that ultra-rapid high-sensitivity troponin assays safely eliminate prolonged observation in patients presenting with chest pain. Zero- and one-hour protocols boast a negative predictive value of 99.5%, effectively indistinguishable from absolute certainty. Yet, despite clear proof of safety, these pathways continue to meet fierce resistance from emergency physicians raised on the HEART Score and hesitant to relinquish ingrained habits. The culprit is an entrenched cultural mindset fixated on zero-risk clinical practice, an impossible standard that medicine cannot, and should not, sustain. Physicians must embrace the challenge of reorienting clinical thinking around data-driven certainty rather than medicolegal anxiety. The parallels to pediatric drowning are clear and powerful. Just as meticulous chest pain research demolished outdated clinical dogmas, drowning data unequivocally demonstrate that stable, asymptomatic pediatric immersion victims do not deteriorate after discharge. Patient-centered outcomes, safety, satisfaction, and reassurance, align seamlessly across these clinical domains. Patients discharged immediately after appropriate evaluation in both settings overwhelmingly remain safe, content, and complication-free. As with chest pain, rejecting unwarranted fears around drowning demands bravery from clinical leadership. Chest pain management ultimately evolved because clinicians courageously placed trust in data and decisively reframed their approach. Emergency medicine now stands at an identical crossroads with pediatric drowning. Will clinicians perpetuate disproven rituals out of caution, or confidently embrace rigorous evidence for immediate discharge? The decision, while uncomfortable for some, is clinically obvious and ethically imperative. Just as chest pain guidelines evolved from unfounded fear to firm, data-driven pathways, pediatric drowning guidelines must similarly abandon needless caution for confident clinical clarity. The outcome, supported by decades of robust data, is unequivocalâzero-miss medicine that prioritizes patients above outdated anxieties. At its core, the reluctance to abandon outdated observation protocols is driven not by evidence, but by entrenched psychological and cultural forces. Foremost among these is the pervasive myth of âzero-missâ medicine: the unattainable belief that physicians can eliminate every conceivable risk. Emergency medicine, more than any other specialty, operates beneath a relentless spotlight, constantly pressed to defend each clinical decision against hypothetical worst-case scenarios. This anxiety is not without tangible consequences. Surveys consistently demonstrate that fear of litigation directly increases unnecessary hospital admissions and drives excess diagnostic testing. A comprehensive national survey of emergency physicians revealed that over 90% order tests or admit patients explicitly out of malpractice anxiety rather than clinical necessity.7 Such practices provide a false sense of security, inflating costs while delivering no measurable improvement in patient outcomes. Amplifying these fears are persistent misinformation campaigns propagated across social media platforms. Viral anecdotes about so-called âdry drowningâ have been particularly effective at instilling unwarranted parental panic, indirectly pressuring clinicians into unnecessary interventions. Despite repeated clarifications from authoritative medical bodies dismissing the concept as unfounded, sensationalized reports persistently resurface each summer, prompting waves of worried parents to flood emergency departments with children who are, by all clinical measures, entirely healthy. Chest pain management mirrors this psychology precisely. Although robust, validated protocols provide near-certainty of safe discharge within hours, clinicians often default to extended stays purely out of medicolegal worry. Even with clear data like the nearly 100% negative predictive value from zero- and one-hour troponin protocols, the fear of missing a rare catastrophic event remains disproportionately influential. The consequence of this fear-driven mindset extends beyond individual patients. It shapes the culture of emergency departments nationwide, reinforcing practices grounded in caution rather than confidence, defensive reflexes rather than decisive action. Physicians conditioned by the fear of litigation and social-media-driven anxieties inevitably lean toward caution, even when caution offers no additional safety, only increased cost and patient discomfort. Addressing the culture of unnecessary observation means acknowledging these entrenched fears for what they are: costly relics of defensive medicine, incompatible with contemporary evidence. To meaningfully improve care, clinicians must confront these psychological barriers directly, reframing medical bravery as reliance on robust data rather than defensive routines. The next step is clear: quantifying the real, measurable costs of fear-driven medicine and recognizing the systemic harms hidden beneath