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PubMed2005

Application of a human error framework to conduct train accident/incident investigations.

Accident/incident investigations are an important qualitative approach to understanding and managing transportation safety. To better understand potential safety implications of recently introduced remote control locomotive (RCL) operations in railroad yard switching, researchers investigated six railroad accidents/incidents. To conduct the investigations, researchers first modified the human factors analysis and classification system (HFACS) to optimize its applicability to the railroad industry (HFACS-RR) and then developed accident/incident data collection and analysis tools based on HFACS-RR. A total of 36 probable contributing factors were identified among the six accidents/incidents investigated. Each accident/incident was associated with multiple contributing factors, and, for each accident/incident, active failures and latent conditions were identified. The application of HFACS-RR and a theoretically driven approach to investigating accidents/incidents involving human error ensured that all levels of the system were considered during data collection and analysis phases of the investigation and that investigations were systematic and thorough. Future work is underway to develop a handheld software tool that incorporates these data collection and analysis tools.

Accidents↗
PubMed1975

Aircraft-type crash injury investigation of a commuter train collision.

Until recently, the investigation of crash injuries and their causes in railroad crashes has been relatively nonexistent. Now, however, with the trend toward a more balanced transportation system, the number of railroad passengers is increasing and there is a concurrent demand for new, rebuilt, or refurbished passenger cars. Most railroad passenger cars in service today appear to have been designed primarily for longevity and easy servicing with secondary emphasis on passenger comfort and little emphasis on passenger safety. It is unlikely that these priorities will be reversed unless crash injury investigations can demonstrate a specific need for improvements in crashworthiness. In line with this objective, techniques developed in aircraft crash investigations were used to collect and evaluate crash injury and escape data from the collision of two commuter trains.

Accidents↗
PubMed1995

[CT-epidurography. A comparison of conventional and CT-epidurography with contrast medium injection through a thoracic peridural catheter].

Epidurography with contrast medium is used to verify the correct position of an epidural catheter and to detect malpositioning. There is great variability in the distribution of contrast medium according to the individual morphology of the epidural space and the way it is injected. Results of investigations of the anatomy of the spinal canal and epidural space performed with anatomic specimens, epiduroscopy, and conventional and computed tomographic (CT) epidurography are sometimes contradictory. We have performed CT epidurography in approximately 30 patients to date. Insights regarding the distribution of contrast medium in the epidural space can help to interpret conventional epidurographies and to explain special features, such as the "rail-road-track phenomenon" or the plica mediana dorsalis. METHODS. Patients scheduled for major abdominal operations were studied. Catheters were introduced into the thoracic epidural space on the day before the operation. Conventional epidurographies were performed routinely after insertion of the catheters with a mobile X-ray apparatus, usually in the recovery room, using 5 ml iopamidol (Solutrast 250 M). Selected patients (good mental state and stable psychic condition), after written consent and with approval of the local ethical committee, were investigated with CT epidurography using the same contrast medium (partly diluted). From among the CT scans performed until now, five characteristic images are presented and compared to conventional epidurographies. RESULTS. When small volumes (5 ml) of iopamidol were injected slowly, we regularly observed a railroad-track phenomenon in the AP images of conventional epidurographies. After rapid injection of larger volumes (10-15 ml), the spread was more homogeneous and sometimes outline a lighter zone of contrast distribution in the midline. CT epidurography in these cases (5 out of 30 patients) revealed a plica mediana dorsalis. In the majority of the CT scans of the thoracic epidural space its anterior (ventral) compartment was unfilled by contrast medium. According to the findings of several investigators, dura mater and ligamentum longitudinal posterius have grown together, so that an epidural space does not exist in ventral thoracic segments of the spinal canal. In lower thoracic and lumbar segments both structures are separate, and a wide anterior epidural space was present and filled with contrast medium. In other cases the dorsal and dorsolateral epidural space was completely filled, but the contrast medium stopped behind the spinal nerves and surrounding dural sheaths, as if these structures, together with the connective tissue strands between them, formed a membrane that spread in a frontal plane. A railroad-track phenomenon is interpreted in the literature as the X-ray correlate of contrast medium spread in the subdural space, indicating an incorrect catheter position. According to conventional epidurographies and confirmed by CT scans, this feature is also seen regularly in cases with correct catheter position. Small volumes of iopamidol spread preferentially into the wider parts of the epidural space between the gaps of the vertebral arcs, whereas the dura mater and periosteal layers touch at the inner side of the pedicules and laminae, allowing the existence of only a potential epidural space. This rhythmic widening and narrowing of the epidural space is the explanation of the "railroad track" in AP contrast epidurographies. CONCLUSIONS. CT epidurography is a valuable tool to provide better insight into the morphology of the epidural space when filled with fluid (contrast medium, local anaesthetics), complementing findings using epiduroscopy and anatomic specimens. It stands to reason that this time- and cost-expensive method can never replace conventional epidurographies, but can help to interpret them properly.

