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1.  Bicycling crash circumstances vary by route type: a cross-sectional analysis 
BMC Public Health  2014;14:1205.
Widely varying crash circumstances have been reported for bicycling injuries, likely because of differing bicycling populations and environments. We used data from the Bicyclists’ Injuries and the Cycling Environment Study in Vancouver and Toronto, Canada, to describe the crash circumstances of people injured while cycling for utilitarian and leisure purposes. We examined the association of crash circumstances with route type.
Adult cyclists injured and treated in a hospital emergency department described their crash circumstances. These were classified into major categories (collision vs. fall, motor vehicle involved vs. not) and subcategories. The distribution of circumstances was tallied for each of 14 route types defined in an earlier analysis. Ratios of observed vs. expected were tallied for each circumstance and route type combination.
Of 690 crashes, 683 could be characterized for this analysis. Most (74%) were collisions. Collisions included those with motor vehicles (34%), streetcar (tram) or train tracks (14%), other surface features (10%), infrastructure (10%), and pedestrians, cyclists, or animals (6%). The remainder of the crashes were falls (26%), many as a result of collision avoidance manoeuvres. Motor vehicles were involved directly or indirectly with 48% of crashes. Crash circumstances were distributed differently by route type, for example, collisions with motor vehicles, including “doorings”, were overrepresented on major streets with parked cars. Collisions involving streetcar tracks were overrepresented on major streets. Collisions involving infrastructure (curbs, posts, bollards, street furniture) were overrepresented on multiuse paths and bike paths.
These data supplement our previous analyses of relative risks by route type by indicating the types of crashes that occur on each route type. This information can guide municipal engineers and planners towards improvements that would make cycling safer.
PMCID: PMC4253622  PMID: 25416928
Bicycling injuries; Bike lanes; Traffic accidents
2.  Personal and trip characteristics associated with safety equipment use by injured adult bicyclists: a cross-sectional study 
BMC Public Health  2012;12:765.
The aim of this study was to estimate use of helmets, lights, and visible clothing among cyclists and to examine trip and personal characteristics associated with their use.
Using data from a study of transportation infrastructure and injuries to 690 adult cyclists in Toronto and Vancouver, Canada, we examined the proportion who used bike lights, conspicuous clothing on the torso, and helmets on their injury trip. Multiple logistic regression was used to examine associations between personal and trip characteristics and each type of safety equipment.
Bike lights were the least frequently used (20% of all trips) although they were used on 77% of trips at night. Conspicuous clothing (white, yellow, orange, red) was worn on 33% of trips. Helmets were used on 69% of trips, 76% in Vancouver where adult helmet use is required by law and 59% in Toronto where it is not. Factors positively associated with bike light use included night, dawn and dusk trips, poor weather conditions, weekday trips, male sex, and helmet use. Factors positively associated with conspicuous clothing use included good weather conditions, older age, and more frequent cycling. Factors positively associated with helmet use included bike light use, longer trip distances, hybrid bike type, not using alcohol in the 6 hours prior to the trip, female sex, older age, higher income, and higher education.
In two of Canada’s largest cities, helmets were the most widely used safety equipment. Measures to increase use of visibility aids on both daytime and night-time cycling trips may help prevent crashes.
PMCID: PMC3490930  PMID: 22966752
Active transport; Bicycle safety; Visibility; Bicycle helmet
3.  Using geographical information systems mapping to identify areas presenting high risk for traumatic brain injury 
The aim of this study is to show how geographical information systems (GIS) can be used to track and compare hospitalization rates for traumatic brain injury (TBI) over time and across a large geographical area using population based data.
Results & Discussion
Data on TBI hospitalizations, and geographic and demographic variables, came from the Ontario Trauma Registry Minimum Data Set for the fiscal years 1993-1994 and 2001-2002. Various visualization techniques, exploratory data analysis and spatial analysis were employed to map and analyze these data. Both the raw and standardized rates by age/gender of the geographical unit were studied. Data analyses revealed persistent high rates of hospitalization for TBI resulting from any injury mechanism between two time periods in specific geographic locations.