caution's comforting veneer. The financial and systemic burdens of fear-based observation extend far beyond the bedside. Every hour spent observing a healthy drowning patient or a chest-pain sufferer with normal troponins drains finite healthcare resources. For example, the RDC protocol demonstrated that immediate discharge of asymptomatic drowning patients saved an average of six bed-hours per patient, time that could be redeployed toward those genuinely needing emergency care. Similar economic clarity emerges from rapid chest-pain protocols. Studies evaluating accelerated high-sensitivity troponin pathways reveal average per-patient savings exceeding $1,000 when low-risk patients are confidently discharged early. This reduction in unnecessary testing and hospital stays significantly alleviates financial strain, freeing hospital capacity for truly emergent cases. But the greatest benefits of eliminating needless observation are likely patient-centered. Immediate discharge avoids the tangible harms of prolonged hospitalization, from increased iatrogenic risk to family disruption and anxiety. Children return swiftly to reassuring homes and adults are spared overnight hospital stays, a truly patient-first approach. Ultimately, embracing evidence-based discharge protocols isn't merely about money saved. It's about stewardship: making responsible use of resources to ensure timely, compassionate care for every patient. Emergency physicians face a clear imperative: it's time to choose data over dread. Decades of evidence demonstrate the futility, and harm, of fear-driven observation practices. Now, clinicians must step forward confidently and let robust data guide clinical decisions. Three concrete steps can immediately dismantle unnecessary caution: Universally adopt RDC protocols. If children have clear lungs and stable vitals after submersion, discharge them home without delay. Fully embrace accelerated, high-sensitivity troponin protocols for chest pain. Rapid discharge pathways safely free hospital resources and spare patients' needless anxiety. Routinely audit departmental observation habits. Identify lingering fear-based practices and root them out, replacing them with evidence-based discharge criteria. Change will require courage, the kind that emergency physicians routinely demonstrate when lives are visibly at stake. Now, the stakes are subtler but equally significant: patient comfort, resource stewardship, and clinical integrity. Medicine's commitment to patients demands action that aligns with data rather than outdated rituals. The smiling, healthy child on the stretcher needs no more watching. He simply needs doctors brave enough to send him home. CME for InFocus Earn CME by completing a quiz about this article. You may read the article here or on our website, and then complete the quiz, answering at least 70 percent of the questions correctly to earn CME credit. The cost of the CME exam is $10. The payment covers processing and certificate fees. Visit http://CME.LWW.com for more information about this educational offering and to complete the CME activity. This enduring material is available to physicians in all specialties, nurses, and other allied health professionals. Lippincott Continuing Medical Education Institute, Inc., is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. Lippincott Continuing Medical Education Institute, Inc., designates this enduring material for a maximum of 1 AMA PRA Category 1 Creditâą. Physicians should only claim credit commensurate with the extent of their participation in the activity. This activity expires July 31, 2027. Learning Objectives for This Month's CME Activity: After participating in this CME activity, readers should be better able to justify the adoption of Rapid Drowning Clearance (RDC) and high-sensitivity troponin protocols, and propose evidence-based discharge criteria when managing patients who experienced prolonged submersion.
This article makes it possible to identify the relationship and influence between land transportation, traffic and road safety for a decentralized municipal autonomous government, as well as to identify strategies and actions to be followed for adequate management of these variables by the GAD of the city of Quevedo. The proposed work contributes to solve the research problem: how does the management of land transportation, traffic and road safety affect the quality of the transportation service in the city of Quevedo; its general objective is to design strategies and strategic actions to enhance its quality. The method used is a qualitative approach of correlational-transversal cut, with a non-experimental design. At the level of disciplinary contribution at a theoretical level, it allows the understanding to improve land transportation services at the canton level, with emphasis on strategic and organizational management. The results show that there is a clear relationship between land transportation, traffic and road safety, integrated aspects that can increase the quality of service in the city of Quevedo.