Adult↗
PubMed2002

Impacts of man-made landscape features on numbers of estuarine waterbirds at low tide.

The potential impact of human disturbance on wintering waterbirds using intertidal mudflats was considered by relating their numbers to the presence of nearby footpaths, roads, railroads, and towns. Data were obtained for six English estuaries from the Wetland Bird Survey Low Tide Count scheme. Counts were undertaken monthly from November to February, and data were available for an average of 2.8 years per estuary for the period 1992-1993 to 1999-2000. Count sections and the positions of man-made landscape features were mapped using a GIS. Generalized linear models tested whether bird numbers varied according to the estuary, month, area, whether or not the section bordered water, and the proportion of each section within a specified distance of each landscape feature. In addition, the proximity of sections to the nearest footpath access point was considered. Numbers of six of nine species, northern shelduck (Tadorna tadorna), red knot (Calidris canutus), dunlin (Calidris alpina), black-tailed godwit (Limosa limosa), Eurasian curlew (Numenius arquata) and common redshank (Tringa totanus), were significantly lower where a footpath was close to a count section, while those of brant (Branta bernicla) were greater. Northern shelduck, black-bellied plover (Pluvialis squatarola), dunlin, and black-tailed godwit numbers were reduced close to railroads and those of common ringed plover (Charadrius hiaticula), black-bellied plover, and Eurasian curlew close to roads. Common ringed plover numbers were greater close to towns. The relative distances to which species were affected by footpaths corresponded to published information concerning their flight distances in response to human disturbance. The study provided evidence that sustained disturbance associated with footpaths, roads, and railroads reduced local habitat quality for waterbirds and the carrying capacity of estuaries.

Animals↗
PubMed2005

The influence of neighborhood environment on the incidence of childhood asthma: a multilevel approach.

Some ecological analyses suggest an influence of neighborhood environment on asthma outcomes. However, no previous study has applied a multilevel approach to assess an ecological effect of neighborhood environment on the incidence of childhood asthma accounting for individual risk factors. This study assessed the influence of neighborhood and individual-level factors on the incidence of childhood asthma among all children born in Rochester, Minnesota, between 1976 and 1979. We identified asthmatics among all children born in Rochester, between 1976 and 1983. We applied a multilevel survival model with the frailty term to assess the effects of neighborhood characteristics, such as mean family income per census tract (n = 16) from the 1980 census report and the status of whether a census tract faces intersections with major highways or railroads, on asthma incidence. The relative risks (RR) of neighborhood socioeconomic status (SES), the status of whether census tracts face intersections with highways or railroads and the variance of random effect of census tracts were calculated adjusting individual-level covariates for asthma, including gender, birth weight, mother's age at birth and parental educational level at birth. We found that the RR of developing asthma among children living in census tracts facing intersections with highways or railroads was 1.6 (95% CI: 1.1-2.2) compared to those who lived in census tracts not facing intersections, adjusting individual- and neighborhood-level covariates. The variance of the frailty term attributable to census tracts was small (0.0085) and was modified (from 0.004 to 0.0085, 112% change) by adding neighborhood covariates. The overall effects of individual-level factors on asthma incidence were independent of neighborhood environment. The influence of neighborhood environment on childhood asthma in a non-inner-city setting, like Rochester, Minnesota, was small to modest. Incorporating pertinent neighborhood-level covariates into multilevel models needs to be considered in assessing the random effect of clusters.

Asthma↗
PubMed2002

Airborne concentrations of benzene and mineral spirits (stoddard solvent) during cleaning of a locomotive generator and traction motor.