This study shows how geographic information systems can be successfully used to investigate hospitalizaton rates for traumatic brain injury using a range of tools and techniques; findings can be used for local planning of both injury prevention and post discharge services, including rehabilitation.
PMCID: PMC3260231  PMID: 22054220
traumatic brain injury; geographic information systems; geographic visualization; spatial analysis
4.  The long-term safety and efficacy of opioids: A survey of 84 selected patients with intractable chronic noncancer pain 
The use of opioids for chronic noncancer pain (CNCP) remains controversial. Despite a number of randomized controlled trials showing efficacy and safety in the short term, long-term data are limited.
To survey a selected cohort of patients with intractable CNCP with regard to long-term efficacy and safety of opioids.
The present study reports long-term results from a survey of 84 patients with CNCP. The majority of patients had neuropathic pain, were treated with opioids and were followed every three months for a median of 8.4 years. Outcomes examined were pain severity, adverse effects, pain relief, satisfaction, mood, problematic opioid use, tolerance, physical dependency, functional status, health-related quality of life, immune status, sexual function, morbidity and mortality. Measures included a numerical rating scale, the Hospital Anxiety and Depression Scale, Brief Pain Inventory interference scale, Pain Disability Index and Short-Form Health Survey 12, version 2.
Both long- and short-acting opioids were reported to be effective, with few significant long-term adverse effects in many subjects in the present selected cohort. The majority of patients reported at least 50% or greater pain relief and a moderate improvement in disability. Functional status and health-related quality of life scores were not severely affected. Problematic opioid use, tolerance and serious adverse effects, including constipation, were not major issues. The authors emphasize that the results obtained in the present selected group may not be generalizable to all CNCP patients in whom opioids are being initiated.
PMCID: PMC2935720  PMID: 20808965
Chronic noncancer pain; Long term; Neuropathic pain; Opioids
5.  Patterns of Urban Violent Injury: A Spatio-Temporal Analysis 
PLoS ONE  2010;5(1):e8669.
Injury related to violent acts is a problem in every society. Although some authors have examined the geography of violent crime, few have focused on the spatio-temporal patterns of violent injury and none have used an ambulance dataset to explore the spatial characteristics of injury. The purpose of this study was to describe the combined spatial and temporal characteristics of violent injury in a large urban centre.
Methodology/Principal Findings
Using a geomatics framework and geographic information systems software, we studied 4,587 ambulance dispatches and 10,693 emergency room admissions for violent injury occurrences among adults (aged 18–64) in Toronto, Canada, during 2002 and 2004, using population-based datasets. We created kernel density and choropleth maps for 24-hour periods and four-hour daily time periods and compared location of ambulance dispatches and patient residences with local land use and socioeconomic characteristics. We used multivariate regressions to control for confounding factors. We found the locations of violent injury and the residence locations of those injured were both closely related to each other and clearly clustered in certain parts of the city characterised by high numbers of bars, social housing units, and homeless shelters, as well as lower household incomes. The night and early morning showed a distinctive peak in injuries and a shift in the location of injuries to a “nightlife” district. The locational pattern of patient residences remained unchanged during those times.
Our results demonstrate that there is a distinctive spatio-temporal pattern in violent injury reflected in the ambulance data. People injured in this urban centre more commonly live in areas of social deprivation. During the day, locations of injury and locations of residences are similar. However, later at night, the injury location of highest density shifts to a “nightlife” district, whereas the residence locations of those most at risk of injury do not change.
PMCID: PMC2800193  PMID: 20084271
8.  Are seat belt restraints as effective in school age children as in adults? A prospective crash study 
BMJ : British Medical Journal  2002;324(7346):1123.
To study effectiveness of seat belts for protecting school age children in road vehicle crashes.
Crash examinations by trained investigators.