Autonomous vehicles (AVs), defined as vehicles capable of navigation and decision-making independent of human intervention, represent a revolutionary advancement in transportation technology. These vehicles operate by synthesizing an array of sophisticated technologies, including sensors, cameras, GPS, radar, light imaging detection and ranging (LiDAR), and advanced computing systems. These components work in concert to accurately perceive the vehicleâs environment, ensuring the capacity to make optimal decisions in real-time. At the heart of AV functionality lies the ability to facilitate intercommunication between vehicles and with critical road infrastructureâa characteristic that, while central to their efficacy, also renders them susceptible to cyber threats. The potential infiltration of these communication channels poses a severe threat, enabling the possibility of personal information theft or the introduction of malicious software that could compromise vehicle safety. This paper offers a comprehensive exploration of the current state of AV technology, particularly examining the intersection of autonomous vehicles and emotional intelligence. We delve into an extensive analysis of recent research on safety lapses and security vulnerabilities in autonomous vehicles, placing specific emphasis on the different types of cyber attacks to which they are susceptible. We further explore the various security solutions that have been proposed and implemented to address these threats. The discussion not only provides an overview of the existing challenges but also presents a pathway toward future research directions. This includes potential advancements in the AV field, the continued refinement of safety measures, and the development of more robust, resilient security mechanisms. Ultimately, this paper seeks to contribute to a deeper understanding of the safety and security landscape of autonomous vehicles, fostering discourse on the intricate balance between technological advancement and security in this rapidly evolving field.
The concept of smart cities has become prominent in modern metropolises due to the emergence of embedded and connected smart devices, systems, and technologies. They have enabled the connection of every "thing" to the Internet. Therefore, in the upcoming era of the Internet of Things, the Internet of Vehicles (IoV) will play a crucial role in newly developed smart cities. The IoV has the potential to solve various traffic and road safety problems effectively in order to prevent fatal crashes. However, a particular challenge in the IoV, especially in Vehicle-to-Vehicle (V2V) and Vehicle-to-Infrastructure (V2I) communications, is to ensure fast, secure transmission and accurate recording of the data. In order to overcome these challenges, this work is adapting Blockchain technology for real time application (RTA) to solve Vehicle-to-Everything (V2X) communications problems. Therefore, the main novelty of this paper is to develop a Blockchain-based IoT system in order to establish secure communication and create an entirely decentralized cloud computing platform. Moreover, the authors qualitatively tested the performance and resilience of the proposed system against common security attacks. Computational tests showed that the proposed solution solved the main challenges of Vehicle-to-X (V2X) communications such as security, centralization, and lack of privacy. In addition, it guaranteed an easy data exchange between different actors of intelligent transportation systems.
BACKGROUND: Motor vehicle crashes are the leading cause of death among teenagers. In 2007, 48 youth between the ages of 15 years and 19 years died in traffic crashes and almost 4,780 were injured in Minnesota. Of those killed, only 42.8% of teens were wearing their seat belt. The Drive Smart Challenge is a 4-week peer lead safety campaign with the goal to increase safe driving habits for high school age students. METHODS: The 4-week challenge begins with a seat belt check of teen drivers and their front seat passengers at the school's parking lot. Each school's student-leadership group then selected and implemented at least eight Smart Driving interventions from a manual they are provided. A post seat belt check is conducted at the conclusion of the challenge. RESULTS: In 2008, 11 schools agreed to participate in the challenge. More than 21,000 students were exposed to the safe driving messages through public address announcements, posters, mock car crashes, mothers against drunk driving car demonstrations, parent contracts, guest speakers, student developed videos, and web sites. In the end, all the schools documented an increase in seat belt use. The most improved school documented a 15% increase. CONCLUSION: The Drive Smart Challenge is an effective way to get teens involved in a safe driving campaign. Further studies should be done to determine how often teen drivers and their passengers need to be exposed to the messages of the Drive Smart Challenge in order for optimal effectiveness in behavior and attitude change.