Mineral spirits (also called Stoddard solvent), a petroleum distillate, is often used as a degreaser or an industrial cleaning agent. Although several studies measured airborne concentrations of mineral spirits in various occupational settings, none have characterized the airborne concentrations of benzene from use of mineral spirits. Recent case reports have suggested that benzene, as a contaminant in mineral spirits, might be responsible for adverse health effects. Because some claims of health effects in the railroad industry have been attributed to potential historical exposures to mineral spirits and little information is available regarding air concentrations in this type of occupational setting, a simulation study was conducted to quantitate historical exposures a railroad worker might have experienced while spraying mineral spirits on locomotive engine parts in the 1970s. To quantitate potential historical exposures, worker tasks were simulated under worst-case exposure conditions by spraying minerals spirits on a locomotive generator and traction motor. The results of both generator and traction motor cleaning events produced concentrations of mineral spirits ranging from 34 to 221 ppm and an average 1-h concentration of 121 ppm, whereas benzene concentrations associated with the spraying and drying tasks were less than the limit of detection (0.002-0.006 ppm). Results indicate that a railroad worker who cleaned a locomotive traction motor and generator with mineral spirits for 2 h each workday under worst-case exposure conditions would be exposed to an 8-h time-weighted average (based on lapel measurements) of 30.4 ppm airborne mineral spirits. On the basis of the conditions under which these concentrations were obtained, the results should be the reasonable maximum values that can be achieved in a modern-era (post-1970) workplace in the United States.

Air Pollution, Indoor↗
PubMed1978

Neurophysiological effects of long-term exposure to a mixture of organic solvents.

Neurophysiological effects of long-term exposure to a mixture of organic solvents was studied among 102 car painters from 27 car repair garages in Helsinki. The reference group consisted of 102 age-matched railroad engineers from the Finnish State Railways. The mean age was 35 years and the exposure time ranged from 1 to 40 years (mean 14.8, SD 8.5). According to measurements the mean concentration of the solvent mixture was relatively low in the garages, namely, 31.8% of the Finnish threshold limit value (TLV), the range of separate components varying from 4 to 212% of the respective TLVs. The main components of about 20 organic solvents of the mixture were toluene, xylene, butyl acetate and white spirit. Electroencephalograms (EEGs) of all the 102 exposed and 102 nonexposed subjects were studied, but electroneuromyographic measurements were made of only 59 car painters and 53 referents with a similar age distribution. Motor (MCV and CVSF) and sensory conduction (SCV) velocities, as well as motor distal latencies, were recorded from nerves in the upper and lower extremities. Abnormal EEGs were encountered in 32 car painters and 37 referents. The frequency of abnormal EEGs was in both groups higher than expected on the basis of EEG literature (about 10%). Twenty-six car painters had a complex of four common symptoms of disturbances in the central nervous system; the same symptom complex was found in 12 engineers. Forty-six percent of the car painters with this symptom complex had an abnormal EEG, while only 26% of those without this symptom complex had an abnormal EEG. Railroad engineers did not show such a tendency. Abnormally slow MCVs or SCVs and/or prolonged motor distal latencies were found in 12 of the 59 car painters but in none of the 53 engineers studied. Other authors have stressed that many solvents primarily cause neuropathy, while objective signs of central nervous involvement have been minor, if any. Our findings are similar; they showed slight positive signs of slowed nerve conduction velocities among the car painters and no increase in EEG abnormalities in comparison to the reference group of railroad engineers.

Adult↗
PubMedDate not supplied

[Malignant mesothelioma in the industrial area of Colleferro].

The study describes the occurrence of pleural and peritoneal malignant mesothelioma in the Colleferro industrial area (Province of Rome, 9 municipalities, population 63,000, period 1993-98) which is the site of a large chemical plant (BPD) producing organic chemicals, acid mixtures, insecticides, explosives and dynamite, and was involved in manufacturing/maintenance of railroad rolling stock. Asbestos was extensively used in these plants in the past. Mesothelioma cases were actively searched from data in files of pathology archives, hospital admission and discharge (records), and death certificates recorded at local health authority register. 23 potential cases were identified for whom clinical charts and pathological slides were reviewed. A multidisciplinary evaluation of all collected information confirmed 18 cases of cyto-histologically proven malignant mesothelioma (pleural/peritoneal ratio of 2.75:1) among residents and/or workers at BPD. The remaining 5 cases were defined as not mesothelioma; however, two were cases of lung cancer (both occupationally exposed to asbestos). All subjects with malignant mesothelioma had been occupationally exposed to asbestos (14 males and 3 females), except one (1 female with domestic exposure). No mesothelioma case was attributable to environmental exposure. Of the 17 cases with occupational asbestos exposure, 15 occurred in BPD workers employed in manufacturing/maintenance of railroad rolling stock (3 cases), general maintenance services (5 cases), or in the armaments sector (7 cases) and 2 in residents but not BPD workers (1 baker, 1 pipefitter). The incidence rate in residents of the 9 municipalities was 5.5 in males and 1.3 in females (standardized on the Italian population x100,000, census 1981). For Colleferro municipality only, the incidence was 10.1 in males and 4.1 in females, which are the highest rates reported so far in Italy. Besides confirming the risk of mesothelioma risk in railroad rolling stock manufacturing and asbestos-insulated pipe maintenance workers, this study identifies a cluster of malignant mesothelioma in explosives production workers.