Ten Canadian university based crash investigation centres.
470 children aged 4-14 years, with 168 selected for detailed analysis, and 1301 adults.
Main outcomes measures
Use of seat belts by vehicle occupants; severity of injury adjusted for age and crash severity.
Overall, 40% (189/470) of children were unbelted. Of the 335 children in cars driven by belted adults, 73 (22%) were unbelted. The odds of sustaining fatal or moderately severe injury (injury severity score ⩾4) for children in the front passenger seat was more than nine times higher for unbelted children than for belted ones (odds ratio 9.8 (95% confidence interval 2.4 to 39.4)) and for those in the rear left seat was more than two times higher for unbelted than for belted children (2.6 (1.1 to 5.9)). The protection afforded by seat belts compared favourably with the results for adults in the same seat positions (odds ratios for unbelted v belted adults of 2.4 and 2.7 for front and rear seat passengers respectively).
Seat belts helped to protect school age children from injury in road vehicle crashes. However, 40% of children were unbelted. Despite standard seat belts being designed for adults, school age children were at least as well protected as adults.
What is already known on this topicAlthough child restraints protect young children in road vehicle crashes, it is not known whether standard seat belts used by school age children work as wellSchool age children are often unbelted in carsWhat this study addsData from detailed crash assessments indicate that seat belts protected children at least as well as adultsAdults were more likely than children to be belted, and 22% of children travelling with belted drivers were unbelted
PMCID: PMC107902  PMID: 12003883
11.  Comparing the effects of infrastructure on bicycling injury at intersections and non-intersections using a case–crossover design 
Injury Prevention  2013;19(5):303-310.
This study examined the impact of transportation infrastructure at intersection and non-intersection locations on bicycling injury risk.
In Vancouver and Toronto, we studied adult cyclists who were injured and treated at a hospital emergency department. A case–crossover design compared the infrastructure of injury and control sites within each injured bicyclist's route. Intersection injury sites (N=210) were compared to randomly selected intersection control sites (N=272). Non-intersection injury sites (N=478) were compared to randomly selected non-intersection control sites (N=801).
At intersections, the types of routes meeting and the intersection design influenced safety. Intersections of two local streets (no demarcated traffic lanes) had approximately one-fifth the risk (adjusted OR 0.19, 95% CI 0.05 to 0.66) of intersections of two major streets (more than two traffic lanes). Motor vehicle speeds less than 30 km/h also reduced risk (adjusted OR 0.52, 95% CI 0.29 to 0.92). Traffic circles (small roundabouts) on local streets increased the risk of these otherwise safe intersections (adjusted OR 7.98, 95% CI 1.79 to 35.6). At non-intersection locations, very low risks were found for cycle tracks (bike lanes physically separated from motor vehicle traffic; adjusted OR 0.05, 95% CI 0.01 to 0.59) and local streets with diverters that reduce motor vehicle traffic (adjusted OR 0.04, 95% CI 0.003 to 0.60). Downhill grades increased risks at both intersections and non-intersections.
These results provide guidance for transportation planners and engineers: at local street intersections, traditional stops are safer than traffic circles, and at non-intersections, cycle tracks alongside major streets and traffic diversion from local streets are safer than no bicycle infrastructure.
PMCID: PMC3786647  PMID: 23411678
12.  An Attempted Simulation by Computer of a Committee on Admissions 
The rising interest in formalized premedical courses preparatory to professional courses in medicine and the problem of selecting applicants to such courses have led to the formulation of a scoring technique to evaluate applicants to the first year of the premedical course offered by the Faculty of Medicine, University of Toronto. This method was applied to applicants considered for provisional admission in March 1966, and for final admission in August 1966, independently of the conventional selection carried out by the Admissions Committee. The results of the two methods are compared and discussed, and a combined selection procedure, using both the score and the Committee approach, is described.
PMCID: PMC1922806  PMID: 6020345

Results 1-12 (12)