After completing this article, readers should be able to: Although there have been major reductions in the number of children and adolescents dying from injuries in the United States over the last 2 decades, trauma remains the most important cause of serious morbidity and mortality in the pediatric age group beyond infancy. Pediatricians play a central role in reducing the toll from injuries, a role that stretches beyond their office and into the community. In this article, we review the current magnitude of the problem and discuss prevention for some of the most important injuries to children and adolescents.The injury control model is based on the concept that the overall burden of trauma can be reduced through the primary prevention of injuries, optimal acute care of the injured patient, and rehabilitation to regain as much preinjury functioning as possible. The focus of this review is primary prevention, but the other components of injury control are within the purview of pediatricians and should not be ignored (Fig. 1).The injury control community has shifted away from use of the term âaccidentâ to use of the term âinjury.â More than just a semantic difference, this represents a shift in thinking from the idea that âaccidentsâ are, for the most part, random, unpredictable, and nonpreventable events to the approach that âinjuriesâ are preventable and to some degree predictable. It also focuses attention on the damage to the individual and the methods of controlling this damage through primary prevention, acute care, and rehabilitation. In addition, this conceptual shift allows similar approaches to control of intentional injuries (ie, assaults and self-inflicted injuries) and unintentional injuries (ie, âaccidentsâ) that employ the same tools.In 1998, more than 18,000 children and adolescents in the United States died from injuries (Table 1). Two thirds of these injuries were unintentional, with motor vehicle injuries accounting for the single greatest cause of death. The cause of injury death varies with age. Drowning and fire and burn injuries exact the greatest toll in younger children; intentional injuries are primarily a problem in older adolescents. Motor vehicle occupant injuries are a leading cause of trauma death at all ages, but the number of deaths increases dramatically in the later teen years as adolescents become drivers and ride with other teen drivers.Although death is the most serious outcome from trauma, there are an estimated 18 injury hospitalizations and 200 injury-related emergency department (ED) visits for each child injury death. Among children younger than 21 years of age, there are more than 500,000 hospital admissions for injuries annually. More than 10 million injured children and adolescents are treated each year in hospital EDs. Falls represent the most common injury leading to ED care for children younger than age 15 years; being struck by or against something and motor vehicle injuries are the most common sources of ED trauma visits for teens ages 15 to 19 years.Prevention of motor vehicle injuries must be approached from a developmental perspective because the reasons for injury occurrence and the prevention strategies vary substantially across the pediatric age spectrum. Many of the strategies are well known and are not reviewed here; rather, we concentrate on newer problems and strategies.Pediatricians have been at the forefront of occupant protection for infants and toddlers. All 50 states have laws mandating the use of child restraint devices for infants traveling in motor vehicles; many state laws also cover toddlers and children up to 3 years of age. When children graduate from child car seats, they commonly are placed in adult seat belts or travel unrestrained. Only about one fifth of 4- and 5-year-old children are reported always to be restrained in a child-specific device. Some children place the shoulder belt of adult restraint systems behind them because it comes high across the neck or even the face. Others slouch forward in the seat to allow the knees to bend over the edge of the seat, which causes the lap belt to ride up on the abdomen instead of being anchored on the bony pelvis.There are clear hazards to young children using adult restraint systems. Seat belt-related injuries commonly consist of perforation and deserosalization injuries of the intestine and flexion-distraction injuries of the lumbar spine, with potential for cord damage (Fig. 2). In addition, there is an increased risk of head injuries from striking the interior parts of the car. These injuries are due to the lap belt riding up onto the abdomen instead of being anchored on the pelvis and lack of adequate restraint of the torso in a crash.Seat belt-related injuries can be prevented through the use of booster seats, which are perhaps better labeled âbelt-positioning devices.