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BACKGROUND As the number of older US drivers has increased over the past decades, so has the number of injuries, hospitalizations, and deaths from motor vehicle crashes (MVCs) involving elderly drivers. We seek to identify personal, environmental, and roadway features associated with increased crashes involving elderly drivers. We hypothesize that elderly drivers are more likely to be involved in MVCs at intersections with more complex signage and traffic flow. METHODS This is a retrospective observational study using 2015 to 2019 police traffic crash reports and a Department of Public Health database of built-environment variables from a single urban center. Demographics and environmental/road features were compared for vehicle-only MVCs involving elderly (≥65 years) and younger drivers. χ2 and nonparametric tests were used to analyze 36,168 drivers involved in MVCs. RESULTS There were 2,575 (7.1%) elderly drivers involved in MVCs during the study period. Left turns and all-way stop signs were associated with increased crash risk among elderly drivers compared with younger drivers. Elderly-involved MVCs were less likely to occur at intersections with left-turn restrictions, traffic lights, only one-way streets, and bike lanes compared with MVCs with younger drivers. Elderly drivers were more likely to be involved in MVCs on weekdays, less often intoxicated at the time of the crash, and less frequently involved in fatal MVCs compared with younger drivers. However, elderly drivers were more frequently the at-fault party, especially after the age of 75 years. CONCLUSION Updates to roadway features have potential to decrease injury and death from MVCs involving elderly adults. Left turn restrictions or other innovative safety treatments at all-way stops or where left turns are permitted may mitigate road crashes involving older adults. Education may increase awareness of higher-risk driving tasks such as turning left, and driving alternatives including public transportation/paratransit may offer alternate means to maintain activities of daily living. LEVEL OF EVIDENCE Prognostic/Epidemiological, level IV.

BACKGROUND Nearly half of pediatric homicides under age 5 are attributable to child abuse. Parents are most commonly the perpetrators, but less is known about incidents involving biological vs. surrogate parents. We sought to evaluate the characteristics of fatal child abuse involving biological and surrogate parents using the Georgia National Violent Death Reporting System (NVDRS), which we believe may differ in demographics and incident characteristics. METHODS This database was used to examine all homicides of children under age 18 from 2011-2017. Demographics and incident characteristics were analyzed using existing NVDRS variables and incident narratives. Chi-squared and nonparametric tests were used to compare fatal child abuse incidents involving biological and surrogate parents (e.g., adoptive, foster, step-parents, intimate partners of biological parent). RESULTS There were 452 pediatric homicides and 219 cases of fatal child abuse. Of all cases of fatal child abuse, 60% involved biological and 29% involved surrogate parents. Compared to children killed by biological parents, children killed by surrogate parents were older (4 vs. 3 years old), more often male (71% vs. 51%), more likely to survive the initial injury and present to the ED before death (96% vs. 69%), and less likely to have a medical comorbidity (2% vs 11%), all p < 0.05. Surrogate parents were more likely to be male (90% vs. 48%) and use a firearm (20% vs. 13%) to inflict the injury, both p < 0.05. The race/ethnicity of the child was not associated with the parent's relationship. CONCLUSIONS Child abuse accounts for half of all pediatric homicides. Parents are the most common perpetrators of fatal child abuse, but surrogate parent perpetrators are almost exclusively male and more likely to use firearms. Most children have a history of abuse, leaving an opportunity to intervene on potentially preventable deaths if abuse is identified in a timely fashion. LEVEL OF EVIDENCE Level IIIStudy TypeRetrospective cohort study.

With an obesity rate of over 30% in the United States, obesity continues to be a serious epidemic. In addition to excessive weight, obesity involves a myriad of comorbidities that contribute to severe morbidity and mortality. Bariatric surgery has been shown to lead to significant weight loss, resolution of obesity-related comorbidities, and overall improved quality of life. After several decades, laparoscopic sleeve gastrectomy has emerged as a leading bariatric procedure, and emergent surgical robotic technology has led to the advent of the robotic sleeve gastrectomy. This procedure has been shown to have outcomes on par with laparoscopic sleeve gastrectomy along with similar and sometimes lower risks and complications. Additionally, surgeons have become more comfortable and proficient in using robotic surgery overall. While currently an expensive procedure, robotic sleeve gastrectomy has the potential to emerge as the preferred procedure as technology continues to improve, as the surgical robot becomes cheaper and more widely available, and as physicians continue to learn to perform robotic procedures early on in their training.

Among all the world’s inhabited regions the twenty states of Oceania apply the most stringent gun controls. Pacific nations also suffer the lowest rates of gun trafficking and armed violence. This chapter outlines the clear historical, legal, geographical, and societal causes of a regional phenomenon known as the Pacific consensus for disarmament. The authors discuss the deadly conflicts that shaped the Pacific, followed by the peacetime public health effects of gun crime, interpersonal armed violence, and gun suicide. The chapter outlines the solutions deployed to prevent and reduce firearm-related death and injury, and the measurable effects of these interventions on public safety. The result is a clear contrast between the Pacific and other world regions, making the Pacific case one from which lessons may be learnt and applied to other regions as ways to effectively address gun violence.

Statement of Purpose This study analyzes changes in sociodemographic and clinical characteristics of violently injured patients to guide injury prevention strategies. Methods/Approach Trauma registry data from 2005 to 2018 was analyzed to identify trends among victims of community violence. This hospital is the only level I trauma center in a large, urban area, treating 99% of all violently injured patients in the city. Results Since 2005, the median age of violently injured patients increased 9 years from 26 to 35. During this same timeframe, there was an 8.2% increase in violent injury among the White population, a 6.3% increase among the Latinx population, and a 4.9% decrease among the Black population. The rate of severe injury per 100,000 decreased from 118 to 86 in the White population and 325 to 212 in the Black population but increased from 267 to 305 in the Latinx population. There was an 18.5% decrease in penetrating injuries and 18.5% increase in blunt injuries. The mean length of hospital stay following violent injuries increased by 4.1 days. Conclusions The age of violently injured patients is increasing, and the demographic makeup of violently injured patients is shifting to include a greater proportion of White and Latinx individuals. During the study period, the proportion of Black residents in the city decreased by 28%, but the observed decrease in violent injury in this population was much lower. Additionally, the percentage of Latinx residents in the city increased by 8% during this time, but violent injury increased disproportionately. Significance and Contributions to Injury and Violence Prevention Science As older populations may have different risk factors, understanding these trends is essential to ensure violence prevention programs provide appropriate interventions and can adapt to effectively target the older population. Prolonged hospital stays may extend the opportunities for interventions to be offered.