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Background: One of the greatest challenges to conducting multicenter research studies in low and middle-income countries (LMICs) is the heterogeneity in regulatory processes across sites. Previous studies have reported variations in requirements with a lack of standardization in the Institutional Review Board (IRB) processes between centers, imposing barriers for approval, participation, and development of multicenter research., Objectives: To describe the regulatory process, variability and challenges faced by pediatric researchers in LMICs during the IRB process of an international multicenter observational point prevalence study (Global PARITY)., Design: A 16-question multiple-choice online survey was sent to site principal investigators (PIs) at PARITY study participating centers to explore characteristics of the IRB process, costs, and barriers to research approval. A shorter survey was employed for sites that expressed interest in participating in Global PARITY and started the approval process, but ultimately did not participate in data collection (non-participating sites) to assess IRB characteristics., Results: Of the 91 sites that sought IRB approval, 46 were successful in obtaining approval and finishing the data collection process. The survey was completed by 46 (100%) participating centers and 21 (47%) non-participating centers. There was a significant difference between participating and non-participating sites in IRB approval of a waiver consent and in the requirement for a legal review of the protocol. The greatest challenge to research identified by non-participating sites was a lack of research time and the lack of institutional support., Conclusions: Global collaborative research is crucial to increase our understanding of pediatric critical care conditions in hospitals of all resource-levels and IRBs are required to ensure that this research complies with ethical standards. Critical barriers restrict research activities in some resource limiting countries. Increasing the efficiency and accessibility of local IRB review could greatly impact participation of resource limited sites and enrollment of vulnerable populations., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (© 2024 Lopez-Baron, Abbas, Caporal, Agulnik, Attebery, Holloway, Kissoon, Mulgado-Aguas, Amegan-Aho, Majdalani, Ocampo, Pascal, Miller, Kanyamuhunga, Tekleab, Bacha, González-Dambrauskas, Bhutta, Kortz, Murthy, Remy and the Global Health Subgroup of the Pediatric Acute Lung Injury and Sepsis Investigators (PALISI) Network.)

Introduction: Train-pedestrian conflicts result in a substantial number of serious and fatal injuries annually. Signs indicating safe and permissible behaviors near railroad rights of way are commonly relied upon to mitigate collisions. However, the effectiveness of these signs in preventing accidents often depends on clarity and interpretation of the sign. The objective of this study was to evaluate the (1) effectiveness of sign messaging strategies and designs at pedestrian-railroad crossings, and (2) effects of context and risk-taking propensity on decisions to cross tracks., Method: A survey study (N = 1011) was conducted comparing likeliness to cross for a variety of pedestrian-railroad scenarios. The DOSPERT scale was included to estimate an individuals' risk-taking., Results: Findings reveal that action-conveying and emotionally-motivated signs are more effective in discouraging railroad crossing in high-risk situations (i.e., train present, crossing gates down, or warning lights flashing), compared to information-only signs. However, decisions to cross are primarily influenced by the presence of a train and crossing gates' status, followed by sign type. MaxDiff analysis show that yellow signs with black symbols and square shaped signs are perceived as the clearest in conveying safety information, compared to black on white, red on white, and circular signs. Additionally, individuals who cross railroad tracks as pedestrians more frequently exhibit higher risk-taking tendencies, while there is no relationship between driving across tracks and risk-taking propensity. Males and younger individuals also have higher risk-taking tendencies., Conclusions and Practical Applications: These findings have implications for policy and practice, such as revising manuals to incorporate more effective sign designs and targeted educational campaigns for high-risk groups. It is also crucial to conduct ongoing monitoring of implemented interventions, which could follow the framework presented in this paper. The study emphasizes collaboration across sectors to improve overall safety at pedestrian-railroad crossings, contributing to safer transportation infrastructure for all., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 National Safety Council and Elsevier Ltd. All rights reserved.)

Objective: Driver characteristics have been linked to the frequency and severity of car crashes. Among these, age and gender have been shown to impact both the possibility and severity of a crash. Previous studies have used standard ordered probit (OP) models to analyze crash data, and some research has suggested heteroskedastic ordered probit (HETOP) could provide improved model fit. The objective of this paper is to evaluate potential improvements of the heteroskedastic ordered probit (HETOP) model compared to the standard ordered probit (OP) model in crash analysis, by examining the effect of gender across age on injury severity among drivers. This paper hypothesizes that the HETOP model can provide a better fit to crash data, by allowing heteroskedasticity in the distribution of injury severity across driver age and gender., Methods: Data for 20,222 crashes were analyzed for North Carolina from 2016 to 2018, which represents the state with the highest number of fatalities per 100 million vehicle miles traveled amongst available crash data from the Highway Safety Information System., Results: Darker lighting conditions, severe road surface conditions, and less severe weather were associated with increased injury severity. For driver demographics, the probability of severe injuries increased with age and for male drivers. Moreover, the variance of severity increased with age disproportionately within and across genders, and the HETOP was able to account for this., Conclusions: The results of the two applied approaches revealed that HETOP model outperformed the standard OP model when measuring the effects of age and gender together in injury severity analysis, due to the heteroskedasticity in injury severity within gender and age. The HETOP statistical method presented in this paper can be more broadly applied across other contexts and combinations of independent variables for improved model prediction and accuracy of causal variables in traffic safety.