Aged↗
PubMed2001

[Detection and prevalence of risk factors to develop chronic noninfectious diseases in the organized population group in West Siberia].

AIM: To study prevalence of factors of risk to develop chronic noninfectious diseases (CNID) in the population of railroad men of the West Siberia and these factors association with ischemic heart disease (IHD) and cerebrovascular disorders. MATERIAL AND METHODS: A one-stage sample epidemiological survey of CNID risk factors enrolled 10,677 railroad men of West Siberia aged 20-65 years. The risk factors were: arterial hypertension (AH), smoking, hypercholesterolemia (HCE), obesity, low physical activity (LPA), impaired flucose tolerance (IGT). RESULTS: High incidence of AH, HCE, smoking, obesity, LPA, IGT as well as nutritional shift to food rich in fat was found. The results of the regression multivariate analysis show that such factors as AH, HCE and smoking are associated with and contribute much to high risk of IHD; AH, severe HCE and obesity contribute to high risk of cerebral pathology. CONCLUSION: Further studies are needed of CNID prevalence among railroad men. Measures of primary multifactor prevention should be designed and introduced to correct the above risk factors.

Adult↗
PubMed1980

[Incidence and prediction of coronary heart disease in the Italian cohorts of the Seven Countries Study. 10 year experience (author's transl)].

Three cohorts of man aged 40-59 at entry have been enrolled in Italy within the Seven Countries Study and followed-up for 10 years. They included demographic samples in the rural areas of Crevalcore, north Italy (n. 993) and of Montegiorgio, central Italy (n. 719) and a sample of Railroad men living in Rome and surroundings (n. 768) with an entry participating of about 92% and a 5 and 10 year follow-up participating of about the same level. Incidence of coronary heart disease in 10 years in men coronary-free at entry has been, for the pool of the three cohorts, of about 0.4% per year for hard criteria coronary heart disease (coronary deaths and hard infarcts) and of about 1% per year for all kinds of coronary heart disease including softer diagnoses. Differences between cohorts were small and altogether not significant except for coronary deaths which were higher in the Railroad group than in Montegiorgio. The prediction of coronary heart disease as function of the entry levels of some risk factors, estimated by the multiple logistic equation, suggested that also for these Italian samples, age, blood pressure, serum cholesterol, smoking habits and physical activity (the latter with a protective role) are the main risk factors although cholesterol seems to play a lesser role in the Railroad group than in the Rural cohorts. Proportions of 34 to 68% of the observed cases were located in the upper 20% of the distribution of the estimated risk and the ratio between cases in the upper and bottom quintile of risk ranged 4 to 14 folds. The degree of discrimination suggested by these and other indicators resulted to be directly related to the severity of the coronary heart disease manifestations considered as end-points (deaths, hard cases, all cases). Such varying discriminating role was mainly due to the varying predicting power of serum cholesterol.

Adult↗
PubMed1996

Coronary heart diseases: assessment of risk associated with work exposure to ultralow-frequency magnetic fields.

The present analysis was stimulated by previous findings on the possible influence of natural ultralow-frequency (ULF; 0.001-10 Hz) geomagnetic field variations on the cardiovascular system and indications of an effect of man-made ULF magnetic fields on the rate of myocardial infarction. In the present study, we considered the occupational health hazards of the strongest ULF magnetic fields in densely populated urban areas. Measurements of ULF magnetic field fluctuations produced by trains powered by DC electricity were performed by means of a computer-based, highly sensitive, three-component magnetometer. We found that the magnitude of magnetic field pulses inside the driver's cab of electric locomotives (ELs) could be > or = 280 microT in the horizontal component perpendicular to the rails and up to approximately 130 microT in the vertical component, and, in the driver's compartment of electric motor unit (EMU) trains, they were approximately 50 and 35 microT, respectively. We have investigated the relationships between the occupational exposure to ULF magnetic field fluctuations produced by electric trains and cardiovascular diseases (CVDs) among railroad workers in the former Soviet Union. We have analyzed medical statistical data for a period of 3 years for approximately 45,000 railroad workers and 4,000 engine drivers. We have also analyzed 3 years of morbidity data for three subgroups of engine drivers (approximately 4,000 in each group) operating different types of trains. We find that EL drivers have a twofold increase in risk (2.00 +/- 0.27) of coronary heart diseases (CHDs) compared with EMU drivers. Because our analysis of major CVDs shows that the examined subpopulations of drivers can be considered to have had equal exposure to all known risk factors, the elevated CHD risk among EL drivers could be attributed to the increased occupational exposure to ULF magnetic fields.