â These relatively inexpensive seats raise the child up to allow proper use of the shoulder harness and provide an âartificial pelvisâ to serve as the anchor points for the lap belt. Available data indicate that they can reduce the risk of injury substantially among children in the 4- to 8-year age group. Educational programs can increase use because most parents are unaware of the proper age for graduation of children to adult restraint systems (Table 2). A successful program in Seattle doubled booster seat use within 1 year. The impact of educational programs can be enhanced through legislation mandating use. Washington was the first state to pass such legislation, and other states, including Arkansas and California, have followed. Up-to-date information on choosing the correct car seats for children is available from the American Academy of Pediatrics (Table 3).Ample data indicate that the rear seat is safer than the front seat for both children and adults. One study of children younger than age 15 years found that the risk of serious or fatal injury in a crash was 27% lower for children in the rear seat compared with those sitting in the front seat. In addition, studies conducted by the National Highway Traffic Safety Administration and others indicate that airbags increase the risk of death for children younger than age 13 years who are seated in the front seat. Front airbags appear to offer little protection to children in a crash, but present a risk of serious or fatal injury from airbag deployment. The safest place for children clearly is in the rear seat, properly restrained for their age and size. Educational and legislative interventions to increase the number of children traveling in the rear have been successful.Motor vehicle crashes are the most common cause of injury death among teens in the United States. About 50% of teens who die in motor vehicle crashes are passengers; about 60% of those who die are riding with a teen driver. The risk of motor vehicle crashes is highest among teen drivers and higher among males than females. A 16-year-old teen driver is seven times more likely to crash per mile driven than is a 25- to 29-year-old driver. Research over the last decade has revealed a number of important risk factors for this increased likelihood to crash as well as some effective countermeasures.The number of passengers traveling with teen drivers appears to have a clear influence on the risk of crash. The risk of death among 17-year-old drivers is 50% greater driving with one passenger compared with driving alone; this risk is 2.6-fold higher with two passengers and threefold higher with three or more passengers. The risk is increased further if the passengers are younger than 30 years of age. Dangerous driving behaviors, such as speeding, swerving, running a red light, and drinking while driving, are more common if peers are in the car.Nighttime crashes account for more than one third of teen motor vehicle fatalities. Teens are five- to tenfold more likely to be in a fatal crash driving at night compared with driving during the day. The difficulty of driving at night combined with the inexperience of teen drivers is a deadly combination.Driving after drinking increases the risk of a crash at all ages, but especially for teens. Studies show that the threshold for impairment of driving skills is far below the 0.1 g/dL blood alcohol level commonly defined as intoxication. Recognizing this, all states have now adopted a âzero toleranceâ policy for alcohol use among teen drivers. As a result of these and other policies, alcohol-involved fatal crashes among teens have decreased by 61% over the last 2 decades to a low of 21% of fatal crashes in 1998.One strategy for addressing the risks of teen driving is a program of graduated driver licensing (GDL). GDL is based on the premise that driving is a skill that must be practiced, and the time of practice for new drivers should occur under the safest possible conditions. In the past 4 years, 34 states and the District of Columbia have implemented GDL systems. To be effective, at least three stages in GDL are necessary: a beginner stage that has maximum restrictions to ensure safe learning, an intermediate stage that has restrictions on passengers and nighttime driving, and a final stage of unrestricted licensing. A teen moves through the stages only when skills have been demonstrated without citations or crashes and there has been sufficient time for practice. Recent studies from North Carolina and Michigan indicate that fatal crashes among 16-year-old drivers declined by 57% and 25%, respectively, following the institution of GDL. Not surprisingly, GDL laws are widely supported by most parents.High school driver education is a rite of passage for most teens in the United States. A recent evaluation of high school driver education, however, found no good evidence that teens who complete these courses have fewer crashes or violations than those who do not. No differences were found in the short or long term. Additionally, there may be a hidden risk in these programs if state law allows teens who take driver education to be fully licensed at an earlier age. If more young drivers are on the road without a demonstrable increase in driver safety, the net effect may be an increase in motor vehicle deaths.Approximately 250,000 people are hospitalized each year in the United States for traumatic brain injury (TBI), and about 50,000 die. TBI accounts for 70% to 80% of trauma deaths in children, with a particularly high risk among adolescent males. Many survivors have lifelong disability. The most common cause of TBI among children is motor vehicle crashes. Strategies to reduce motor vehicle occupant injury, described previously, are crucial in the prevention of childhood TBI. However, recreational injuries are another important cause of TBI that are amenable to injury control efforts.Bicycles are ubiquitous in childhood; unfortunately, many children do not practice proper riding habits or wear bicycle helmets. Consequently, 30% of bicycle deaths occur in the 5- to 14-year-old age group. Although 