The study evaluated the connectedness of spontaneous speech production in individuals with dementia as a potential predictor of dementia severity. Data were derived from the baseline sample of 143 individuals with dementia in the English Pitt corpus. Dementia severity was assessed via the Mini Mental Status Exam, the Mattis Dementia Rating Scale, and the Blessed Dementia Scale. Language abilities were evaluated using verbal fluency and picture description tasks. Graph analysis was carried out for the picture description task using the computational tool SpeechGraphs to calculate connectedness. Results demonstrated that higher educational attainment, higher verbal fluency and strongly-connected spontaneous speech were associated with better cognitive function. Results suggest that automated language processing approaches, such as graph structure analysis, may provide a faster and ecologically valid method of detecting dementia symptoms., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Botezatu, Miller and Kiselica.)

Background: The burden of pediatric critical illness and resource utilization by children with critical illness in resource limited settings (RLS) are largely unknown. Without specific data that captures key aspects of critical illness, disease presentation, and resource utilization for pediatric populations in RLS, development of a contextual framework for appropriate, evidence-based interventions to guide allocation of limited but available resources is challenging. We present this methods paper which describes our efforts to determine the prevalence, etiology, hospital outcomes, and resource utilization associated with pediatric acute, critical illness in RLS globally., Methods: We will conduct a prospective, observational, multicenter, multinational point prevalence study in sixty-one participating RLS hospitals from North, Central and South America, Africa, Middle East and South Asia with four sampling time points over a 12-month period. Children aged 29 days to 14 years evaluated for acute illness or injury in an emergency department) or directly admitted to an inpatient unit will be enrolled and followed for hospital outcomes and resource utilization for the first seven days of hospitalization. The primary outcome will be prevalence of acute critical illness, which Global PARITY has defined as death within 48 hours of presentation to the hospital, including ED mortality; or admission/transfer to an HDU or ICU; or transfer to another institution for a higher level-of-care; or receiving critical care-level interventions (vasopressor infusion, invasive mechanical ventilation, non-invasive mechanical ventilation) regardless of location in the hospital, among children presenting to the hospital. Secondary outcomes include etiology of critical illness, in-hospital mortality, cause of death, resource utilization, length of hospital stay, and change in neurocognitive status. Data will be managed via REDCap, aggregated, and analyzed across sites., Discussion: This study is expected to address the current gap in understanding of the burden, etiology, resource utilization and outcomes associated with pediatric acute and critical illness in RLS. These data are crucial to inform future research and clinical management decisions and to improve global pediatric hospital outcomes., Competing Interests: DH is the owner of Analytical Solutions Group, Inc. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Abbas, Holloway, Caporal, López-Barón, Agulnik, Remy, Appiah, Attebery, Fink, Lee, Hooli, Kissoon, Miller, Murthy, Muttalib, Nielsen, Puerto-Torres, Rodrigues, Sakaan, Rodrigues, Tabor, von Saint Andre-von Arnim, Wiens, Blackwelder, He, Kortz and Bhutta.)

Objective: Automated Truck-Mounted Attenuators (ATMAs) have the potential to improve work zone safety by removing the human driver out of a vehicle that is positioned in work zones to absorb impact from errant vehicles. However, this automated technology is expensive and can be detrimental to safety and project success if operated incorrectly (e.g., operating limitations and procedures not followed). Therefore, it is important to understand users' perceptions of ATMAs and how training can improve appropriate adoption of this technology. The objective of this study was to evaluate how work zone workers perceive the usefulness of and the capabilities of automation in Truck-Mounted Attenuators., Methods: A survey study was conducted with 13 Department of Transportation (DOT) workers in Colorado and California. Each of the DOT workers in this study had some previous experience with the ATMA, either in real-world applications and/or formal training. The survey collected information on participant job specifications, experience with the ATMA, training received, trust in the ATMA, usability of the HMIs, and operating capabilities of the automation., Results: Workers reported an overall positive acceptance of this technology. This was supported by their expectation that it would reduce crash severity; that there was a reasonable workload associated with operating procedures for the automation; and by their overall trust in the automation's reliability. However, workers noted concerns regarding their trust in the automation under various contexts, such as poor visibility and denser traffic volumes. Further, trust in the technology was greatest among workers with higher levels of ATMA training and longer experience working with the ATMA., Conclusions: This research presents a novel perspective on user acceptance of ATMA technology. These findings can help jurisdictions achieve the safety improvements that investment and deployment of automation in work zones offers, by identifying the disconnect between operators and technology.

Objective: A driving simulator study was conducted to evaluate the longitudinal effects of an intervention and withdrawal of a lane keeping system on driving performance and cognitive workload., Background: Autonomous vehicle systems are being implemented into the vehicle fleet. However, limited research exists in understanding the carryover effects of long-term exposure., Methods: Forty-eight participants (30 treatment, 18 control) completed eight drives across three separate days in a driving simulator. The treatment group had an intervention and withdrawal of a lane keeping system. Changes in driving performance (standard deviation of lateral position [SDLP] and mean time to collision [TTC]) and cognitive workload (response time and miss rate to a detection response task) were modeled using mixed effects linear and negative binomial regression., Results: Drivers exposed to the lane keeping system had an increase in SDLP after the system was withdrawn relative to their baseline. Drivers with lane keeping had decreased mean TTC during and after system withdrawal compared with manual drivers. There was an increase in cognitive workload when the lane keeping system was withdrawn relative to when the system was engaged., Conclusion: Behavioral adaptations in driving performance and cognitive workload were present during automation and persisted after the automation was withdrawn., Application: The findings of this research emphasize the importance to consider the effects of skill atrophy and misplaced trust due to semi-autonomous vehicle systems. Designers and policymakers can utilize this for system alerts and training.