Adult↗
PubMed2003

Prioritizing abandoned coal mine reclamation projects within the contiguous United States using geographic information system extrapolation.

Coal mine reclamation projects are very expensive and require coordination of local and federal agencies to identify resources for the most economic way of reclaiming mined land. Location of resources for mine reclamation is a spatial problem. This article presents a methodology that allows the combination of spatial data on resources for the coal mine reclamation and uses GIS analysis to develop a priority list of potential mine reclamation sites within contiguous United States using the method of extrapolation. The extrapolation method in this study was based on the Bark Camp reclamation project. The mine reclamation project at Bark Camp, Pennsylvania, USA, provided an example of the beneficial use of fly ash and dredged material to reclaim 402,600 sq mi of a mine abandoned in the 1980s. Railroads provided transportation of dredged material and fly ash to the site. Therefore, four spatial elements contributed to the reclamation project at Bark Camp: dredged material, abandoned mines, fly ash sources, and railroads. Using spatial distribution of these data in the contiguous United States, it was possible to utilize GIS analysis to prioritize areas where reclamation projects similar to Bark Camp are feasible. GIS analysis identified unique occurrences of all four spatial elements used in the Bark Camp case for each 1 km of the United States territory within 20, 40, 60, 80, and 100 km radii from abandoned mines. The results showed the number of abandoned mines for each state and identified their locations. The federal or state governments can use these results in mine reclamation planning.

Carbon↗
PubMed1994

Traumatic train injuries.

Train accidents involving motor vehicles and pedestrians can be devastating. Approximately 1,234 fatalities were recorded in the United States in 1989. The literature from the United States is sparse, prompting a 7-year review of 23 consecutive train accident victims. Twenty (87%) were male, with an average age of 30.6 years. Sixteen (70%) were intoxicated at the time of the accident, and the average Injury Severity Score was 21.4. There was a total of eight traumatic amputations occurring in the 11 (48%) patients involved as pedestrians. Two of these were railroad workers, and nine were trespassers. Fourteen (61%) accidents occurred between the hours of 2300 and 0700. Three (14%) patients died. Although alcohol use occurred in 16 (70%), there was no significance between alcohol use and amputation. Thus, non-railroad employed pedestrians, because of a lack of protection, are more prone to traumatic amputations, primarily of the lower extremities, than those involved in motor vehicle accidents.

Accidents↗
PubMed2005

Accident prediction model for railway-highway interfaces.

Considerable past research has explored relationships between vehicle accidents and geometric design and operation of road sections, but relatively little research has examined factors that contribute to accidents at railway-highway crossings. Between 1998 and 2002 in Korea, about 95% of railway accidents occurred at highway-rail grade crossings, resulting in 402 accidents, of which about 20% resulted in fatalities. These statistics suggest that efforts to reduce crashes at these locations may significantly reduce crash costs. The objective of this paper is to examine factors associated with railroad crossing crashes. Various statistical models are used to examine the relationships between crossing accidents and features of crossings. The paper also compares accident models developed in the United States and the safety effects of crossing elements obtained using Korea data. Crashes were observed to increase with total traffic volume and average daily train volumes. The proximity of crossings to commercial areas and the distance of the train detector from crossings are associated with larger numbers of accidents, as is the time duration between the activation of warning signals and gates. The unique contributions of the paper are the application of the gamma probability model to deal with underdispersion and the insights obtained regarding railroad crossing related vehicle crashes.

Accidents↗
PubMedDate not supplied

Effects of diesel exhaust on neurobehavioral and pulmonary functions.