90% of these deaths involve collision with a motor vehicle, most nonfatal head injuries are the result of a simple fall. More than 100,000 child cyclists suffer nonfatal head or facial injuries each year, with 20% sustaining a traumatic brain injury.Studies of helmet effectiveness reveal that helmets decrease the risk of bicycle-related TBI by 70% to 88%. They also appear to decrease the risk of injury to the mid- and upper face by 65%. Helmets are effective at all ages and appear to provide benefit whether the crash is a result of a fall or collision with a motor vehicle. The Consumer Product Safety Commission (CPSC) now sets standards for all helmets sold in the United States. Safe helmets can be purchased for less than $20. Community-based programs have been effective in increasing the use of helmets by children. These programs are most effective when they involve multiple venues for the message, when physicians are involved, and when legislation requires children to be helmeted.Parents play a key role in bicycle safety for children. Studies by various groups indicate that most children wear helmets if their parents or accompanying adults are helmeted; fewer than one third of children are helmeted if the accompanying adult fails to wear a helmet. Inculcating the need for wearing a helmet from the first time children ride is the best way to ensure helmet use throughout childhood. Just as young children should not cross streets by themselves, parents need to choose safe areas for young children to bicycle that are away from traffic. Most severe bicycle injuries occur in bicycle-motor vehicle collisions. Parents should limit riding by adolescents who refuse to wear helmets.Head injuries are common in other sports, including skiing, snowboarding, horseback riding, and skateboarding. Although case-control studies have not examined helmet effectiveness for these sports, as they have for bicycling, the overwhelming evidence from studies of bicycle helmets and the availability of helmets for these other sports at a reasonable price strongly argue for their use.Nearly all fire and burn-related deaths to children and adolescents in the United States are due to residential fires. Most of these deaths occur at the scene and are due to smoke inhalation. Those at greatest risk are children younger than age 5 years and the elderly. Counseling to prevent residential fires might include advice to quit smoking (or to keep matches and smoking materials securely stored) and to maintain and use space heaters or other electrical devices properly. Unfortunately, the benefit of such counseling is unproven.Smoke detectors are designed as early warning devices to alert residents that a fire has started so they can vacate the premises and call the fire department. Smoke detectors appear to decrease the risk of fatality in a house fire by 60% to 70%. The prevalence of smoke detectors in the United States varies from 79% in Hawaii to 99% in Maryland. Homes that are most likely to require protection (older dwellings in deprived areas) are least likely to have working smoke detectors.One barrier to smoke detector effectiveness is homeowners taking out the batteries because of frequent false alarms. Among smoke detectors that failed to alarm in a house fire, 59% had been disconnected from their power source, most commonly because of nuisance alarms. One approach to reducing false alarms is to employ photoelectric rather than ionization smoke detectors. Photoelectric detectors have a far lower false alarm rate and are more sensitive to smoldering fires. Unfortunately, most smoke detectors in current use are ionization detectors, in part because they are about half the price.Counseling in physician offices may increase smoke detector ownership and use. Pediatricians can remind families to replace detector batteries every 6 months and to consider obtaining photoelectric detectors if nuisance alarms are a problem. A more practical approach may be to ask public health nurses or other home health visitors to provide information about proper smoke detector installation and use, along with access to low-cost safety equipment. Families also can be encouraged to develop and practice a fire escape plan for their home.Scald injuries are the most common burns in children younger than 4 years of age. Children may be burned when they pull hot liquids onto themselves from a stove, counter, or table. Children have thinner skin than adults and suffer deeper injuries when exposed to the same amount of thermal energy. In addition, a given volume of hot liquid burns a larger proportion of a childâs skin surface than an adultâs. Families can be reminded to use the rear burner on the stovetop, to turn pot handles away from exploring hands, and to keep hot liquids at least 10 in from the tableâs edge.Tap water scalds can occur while bathing or washing with inadequate supervision. Although parents always should supervise bathing, simple adjustments to the water heater may be a more effective countermeasure to prevent these scald injuries. Tap water at 160°F (40.7°C) can produce a full-thickness scald burn in less than 1 second. At 120°F (48.4°C), many minutes of exposure are required to produce the same degree of injury. Although many new water heaters are factory-set to maintain a lower water temperature, most families are not served by new water heaters. Parents should be encouraged to test the temperature of their hot water, adjust the water heater as required, and retest the temperature. A water temperature of 120°F (48.4°C) reduces the risk of unintentional tap water scalds, saves energy and energy and not the of most Pediatricians may need to for this on of families in injuries to children are because of their high fatality The outcome for most children who is by their on at the and care care appear to have relatively little impact on in morbidity and mortality must from primary strategies to prevent are are as a to children safer water and decrease the risk of death. Some have implemented for young children. high in Hawaii have implemented a program that requires to complete a The in this allows for energy while No however, have the effect of One study demonstrated that and safety skills of children were through this into an in during a is are the most important of for young children. adult is required when children have access to protection strategies also can play a the last many have laws the of and public More studies have examined whether the of a a studies of show to be much more effective in reducing the risk of to this are studies that to of of the are the most by children as young as 2 years of age. little if the child can one study the time for to a was have been as a better barrier that reduces but a that is not the most important is a these and other into the has a of for residential available at their (Table in of water while or as children into Among alcohol use is with as many as 50% of to reduce access to along with educational designed to reduce alcohol while represent a approach to teen prevention and should be use of devices or also has been as an important to decrease in water such as should not be in place of or for Unfortunately, because no studies have examined the of to prevent the magnitude of protection is One was successful in increasing use from 20% to Children were most likely to use if by an adult using a that use was among adolescents and young adults. Pediatricians can review safe with families at risk and should use by of all ages, of and adult of children year in the United an estimated to million people accounting for up to of all ED Children younger than age 10 years are at greatest and most injuries in this age group involve the head and of are in severe and fatal of the deaths in the United States from are to and a number of were in the other Most are or are known to the are more likely to a child than are of strategies has been including children about and a and one who is of of by control and educational programs ownership and Unfortunately, the effectiveness of these strategies is Parents must consider the risks of especially those who have the burden that injury-related morbidity and mortality on children, pediatricians have long been in the of injury It is to that United States child injury mortality has declined by in the last However, the United States among the most in of child injury death that for with the and impact of childhood injury may to in to this It is on however, to the same standards of evaluation to injury prevention programs as they to or community In an of physicians should consider the of a prevention program to their with the program an injury that is common or especially it require to there evidence from that the reduces Many programs can be demonstrated to about injury but this into in their or in the risk of injury A review of childhood injury prevention strategies is available at the and Research (Table are the group in the United States. injury prevention strategies must take into account children and parents who only and of materials and to pediatricians in practice should that the office is not always the for injury Families at the highest injury risk also are the least likely to have access to primary care and In many with community or is required to the impact of physician in injury
Private-ownership of roads in Nigeria is still at the deliberation stage. In other words roads (tarred and untarred) are owned by Federal, State and Local authorities in Nigeria. Most of these roads, however, share a common characteristic of being âunsafe at any speedâ, at any time of the day. This is as a result of the low quality of the road components, structures and patterns. For example, road surfaces are undulating and rough. Also, the poor standard of road infrastructure like guard railings/barriers; pavement marking and signs; illumination levels, traffic signals, horizontal/vertical alignment and sight lines contribute largely to the increasing carnage on Nigerian road network. This trend persists because authorities in Nigeria have practically relegated to the background regular road safety audit operations. This is an inevitable aspect of modern methods of road administration and management, which determines a number of traffic potentials concerning highway high collision locations; protection of errant vehicles from light poles, trees, ditches, replacement of damaged and missing signs, street lighting, capacity and level of service analysis. Finally, this paper suggests commissioning of a National Road Research Fund, with a view to developing an efficient road safety audit operational system. Also, the introduction of private initiatives and a Community-based Approach in road administration, as well as decentralization of road administration framework at all levels, will greatly help âengineer outâ potentially unsafe features across Nigerian roads, towards a better road traffic environment in the 21st century.