Ten railroad workers and 6 electricians referred for shortness of breath also had slowness of response, memory loss, and disordered sleep, all of which suggested neurobehavioral impairment. The hypothesis was that diesel exhaust causes central nervous system impairment. Six electricians worked within enclosed concrete walls and roofs that trapped diesel exhaust from trucks. Seven railroad mechanics had tuned diesel engines indoors for 15-50 y, and 3 crewmen rode in locomotives. Neurobehavioral and visual functions were measured with a 26-test battery. Compared with unexposed men, the 16 in this study had significantly impaired reaction time, balance, blink reflex latency R-1, Culture Fair, peg placement, trail making, and verbal recall. Thirteen men had abnormal visual fields, and 11 had abnormal color confusion indices. Nine men had airways obstruction. The author could not attribute abnormalities to confounding factors or bias. Severe neurobehavioral impairment was associated with exposure to confined diesel exhaust. In additional studies of diesel-exposed workers, especially drivers of locomotives and trucks, investigators should use sensitive neurobehavioral methods.

Adult↗
PubMed1997

A 15-year review of railway-related deaths in Jefferson County, Alabama.

A retrospective computer search of the records of the Jefferson County Coroner/Medical Examiner Office covering the 15-year period from 1981 to 1995 revealed 86 cases in which either a train caused death or in which a body was found dead by the tracks. The average age of the decedents was 39 years (range, 3 weeks-87 years). Men accounted for 88% of the deaths. The manners of death were as follows: three natural, 64 accident, seven suicide, six homicide, and six undetermined. Six decedents were found dead by the tracks, but death was not caused by a train. Six decedents were railroad employees who died on the job. In 47 cases, the decedents were trespassing on railroad property. Five trespassers were riding the rails, and 42 were pedestrians struck by a train. Motor vehicle collisions with trains claimed 27 lives--19 drivers and eight passengers. All together, 45% of the decedents were intoxicated. Intoxication was greatest by far in individuals witnessed to have been lying on the tracks before being hit by a train. The nature of individuals riding the rails has changed in the past few decades. Freight trains today are being used by illegal immigrants as transportation within the United States. The majority of traffic fatalities occurred because the driver intentionally tried to beat the train to the crossing. These drivers were seldom intoxicated, and only two were teenagers. Lives of such impatient drivers might be spared by the installation of a crossing guard-rail that cannot be circumvented.

Accidents↗
PubMedDate not supplied

Train injuries in children.

OBJECTIVE: To describe the pattern of injuries sustained in pediatric victims of train accidents. DESIGN: Retrospective review of patients identified in a search of two trauma registries for the years 1984-1994. SETTING: Two pediatric level one trauma centers in one metropolitan area. PATIENTS: Between 1984 and 1994, seventeen children were identified as treated for injuries sustained in train accidents. Children pronounced dead at the scene and those injured when a car was struck by a train were excluded. INTERVENTION: ATLS protocols were followed. All open musculoskeletal injuries were treated with multiple operative irrigation and debridement procedures and broad spectrum antibiotics. MAIN OUTCOME MEASUREMENTS: Variables included the following: age, sex, mechanism of injury, circumstances surrounding the injuries, all injuries sustained, operations performed during the acute hospitalization, subsequent operations, level of amputation(s), complications, and cost and length of hospitalization. RESULTS: Presenting injuries included eight patients with ten complete amputations and eight patients with ten near-complete amputations. The average number of operative procedures for the survivors during the initial hospitalization was 5.7 (range three to sixteen). Five patients (five extremities) required amputation revision to a more proximal level after the initial surgical intervention but prior to definitive wound closure. Secondary surgical procedures have been required in 50% of survivors to date. The financial cost of these injuries is substantial, with acute hospitalization costs averaging $61,000. CONCLUSION: Pediatric survivors of train-pedestrian accidents are likely to suffer isolated musculoskeletal injuries, the majority of which are amputations of the lower extremity. These injuries require multiple operative debridements and frequent revision to higher levels of amputation are expected. The percentage of these injuries in children at play around railroad tracks emphasizes the need for limitation of access to railroad areas and for prevention through public education.

Accidents↗
PubMed1995

Wrist squareness and median nerve impairment.

Previous research indicated that a wrist-squareness ratio (thickness/width) greater than .7 is likely to indicate a median nerve sensory latency greater than 3.7 ms, usually a predictor of carpal tunnel syndrome (CTS). In this study, wrist thicknesses and widths were measured and wrist-squareness ratios were calculated for a sample of 417 railroad maintenance workers. Electrodiagnostic testing, in accordance with American Academy of Electrodiagnostics Medicine guidelines, was performed on both motor and sensory fibers of the median nerve to evaluate subjects for the presence of median nerve impairment typical of CTS. Results of this study indicate that wrist squareness is not a useful predictor of median nerve impairment typical of CTS in the railroad maintenance workers tested.

Adult↗